The New Asylum: Revisiting an Old Approach to Mental Health Care
March 31, 2015
In the context of mental illness, the word “asylum” conjures, for many of us, some very negative images. We picture a scene with characters like the abusive Nurse Ratched from the movie “One Flew over the Cuckoo’s Nest,” or even worse, tragic true stories of the overcrowded, understaffed psychiatric hospitals of the last century where healthy, sick, disabled, and poor patients alike were locked away for years with no effective treatment or hope of release. These images may be the reason that a
published last month has garnered so much attention: Bioethicists from the Perelman School of Medicine at the University of Pennsylvania are calling for a return to asylums for long-term psychiatric care. At Penn, Dominic Sisti, PhD, Andrea Segal, MS, and Ezekiel Emanuel, MD, PhD, have been studying the current system for treating the chronically mentally ill and the evolution over the past half-century away from inpatient psychiatric hospitals. They observe that although the United States population has doubled since 1955, the number of inpatient psychiatric beds has been cut by nearly 95 percent to just 45,000—a very small number when compared to the 10 million U.S. residents who are currently coping with serious mental illness. According to Sisti and his colleagues, the result of this trend has not be “de-institutionalization” but rather “trans-institutionalization.” That is, people with chronic mental illness are being treated in hospital emergency rooms and nursing homes at best, and more often receiving no treatment and living on the street. “Most disturbingly, U.S. jails and prisons have become the nation’s largest mental health care facilities,” say the authors, in a January 20
Penn Medicine press release
. “Half of all inmates have a mental illness or substance abuse disorder; 15 percent of state inmates are diagnosed with a psychotic disorder…. This results in a vicious cycle whereby mentally ill patients move between crisis hospitalization, homelessness, and incarceration.” As a solution, the authors propose a modern and humane asylum—but they use the word in its original sense, that is, a place of safety, sanctuary, and healing. In addition, they advocate reforms in the psychiatric services offered in such institutions, including both inpatient services, for those who are a danger to themselves and others, as well as outpatient care for those with milder forms of mental illness. The proposal has been controversial, to say the least. Some in the mental health community find the idea of a return to asylums misguided and even frightening. In her article called
“Asylum or Warehouse?”
author Linda Rosenberg, President and CEO of the National Council for Behavioral Health, asserts that although Sisti and his colleagues accurately describe the problems of the current mental health system, their solution is to “just simply lock some people up” and that “the simple solution offered, recreating asylums, is not helpful—it’s dangerous.” Others have viewed the proposal in a more positive light. Christine Montross, a staff psychiatrist at Butler Hospital in Providence, Rhode Island and author of “Falling into the Fire: A Psychiatrist’s Encounters with the Mind in Crisis” wrote an
in the February 18
New York Times
in support of a move toward modern asylums. “The goals of maximizing personal autonomy and civil liberties for the mentally ill are admirable,” says Montross. “But as a result, my patients with chronic psychotic illnesses cycle between emergency hospitalizations and inadequate outpatient care. They are treated by community mental health centers whose overburdened psychiatrists may see even the sickest patients for only 20 minutes every three months. Many patients struggle with homelessness. Many are incarcerated. A new model of long-term psychiatric institutionalization, as the Penn group suggests, would help them.” What do you think? Are modern, reimagined asylums a potential solution for the chronically mentally ill, or has history proven that institutions cannot work? PAR wants to hear from you, so leave a comment and join the conversation!
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long-term psychiatric care
March 24, 2015
[caption id="attachment_2133" align="alignright" width="300"]
The PARty Animals have a lot to bark about this year![/caption] A group of animal-loving PAR employees, known as the PARty Animals, led the pack at this weekend’s Bark in the Park event, benefitting the
Humane Society of Tampa Bay
. As the top fundraising team this year, we will be proudly displaying the Bark in the Park trophy in the PAR lobby for another year. Last year’s Bark in the Park event raised enough money to:
save 5,611 animals
transfer 2,765 animals from high euthanasia shelters
achieve a 96% save rate
treat 25,857 owned pets at the Animal Health Center
trap, neuter, and return 5,399 feral cats
perform 11,506 spay/neuter surgeries for the public
give 1,708 free pet vaccinations in disadvantaged neighborhoods
give 286,150 pounds of free pet food to the pets of disadvantaged and homebound citizens
We are so proud to be able to support such a wonderful cause. We can’t wait to see what this year brings for the Humane Society of Tampa Bay.
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Meet the Author
Reading to Infants and Young Children Important in Developing Reading Motivation
March 17, 2015
This week’s blog was contributed by PAR Author
Adele Eskeles Gottfried, PhD
. Dr. Gottfried is the author of the
Children’s Academic Intrinsic Motivation Inventory (CAIMI)
. The study she describes in this blog is part of a broader investigation in which she examines the importance of home environment and parental stimulation on the development of children’s academic intrinsic motivation.
In a longitudinal study spanning 28 years, new research just published in
Parenting: Science and Practice
examined the long-term effect of children’s home literacy environment during infancy and early childhood on their subsequent reading intrinsic motivation and reading achievement from childhood through adolescence and their educational attainment during adulthood. This type of motivation, which is the enjoyment or pleasure inherent in the activity of reading, is found to relate to various aspects of children’s literacy behaviors. Literacy environment was assessed from infancy through preschool using the amount of time mothers read to their children and the number of books and reading materials in the home. Analyzing the data using a statistical model, the study examined literacy environment as it related to children’s reading intrinsic motivation (measured with the Reading scale of the CAIMI) and reading achievement across childhood through adolescence and their educational attainment during adulthood. Results demonstrated that it was the amount of time mothers spent reading to their children—not the number of books and reading materials in the home—that significantly related to reading intrinsic motivation, reading achievement, and educational attainment. Specifically, when mothers spent more time reading to their children across infancy through early childhood, their children’s reading intrinsic motivation and reading achievement were significantly higher across childhood through adolescence. In turn, higher reading intrinsic motivation and reading achievement were significantly related to educational attainment during adulthood. These findings were found regardless of mothers’ educational level. The implications for practice are clear: Reading to children during infancy and early childhood has significant and positive long-term benefits, and this information must be disseminated. Mothers, fathers, and other caregivers need encouragement and support to read to infants and young children, and they need to know what a difference it will make to children’s intrinsic motivation to read and learn.
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Adele Eskeles Gottfried
Children’s Academic Intrinsic Motivation Inventory
Now available: The new Child and Adolescent Memory Profile (ChAMP)
March 10, 2015
PAR is delighted to announce the publication of the new
Child and Adolescent Memory Profile™ (ChAMP™)
by renowned pediatric neuropsychology experts Elisabeth M. S. Sherman, PhD, and Brian L. Brooks, PhD. The ChAMP is a research-based memory assessment specifically designed to be engaging and relevant to children, adolescents, and young adults ages 5 to 21 years. Covering verbal, visual, immediate, delayed, and total memory domains in a brief, easy-to-use format, the ChAMP takes about 35 minutes to administer—and its Screening Index takes only 10 minutes. With real-life scenarios and colorful stimuli that are appealing to young examinees, ChAMP subtests are focused on learning. Intervention recommendations for both home and school are included. And especially important for very young examinees—or for those with motor impairments—the ChAMP does not require any motor responses. On the technical side, the ChAMP allows for in-depth analysis and monitoring through discrepancy score analysis and reliable change scores; a base rate analysis of low scores, a strengths and weakness analysis, and a built-in validity indicator are also included. The ChAMP was standardized using a normative sample of more than 1,200 participants and validated on a large clinical sample including individuals with learning disabilities, ADHD, autism spectrum disorder, brain injury, and intellectual disability. The ChAMP is an excellent value, with complete introductory kits available for just $385. To learn more or to place an order, visit
or give us a call at 1.800.331.8378. We’d love to hear from you!
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Child and Adolescent Memory Profile
We Are All People With Ability
March 6, 2015
Ronald Reagan declared
the month of March as National Disabilities Awareness Month. It serves as a formal time to recognize the efforts, struggles, and initiatives surrounding people with disabilities. In 1990, the
Americans with Disabilities Act
was passed, thus officially giving legal rights to those with disabilities regarding workplace discrimination. According to The Arc, whose
is to protect the rights of human beings with intellectual and developmental disabilities, at least
4.6 million Americans
have a disability. The Arc
in many ways for those with disabilities, including shaping public policy, providing services like employment programs and residential support, and preserving and protecting rights through education and activism.
is a nonprofit organization in Malden, Massachusetts, that “empowers people with disabilities to enjoy rich, fulfilling lives.” Together with the
Accessible Icon Project
, they are working to transform the original
International Symbol of Access
into something more visually representative of today’s individuals with disabilities. The new image conjures up words like “active, abled, engaged, ready for action, determined, and motivated…which helps provoke discussion on how we view disabilities and people with disabilities in our culture.” (Read more on the
section of the Accessible Icon Project Web site.) Follow these suggestions or add your own to raise awareness for those with disabilities:
your profile picture on Facebook, and post a status on social media (i.e., Facebook, Twitter) like, “I support and celebrate people with disabilities, and you should too!”
Volunteer or donate to the cause in your area. Use the
Network for Good
as a starting place.
to advocate for public policy to assist people with disabilities.
Support businesses that employ people with disabilities.
Take time to
and others about the needs of people with disabilities in your area.
Make sure that your own
words and actions
are respectful of those with disabilities.
Get involved in community-based activities that raise awareness in your
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Conscientiousness: More Important Than You Think
March 3, 2015
If you are ambitious in the workplace, new research suggests that you will more likely achieve your goals if you have a spouse who is also conscientious. Several previous studies have examined how personality predicts workplace success. One such
, by Paul Sackett and Philip Walmsley and published in
Perspectives on Psychological Science
, used the
Five Factor Model
(FFM) of personality traits— neuroticism, extraversion, openness, agreeableness, and conscientiousness—to examine which of these traits companies value most when hiring. Conscientiousness is at the top of most companies’ lists, but Sackett and Walmsley wanted to see whether this was really the best indicator of employees’ future success. It turns out that it is. After examining the relationship between personality traits and three work performance criteria— whether an employee is able to complete their work to satisfaction, how often an employee goes above and beyond at work, and how often they engage in negative behaviors—conscientiousness topped the list of traits needed to accomplish these goals, with agreeableness being a close second. Now a
out of Washington University in St. Louis reveals even more about how important conscientiousness may be to workplace success: you have an increased chance of achieving greater goals in your career if your spouse is also conscientious. Brittany Solomon and Joshua Jackson examined more than 4,500 heterosexual married participants to measure the effect their spouse’s personality has on their own job satisfaction, income, and likelihood of being promoted. The researchers used the FFM personality traits as their guide. Their work revealed that job satisfaction, pay increases, and promotions were all more likely for those people who had a spouse (male or female) with high scores on one particular personality trait: conscientiousness. “Our findings indicate that highly conscientious partners help improve their spouses’ occupational success, as measured by job satisfaction, income, and promotion. This benefit does not arise from partners doing their spouses’ work; rather, it is due to partners creating conditions that allow their spouses to work effectively,” Solomon and Jackson
. A short
by TouchVision gives an entertaining explanation of their findings. What personality traits do you think are most important in an employee?
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