In Committed, psychiatrists Dinah Miller and Annette Hanson offer a thought-provoking and engaging account of the controversy surrounding involuntary psychiatric care in the United States. They bring the issue to life with first-hand accounts from patients, clinicians, advocates, and opponents. Looking at practices such as seclusion and restraint, involuntary medication, and involuntary electroconvulsive therapy--all within the context of civil rights--
Human values are innate, a product of man's evolution and genetics. This is the unorthodox thesis of this major work, which for the first time places the study of values on a firm scientific foundation. Drawing on biological findings which indicate that the fundamental behavioral motivations of each species are inherited, the author looks at the human brain as a biological decision system in which innate values in the form of human motivations serve as the decision criteria.
Doubts about the reality of mental illness and the benefits of psychiatric treatment helped foment a revolution in the law's attitude toward mental disorders over the last 25 years. Legal reformers pushed for laws to make it more difficult to hospitalize and treat people with mental illness, and easier to punish them when they committed criminal acts. Advocates of reform promised vast changes in how our society deals with the mentally ill; opponents warily predicted chaos and mass suffering. Now, with the tide of reform ebbing, Paul Appelbaum examines what these changes have wrought. The message emerging from his careful review is a surprising one: less has changed than almost anyone predicted. When the law gets in the way of commonsense beliefs about the need to treat serious mental illness, it is often put aside. Judges, lawyers, mental health professionals, family members, and the general public collaborate in fashioning an extra-legal process to accomplish what they think is fair for persons with mental illness. Appelbaum demonstrates this thesis in analyses of four of the most important reforms in mental health law over the past two decades: involuntary hospitalization, liability of professionals for violent acts committed by their patients, the right to refuse treatment, and the insanity defense. This timely and important work will inform and enlighten the debate about mental health law and its implications and consequences. The book will be essential for psychiatrists and other mental health professionals, lawyers, and all those concerned with our policies toward people with mental illness.
How can professionals maintain or improve the quality of care they provide when pressured by payers to reduce the cost of care? Clinicians today face the challenge of providing optimal care in an environment where costs drive clinical practice. But high quality, not cost, remains the goal of professionals. By arming themselves with measurable results, clinicians can improve the processes of delivering mental health care and translate those improvements into better outcomes for patients and their families. In this timely guide, the editors have gathered the work of 49 distinguished contributors and crafted a valuable resource for overcoming the extraordinary challenge of delivering high quality mental health care. This groundbreaking book is divided into three sections: The challenges today's clinicians face in providing optimal mental health care -- Beginning with a review of the report to then-President Clinton from the Advisory Commission on Consumer Protection and Quality in the Health Care Industry, subsequent chapters discuss professional ethics and managed care, how Wall Street investors are changing the practice of medicine, problems faced by managed care, and changes needed in medical education to ensure that physicians are well prepared to practice medicine in the 21st century. Proven techniques for quality measurement -- Measuring quality of care presents significant conceptual and methodological problems. These chapters review quality measurement methods and describe support by the federal government to improve these methods. Also addressed are how consumers are joining the quality of care measurement movement and how one large urban county mental health program is advancing quality measurement. Fourteen case reports of quality improvement projects -- These chapters detail principles and techniques that can be replicated or tailored to fulfill the requirements of a variety of clinical settings, ranging from the national health service in Great Britain to a small geriatric unit in a large hospital. The work showcased here was done by clinicians or administrators who, concerned about the quality of care in their own settings, used data to test for themselves whether their interventions resulted in improved care. Even if managed care disappeared, we would still need to question, examine, and improve the quality of patient care -- with clinicians taking the lead, because only they can appreciate the subtle nuances that maintain or improve quality standards, and only they can make substantive changes in their clinical settings. As both a broad conceptual framework for considering the quality of mental health care and as a practical field guide to real-life techniques for measuring the quality of care, this volume will prove exceptionally valuable for mental health care professionals, administrators, and policymakers as well as for consumers and consumer advocates, researchers, students, and public health professionals.
Acceptance and commitment therapy, or ACT (pronounced as a word rather than letters), is an emerging psychotherapeutic technique first developed into a complete system in the book Acceptance and Commitment Therapy by Steven Hayes, Kirk Strosahl, and Kelly Wilson. ACT marks what some call a third wave in behavior therapy. To understand what this means, it helps to know that the first wave refers to traditional behavior therapy, which works to replace harmful behaviors with constructive ones through a learning principle called conditioning. Cognitive therapy, the second wave of behavior therapy, seeks to change problem behaviors by changing the thoughts that cause and perpetuate them. In the third wave, behavior therapists have begun to explore traditionally nonclinical treatment techniques like acceptance, mindfulness, cognitive defusion, dialectics, values, spirituality, and relationship development. These therapies reexamine the causes and diagnoses of psychological problems, the treatment goals of psychotherapy, and even the definition of mental illness itself. ACT earns its place in the third wave by reevaluating the traditional assumptions and goals of psychotherapy. The theoretical literature on which ACT is based questions our basic understanding of mental illness. It argues that the static condition of even mentally healthy individuals is one of suffering and struggle, so our grounds for calling one behavior 'normal' and another 'disordered' are murky at best. Instead of focusing on diagnosis and symptom etiology as a foundation for treatment-a traditional approach that implies, at least on some level, that there is something 'wrong' with the client-ACT therapists begin treatment by encouraging the client to accept without judgment the circumstances of his or her life as they are. Then therapists guide clients through a process of identifying a set of core values. The focus of therapy thereafter is making short and long term commitments to act in ways that affirm and further this set of values. Generally, the issue of diagnosing and treating a specific mental illness is set aside; in therapy, healing comes as a result of living a value-driven life rather than controlling or eradicating a particular set of symptoms. Emerging therapies like ACT are absolutely the most current clinical techniques available to therapists. They are quickly becoming the focus of major clinical conferences, publications, and research. More importantly, these therapies represent an exciting advance in the treatment of mental illness and, therefore, a real opportunity to alleviate suffering and improve people's lives. Not surprisingly, many therapists are eager to include ACT in their practices. ACT is well supported by theoretical publications and clinical research; what it has lacked, until the publication of this book, is a practical guide showing therapists exactly how to put these powerful new techniques to work for their own clients. Acceptance and Commitment Therapy for Anxiety Disorders adapts the principles of ACT into practical, step-by-step clinical methods that therapists can easily integrate into their practices. The book focuses on the broad class of anxiety disorders, the most common group of mental illnesses, which includes general anxiety, panic disorder, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder. Written with therapists in mind, this book is easy to navigate, allowing busy professionals to find the information they need when they need it. It includes detailed examples of individual therapy sessions as well as many worksheets and exercises, the very important 'homework' clients do at home to reinforce work they do in the office. The book comes with a CD-ROM that includes electronic versions of all of the worksheets in the book as well as PowerPoint and audio features that make learning and teaching these techniques easy and engagin
Contributors to this volume present and discuss new data which suggest that major mental disorder substantially increases the risk of violent crime. These findings come at a crucial time, since those who suffer from mental disorders are increasingly living in the community, rather than in institutions. The book describes the magnitude and complexity of the problem and offers hope that humane, effective intervention can prevent violent crime being committed by the seriously mentally disordered.
