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Table of Contents
Vol. 66, No. 1, 2012
Issue release date: July 2012
Neuropsychobiology 2012;66:70–75
(DOI:10.1159/000338549)

Psychosocial Interventions in People with Severe Mental Illness: A Bleulerian Perspective

Becker T. · Kösters M.
Department of Psychiatry II, Ulm University, Günzburg, Germany

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Abstract

Background: Eugen Bleuler, in his book Dementia praecox oder Gruppe der Schizophrenien, discussed issues of social psychiatry, and he considered complex interventions pivotal in the care for people with schizophrenia. Bleuler emphasised the potential of therapeutic communities in providing care, the drawbacks of extended hospitalisation and the therapeutic potential of planned ‘early discharge’ and job integration. Methods: Some of the current evidence on therapeutic communities, planned early hospital discharge, alternatives to inpatient care and job integration in people with severe mental illness are reviewed. Results: (i) Current evidence suggests that therapeutic communities (and new forms of milieu therapy, e.g. Soteria) are an effective ingredient of care; (ii) the evidence on planned early discharge suggests that there is scope for early discharge if continuity of care is ensured, and (iii) the evidence on supported employment suggests that there is scope for early job placement/supported employment among people with schizophrenia with little risk to clinical stability. Conclusion: Eugen Bleuler was a far-sighted social psychiatrist who concentrated on treatment issues and complex interventions that are considered cornerstones of care for people with severe mental illness one hundred years later.



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References

  1. Dixon LB, Dickerson F, Bellack AS, et al: The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements. Schizophr Bull 2010;36:48–70.
  2. Bleuler E: Dementia praecox oder Gruppe der Schizophrenien. Leipzig, Deuticke, 1911.
  3. Charlwood P, Mason A, Goldacre M, Cleary R, Wilkinson E: Health Outcome Indicators: Severe Mental Illness. Report of a working group to the Department of Health. Oxford, National Centre for Health Outcomes Development, 1999.
  4. Bleuler M: Zur Behandlung von Schizophrenen; in Haase H (ed): Die Behandlung der Psychosen des Schizophrenen und manisch-depressiven Formenkreises. Stuttgart, Schattauer, 1976, pp 1–7.
  5. Hell D, Scharfetter C, Möller A: Eugen Bleuler, Leben und Werk. Bern, Huber, 2001.
  6. Tölle R: On the early discharge of schizophrenic patients (in German). Psychiatr Prax 2004;31:429–430.

    External Resources

  7. Bleuler E: Frühe Entlassungen. Psychiatr Neurol Wochenschr 1904;6:441–444.
  8. Roberts J: How to recognise a therapeutic community. Prison Serv J 1997;111:4–7.
  9. Jones M: The concept of a therapeutic community. Am J Psychiatry 1956;112:647–650.
  10. Jones M: Towards a clarification of the ‘therapeutic community’ concept. Br J Med Psychol 1959;32:200–205.
  11. Dederich C: The Circle and the Triangle: The Synanon Social System. Marshall, Synanon Foundations, 1978.
  12. Lees J, Manning N, Rawlings B: Therapeutic Community Effectiveness: A Systematic International Review of Therapeutic Community Treatment for People with Personality Disorders and Mentally Disordered Offenders (CRD Report No. 17). York, NHS Centre for Reviews and Dissemination, University of York, 1999.
  13. Mosher LR: Soteria and other alternatives to acute psychiatric hospitalization: a personal and professional review. J Nerv Ment Dis 1999;187:142–149.
  14. Ciompi L, Kupper Z, Aebi E, et al: The pilot project ‘Soteria Bern’ in treatment of acute schizophrenic patients. II. Results of a comparative prospective follow-up study over 2 years (in German). Nervenarzt 1993;64:440–450.
  15. Ciompi L, Bernasconi R: ‘Soteria Bern.’ Initial experiences with a new milieu therapy for acutely schizophrenic patients (in German). Psychiatr Prax 1986;13:172–176.
  16. Alwan NA, Johnstone P, Zolese G: Length of hospitalisation for people with severe mental illness. Cochrane Database Syst Rev 2008;1:CD000384.
  17. Johnstone P, Zolese G: Systematic review of the effectiveness of planned short hospital stays for mental health care. BMJ 1999;318:1387–1390.
  18. Niehaus DJ, Koen L, Galal U, et al: Crisis discharges and readmission risk in acute psychiatric male inpatients. BMC Psychiatry 2008;8:44.

    External Resources

  19. Fiander M, Burns T, McHugo GJ, Drake RE: Assertive community treatment across the Atlantic: comparison of model fidelity in the UK and USA. Br J Psychiatry 2003;182:248–254.
  20. Marshall M, Lockwood A: Assertive community treatment for people with severe mental disorders. Cochrane Database Syst Rev 2000;2:CD001089.
  21. Burns T: The rise and fall of assertive community treatment? Int Rev Psychiatry 2010;22:130–137.

    External Resources

  22. Burns T, Creed F, Fahy T, Thompson S, Tyrer P, White I: Intensive versus standard case management for severe psychotic illness: a randomised trial. UK 700 Group. Lancet 1999;353:2185–2189.
  23. Killaspy H, Johnson S, Pierce B, et al: Successful engagement: a mixed methods study of the approaches of assertive community treatment and community mental health teams in the REACT trial. Soc Psychiatry Psychiatr Epidemiol 2009;44:532–540.

    External Resources

  24. Gühne U, Weinmann S, Arnold K, Atav ES, Becker T, Riedel-Heller S: Home treatment: systematic review and implementation in Germany (in German). Psychiatr Prax 2011;38:114–122.

    External Resources

  25. Burns T, Catty J, Watt H, Wright C, Knapp M, Henderson J: International differences in home treatment for mental health problems. Results of a systematic review. Br J Psychiatry 2002;181:375–382.
  26. Burns T, Catty J, Wright C: De-constructing home-based care for mental illness: can one identify the effective ingredients? Acta Psychiatr Scand Suppl 2006;429:33–35.

    External Resources

  27. The Office of the Deputy Prime Minister: Social Exclusion Unit Report 2004. http://www socialinclusion org uk/publications/SEU pdf, 2004 (accessed July 19, 2011).
  28. Marwaha S, Johnson S: Schizophrenia and employment – a review. Soc Psychiatry Psychiatr Epidemiol 2004;39:337–349.

    External Resources

  29. Bond GR: Supported employment: evidence for an evidence-based practice. Psychiatr Rehabil J 2004;27:345–359.

    External Resources

  30. Crowther R, Marshall M, Bond G, Huxley P: Vocational rehabilitation for people with severe mental illness. Cochrane Database Syst Rev 2001;2:CD003080.
  31. Drake RE, Becker DR: The individual placement and support model of supported employment. Psychiatr Serv 1996;47:473–475.
  32. Burns T, Catty J, Becker T, et al: The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. Lancet 2007;370:1146–1152.

    External Resources

  33. Bechdolf A, Wagner M, Ruhrmann S, et al: Preventing progression to first-episode psychosis in early initial prodromal states. Br J Psychiatry 2012;200:22–29.
  34. Thornicroft G, Lempp H, Tansella M: The place of implementation science in the translational medicine continuum. Psychol Med 2011;41:2015–2021.
  35. Thornicroft G, Alem A, Antunes Dos Santos R, et al: WPA guidance on steps, obstacles and mistakes to avoid in the implementation of community mental health care. World Psychiatry 2010;9:67–77.

    External Resources



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