Living with the characterologically, altered brain injured patient

43 Everyone who receives treatment in the facility-whether in the emergency department, the outpatient department, or the inpatient department--should be given such a statement. A hospital should also post the document in appropriate places, inform patients of the availability of a patient grievance mechanism, and provide at least one paid staff person, a patient representative, to listen to complaints and requests and resolve them equitably. When an institution makes these efforts voluntarily, it is demonstrating its commitment to the persons it serves. METHODS OF SUPPORT 5) Living with the characterologically altered brain injured patient LEZAK, M. D. VA Hosp., Portland, Ore., U.S.A. J. Clhz. Psychiatry 39(7), 592-598, 1978 Characterological defects secondary to brain injury tend to disrupt normal family interaction patterns and create adjustment problems for the patient's close family membei's. Social and psychological ties, expectations, and vulnerabilities make caretaking spouses and dependent children particularly susceptible to emotional stresses. Unrealistic expectations often compound these problems. Almost all family members experience some depression. Counselling family members can improve the quality of their care of the patient. Counselling goals include helping the family readjust expectations, providing practical management advice, and alerting family members to their own needs. Specific recommendations for dealing with common family problems are offered. 6) Chronicity in mental illness: A theory on the role of change CRAIG, A. E. and HYATT, B. A. Perspect. Psychiatr. Care 16(3), 139-144, 153-154, 1978 The development of chronicity was explained within the context of the family system. The relationships between the persistence of individual symptoms, the family system, and the mental health care delivery system were examined. The crux of the problem was defined as" Regression or lack of change in mentally ill persons who have demonstrated potential and capability in the past leads to helplessness and hopelessness on the part of the patient, his/her family and mental health caretakers. These persons are rejected and isolated in various degrees and various manners. Helplessness and hopelessness on the part of family members, tile identified patient, and mental health caretakers, as well as isolation of the patient were examined as secondary consequences to lack of change.

FIRST QUARTER/1980

Principles of change were applied in explaining the process of chronicity in mentally ill persons. Essentially, the family system remains invariant and firstorder change occurs in the form of mental illness. Symptoms exhibited by one family member serve as a rationalization for not allowing second-order change in the family system. This lack of change is perpetuated through use of paradoxical communication in the family system. The current delivery system for mental health care focuses on the individual as the target for change rather than the family system. Not only is change attempted at the wrong level, but the attempt itself contributes to crystallization of a point in family development or no change. Treatment, especially in the form of hospitalization, promotes dependency and helps create a special patient role. PREVENTION AND EARLY DETECTION 7) A case of early mental prophylaxis. The Centre for Early Medico-Social Action at Choisy-le-Roi (French) STORK, H. Caisse Primaire Cent. Assurance Mal. Reg. Parisienne, Paris

Rev. Neuropsychiatr. In]ant. Hyg. Ment. Enfance 26(5--6), 265-275, 1978 The activities of a centre for care and protection intended for children aged from birth to 6 years and their families are described. The centre is based on a concept of integrated mental and physical health and sees to coordination and team work between all the individuals and institutions dealing with young children. It comprises a multidisciplinary team whose skills allow it to act for both early and mediate mental prevention. This centre for early medico-social action is located on the outskirts of Paris and has a progressive constitution which tries to meet the needs of a population that is often deprived in socioeconomic and cultural terms. It consists of the following: an infant welfare and domestic midwife service; health education classes; a child guidance service; and a family planning service. Initial evaluation of results, based on the academic success of children followed through their first years at nursery school, confirms the efficacity of early mental prophylaxis as proposed here. 8) Exercise for a lifetime: An educational effort CORBIN, C. B. and LAURIE, D. R. Dept. Hlth., Kansas State Univ., Manhattan, Kan., U.S.A. Physician Sportsmed. 6(1), 51-55, 1978 The "individualized" or "concepts" approach to helping people learn the why, how and what of physical