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The sustaining clinic; outpatient services for the long-term mentally ill : a case review of low potential rehabilitation patients in the sustaining clinic and the social club, Mental Health Centre, Burnaby, B.C., 1957-1960 Beck, Allan Stewart

Abstract

The Sustaining Clinic is a recently-added service provided by the Mental Health Centre in British Columbia for a selected group of patients who are unable, for a variety of reasons, to benefit from more intensive therapy than a monthly interview. This study reviews the contribution of the therapeutic team at the Sustaining Clinic (of which the social worker is a part), toward the rehabilitation of a difficult group of mentally-ill patients, most of whom require long-term follow-up care. To emphasize the focus on the appropriate type of patients, the method is to review (1) the problems of a sample group of these patients, and (2) the treatment services given to them; thus, establishing how far this meets their needs. Treatment is evaluated with the aid of three rating scales assessing the patient's functioning at the time of referral and at the time of discharge. The evidence is that (1) The enormous disability associated with these patients is to a large extent imposed, preventable, and treatable. Disability originates particularly from parental rejection, and is later magnified by the rejection mechanisms stemming from cultural attitudes. (2) The treatment provided by the Sustaining Clinic is effective because it is related to the needs of the patient and to the specific conditions surrounding his illness. Therapeutic contributions include regulation of medication, support in cases of stress, limit-setting, information-giving, manipulation of the environment, and providing a figure for identification. (3) More resources than the Clinic can provide will be needed, because of the deep-seated personal and social handicaps of these patients. This study itself can be helpful only if coordinated with others which examine other "halfway house" programs, and the social worker's participation in them.

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