Recovery From Schizophrenia: Psychiatry And Political Economy

272 DESEGREGATING SCHIZOPHRENIAFrancisco, California. 9 A residential treatment model that is even further removedfrom the traditional institutional approach to acute care will be described next.FOSTER CARE FOR THE ACUTELY ILLAs part of Southwest Denver Community Mental Health Services in Colorado, inthe 1970s and 1980s, Canadian community psychiatrist Paul Polak and his teamdeveloped an innovative method of caring for the person suffering from an acutepsychotic episode. They found several families in the neighborhood who werewilling to take one or two acutely disturbed people into their homes. Nurses, apsychiatrist and other staff from the mental health agency worked with the fosterfamily to provide care and treatment for the disturbed person. The patient’s ownfamily also participated. Medications were used freely and were closely monitoredby the medical staff. The average length of stay was ten days.Foster families were chosen for their warmth and acceptance. Each client wasgiven his or her own room and was treated as a guest. When able, the patienthelped with shopping, cooking and household tasks. Often he or she wouldbecome friendly with the foster family and remain in touch through telephonecalls, letters or visits.This program, which did everything possible to maintain the client’s status andconnection with the community, proved workable and effective. In operation fortwo decades, it was a viable alternative to hospital care for all but a handful ofpatients. A two-year study using random assignment of patients showed that thecommunity homes were more effective in some respects than a psychiatrichospital in providing intensive treatment, one important advantage being thatclients treated in the family homes felt better about themselves and theirtreatment. 10Southwest Denver Mental Health Center no longer exists as an independentagency and their system of family sponsor homes is not now in operation. Asystem of family crisis homes based on the Southwest Denver model, however, iscurrently in operation at Dane County Mental Health Center in Madison,Wisconsin. More than a dozen family homes provide care to a wide variety ofpeople in crisis most of whom would otherwise be in hospital; about three-quartersof these clients suffer from acute psychotic illness and others are acutely suicidal.About 40 per cent of the clients are admitted from the community as analternative to hospital care; 40 per cent are patients in transition out of the hospital;and 20 per cent are people whose clinical condition is not so severe as to requirehospital care but who are having housing problems or social crises. The averagelength of stay is only three days.Violence and safety are almost never a problem, in part because of carefulselection of appropriate clients and in part because clients feel honored to beinvited into another person’s home; they try to behave with the courtesy ofhouseguests. These crisis homes induce the patient to exercise self-control—a keystrength of human-scale domestic alternatives to hospital care. 11