Page images
PDF
EPUB

"Special alcoholism programs not administratively part of the center but closely coordinated with it. In communities where adequately staffed alcoholism services already exist, formal administrative integration with the center may be neither possible nor desirable. However, such alcoholism services should work collaboratively with the mental health program to assure continuity of care and appropriate referral and consultation.

"Specialized treatment personnel in the community mental health center, but no separate alcoolism ‘units.' Staff with particular interest and training can be designated as 'alcoholism specialists,' available to work with problem drinkers, as well as other patients. They can also serve as the center's alcoholism consultants.

"Special personnel to function primarily in nonclinical roles, but no alcoholism 'units.' This type of personnel engages in little or no treatment but works primarily to ensure that problem drinkers receive appropriate attention in all the activities of the community mental health center. In this capacity they function not only as consultants and as liaison persons with other community agencies, but also as a kind of 'conscience' for both the mental health center and the total community in relation to alcohol problems. They act principally as 'catalysts' and 'change agents' rather than as therapists."

This presentation appears to cover all possible methods of including alcoholism in the community mental health center complex.

The position of the National Council on Alcoholism regarding the community mental health centers has been enunciated in an address delivered by Thomas P. Carpenter, President of the National Council on Alcoholism, in New Orleans, Louisiana February 9. The following quotation from this statement indicates the thinking of NCA in this regard:

". . . assuming that community mental health centers all over the country become operative with a full range of services as outlined above-both the required and the suggested services-and assuming that alcoholism is included in the services (as I fervently hope) there still remains a critical gap with respect to alcoholism. This gap is the function that the Alcoholism Information Center was invented to perform.

"Dr. Fritz Kant in his treatise on "The Treatment of the Alcoholic" stated it this way:

'Discussions of treatment always assume that the patient is under the care of the therapist. To get him there is often the greatest difficulty.'

"He goes on to note that public education has made some impact and: 'More awareness and better recognition of the impending danger of alcoholism has on the whole improved the situation by bringing the patients for treatment earlier than would have been the case 10 years ago.'

"This, however, is only part of the problem. It is not just the 'increased awareness and better recognition of the impending danger of alcoholism' that removes the blocks to effective treatment and prevention. Availability for treatment implies more than the mere getting together of the patient and the therapist, as I am sure Dr. Kant would agree. The major block to effective treatment of the alcoholic and to the establishment of effective programs for such treatment, would seem to lie more in misconceptions of the nature of the problem and therefore what kind of measures are indicated...."

"I think it its apparent that the community mental health center as conceived is in this respect lacking for effective service to alcoholics. I have little doubt but that the prospectuses of many, if not most, community mental health centers will include 'services for alcoholics.' Likewise, I predict, that they will be programmed on the assumption that the patient is already there under the care of the therapist, is there by his own choice and has faith in the therapy offered. "Obviously, the thing that throws most people off in their thinking and planning about alcoholics is that these are entirely warranted assumptions in the case of most illnesses. Most sick people in our society 'know' that their problem is illness and they 'know' what kind of help is effective and where and how to find it. Moreover, they approach the helping source-person or institution-with faith and willingness to cooperate.

"People are not born with this knowledge or these attitudes; they are taught— very carefully taught-by the society in which they live. In fact, in his respect, we might say that the alcoholic is a very good citizen-he believes implicitly about himself, the same things that his society believes. Unfortunately these beliefs prevent him from availing himself of whatever effective help there is

and he is even accepting of the barbarous methods of his society for handling his behavior.

"Remedying this situation is the function that is missing in the mental health center outline and it is the function to which the Alcoholism Information Center addresses itself. Thus the Alcoholism Information Center fits into the general plan as a necessary adjunct at least until such time as the community changes and undertakes this therapeutic function as it does in other illnesses-which I presume will be some time from now."

[APPENDIX A]

ESTIMATES OF ALCOHOLICS WITH AND WITHOUT COMPLICATIONS, UNITED STATES, BY STATES, 1960, AND RATES PER 100,000 ADULT POPULATION (AGED 20 YEARS AND OVER) 1

1

[blocks in formation]

1 Selected statistical tables on the consumption of alcohol, 1850-1962, and on alcoholism from 1930-1960. Prepared by Vera Efron and Mark Keller. Published by Rutgers Center of Alcohol Studies, New Brunswick, N.J.

Note: These estimates are derived by the original Jellinek formula; the rates (on which the numbers are based) are those of the year 1945, with R=5, applied to 1960 populations. The formula may be less reliable in units with smaller populations. These estimates should be considered as very rough approximations. Numbers are rounded to nearest hundred.

[APPENDIX B]

"MODEL" HALF-WAY HOUSE

The surveyed half-way houses give the impression that there is a good deal of variety in the operations of these houses. Nonetheless, even with these differences in approach, all of the half-way houses have had some success. We would

like to select the best features from this survey to fabricate a composite picture of what, to the writers, would be a model half-way house.

The location of the facility deserves careful consideration. It should be in a central urban area where there is low cost public transportation, and near centers of occupation, particularly unskilled and semiskilled employment. It should also be in a city near the homes, or former homes and families of the men. It should be located in a respectable residential neighborhood whose social status is neither too high nor too low, and not close to Skid Row habitats or concentrations of bars. It is also desirable to choose a central urban location so that qualified staff, including part-time, consultive, volunteer, and either unpaid personnel, may be obtained and can travel with relative ease to the treatment center. This would also enable the half-way house to use existing educational, research, and training facilities that are available in such areas.

As for physical charactertistics, the half-way house should be a "family" type residence with furnishings that are adequate though simple, and furniture that has firm rather than stylish construction. There should be space for offices, meetings, recreation, a lounge for quiet reading and relaxation, dining facilities, and sleeping accommodations. Regarding sleeping accommodations, the Belmont Rehabilitation Center in Worcester, Massachusetts, has worked out an interesting and successful system. The men live closely at first in dormitory style. As selfimprovement progresses, the men are advanced to accommodations for three. And finally, when a man is considerably improved he is "graduated" to a single room. Each step in this ladder-like progression provides more comfort, greater convenience, and added prestige through a concrete recognition of his progress. But whether or not some system is used for assigning different accommodations within the plant, it would seem that the model half-way house should have different types of arrangements and, above all, emphasis should be on creating a home and club-like atmosphere.

The bed capacity should be limited to 30. Admission and eligibility requirements should be decided by the administrator and staff with consideration in particular of age, sex, and sobriety. The residents must agree to abide by some general rules and regulations such as curfew, schedules, house chores, program attendance and the like, which should be designed to maximize chances for recovery. Fees should be waived initially, but when employment is obtained the resident should pay a reasonable fee of $15 weekly.

On entering the program of the model half-way house each individual should undergo a three-day orientation phase, beginning with an initial interview and ending with a commencement of the regimen of daily activities. In this orientation period the man would receive a physical examination and would be introduced to procedures and rules, the program and methods, the philosophy and its bearers. At this time he would learn what he can expect from the staff, fellow residents, and the half-way house in general, and what is expected of him. At the same time the staff would formulate suitable plans for his future participation in the program.

The program itself should provide for participation in some kind of counseling or psychotherapy, either individually or in a group. An AA group should be formed for residents only, using their own and outside speakers, and they occasionally should attend outside meetings. The men would also participate in frequent group meetings concerned with daily problems and policies related to government and management of the center. Using principles of self-government, the men themselves would exercise responsible authority in enforcing the rules and policies which govern the behavior of residents. Each man should be helped to find employment as soon as possible after completing orientation, and should receive both casework and vocational counseling in this regard as required. Arrangements should be made for clergy of various denominations to be available for religious counseling and spiritual help at the request of the men. The staff for carrying out the program should include a top-level professional with training in the social or behavioral sciences who would be the director. He should have some experience in administration, supervision, institutions work, treatment, and research. An assistant director with similar qualifications, although of less experience, would aid the director. There also should be a resident supervisor, perhaps a recovered alcoholic who has clearly demonstrated a capacity to assume responsibility. The latter individual is a key figure, for he must see that the affairs of the institution are run smoothly, and be available to meet the needs of the men in times of stress. The director, assistant director, and

resident supervisor would be full-time. In addition there should be on the parttime consulting staff one psychiatrist, two social workers, one psychologist, and one researcher. These part-time consultants would be diagnostic work, and would plan and conduct treatment. All personnel must be equipped with warmth, maturity, and understanding.

Emphasis in the last stages of the program should be placed on easing the member back into a less protected situation in the community. Length of stay in this program should be limited to 90 days. This is not an arbitrary figure, for pragmatic experiences indicate that 3 months is in many ways the optimum length of time it is a suitable period for the majority; it avoids excessive dependency on the protective half-way house; and from the practical point of view it will allow for a reasonable amount of turnover. Readmission policies, however, should be flexible, depending on staff judgment of the individual case. And in any case, opportunities for the use of the recreational and physical facilities should be made available to successful "graduates" of the program, so that discharge does not come as a kind of weaning shock. For discharge, like orientation, is a critical period. It is a time of crisis and decision making. Every possible measure should be taken to avert failure. Efforts, which begin several weeks before discharge, should be directed at finding housing, re-establishing family, religious, and other non-Skid Row relationships, and strengthening all routes of reintegration into society.

CONCLUSION

These ingredients for a model half-way house are presented mainly as guideposts. Local conditions and the relative youthfulness of the half-way house concept of rehabilitation demand that flexibility and continued self-evaluation be a guiding philosophy. Whatever the specific ingredients, however, the general goal that we commend to any half-way house program is that it attempt-through its plant, program, personnel and procedures--to combine the best features of a relaxed home and a therapeutic milieu.

A great many problem drinkers have been and will be helped by half-way house rehabilitation. Through this method they gradually gain increasing personal strength and ability to deal with inwardly and outwardly induced frustration and anxiety in ways that preclude the use of alcohol. Thereby they rebuild their self-respect and sense of dignity, restore their usefulness occupationally, recover their social relationships and eventually ease the heavy burden they had put on the community. And, this is accomplished with "unreachables!"

Mr. ROGERS. Our last witness today is Eugene Sibery.

May I say we will make your statement a part of the record, following your remarks. Now, if you would give us your comments, it would be helpful.

STATEMENT OF D. EUGENE SIBERY, EXECUTIVE DIRECTOR, GREATER DETROIT AREA HOSPITAL COUNCIL

Mr. SIBERY. I shall paraphrase the important items, so that I shall not make a 15-minute commentary on a 7-minute formal statement. Mr. Chairman and members of the subcommittee, I am D. Eugene Sibery, executive director of the Greater Detroit Area Hospital Council. I also serve as chairman of the American Hospital Association's Council on Research and Planning, and I am the president of the Association of Health Planning Agencies. I was the acting coordinator of the Michigan regional medical program during its initial, organizational period, and now serve on that program's regional advisory

group.

I am here today to speak in support of title I, H.R. 15758, to extend the authorization for regional medical programs for heart disease, cancer, and stroke.

As a health planner involved with the coordinated planning activities of a hundred hospitals in one of the Nation's most heavily

urbanized areas, I am strongly attracted by the potential of regional medical programs and impressed by their progress.

The strength of these programs stems from the spirit of voluntary cooperation which underlies them, and which was written into the law largely by your committee 3 years ago.

This voluntary, cooperative approach to problem solving isn't as swift as a more direct approach might appear to be, but I hope that you will be persuaded that it is far more sure.

Regional medical programs are becoming strong and successful forces in our society because they challenge the ingenuity of the participants. They are becoming strong and successful forces in our society because they exist to meet specific local problems, not problems that have been rendered sufficiently vague to be labeled national problems. And finally, regional medical programs are becoming strong and successful forces in our society because they are based upon plans and decisions made by those who must carry out the plans and decisions, and by those who will be affected by them.

The last point-broad-based involvement for cooperative planning and action-is the paramount reason regional medical programs will ultimately succeed in the inner cities of America. It is a program that health planners have long awaited, a program to draw together the hospitals, physicians, public health agencies, and all of the other elements necessary to provide efficient, effective, and economic health services.

It is also a program which must incorporate the opinions and thoughts of the public to be served by these health resources, and this too is a terribly difficult task. The population of our inner cities is depressed in mind and spirit, handicapped by lack of education and opportunity, and all but overwhelmed by poverty and need. This must not deter us. Without the cooperation and the support of these people, no program can succeed.

The development of regional medical programs has seemed slow in the inner cities, but there has been progress. It's not unlike the construction of a building. Until the foundation is laboriously dug and built, and the main structure begins to rise, progress is not apparent. Regional medical programs have been digging their foundations with a process of careful planning, and the structures beginning to mergethe operational programs-will be all the sounder and stronger for this every effort. Briefly stated, from the national view, the progress of regional medical programs has been dramatic. Less than 2 years ago, there were no regional medical programs; today there are 53 organized and at work.

There is one further reason why I view the period of planning as so essential. The experience gained in this program-I wish to stress this point--for heart disease, cancer, and stroke can serve as a guide to make it far easier for other health programs to meet the needs of our country's entire population, including our urban areas. Significant changes in the traditional methods of delivering health care must be effected. I believe with active and meaningful involvement of all health professionals, the regional medical programs will provide the mechanism for the health professionals to markedly improve the patterns of organization and distribution of health care.

93-453-69--15

« PreviousContinue »