Episode 21
Understanding Laws After a Hospital Stay with Adolph Vidal
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HOPE on the Other Side Episode 21 Program Notes:
BIOGRAPHY: Mr. Vidal is a retired clinical social worker who was raised in the Central Valley of California, born in Hanford, CA. He studied at the College of the Sequoias, in Visalia, and then went on to receive his bachelors and masters degrees in Social Work at CSUF, California State University, Fresno. His 37 years in mental health services were partly in adult, and partly in child services. He was a deputy conservator and case manager for those with severe mental illness being treated in the community.
The episode begins with a bit of personal history about Adolph Vidal. He began as a mental health aide in acute hospitals, then later got into the conservatorship office, became a case manager, and ended his career as a LCSW, licensed clinical social worker. Then the interview moved to outpatient legal matters.
Adolph described the conservatorship laws in California. It is the LPS, Lanterman-Petris-Short Act, which helps protect the person living with severe mental illness by requiring that they be treated in the “least restrictive” housing setting. The law was enacted in 1967, and came into full effect in 1972. The legal limitations on the person’s on the patient’s freedoms last for one year. Each year the decision must be reviewed. One is reminded of the American playwright’s work about the old style abuses of mental health, “Suddenly Last Summer,” by Tennessee Williams. The nick-name of the LPS conservatorship is “permanent conservatorship” but it lasts for 12 months at a time.
Note that in an earlier podcast, Episode #02, Dr Marcella Wilson discussed the legal holds leading up to the 12-month conservatorship. Today we are focused on the LPS 12-month conservatorship. A key point Adolph tells about in the laws is that patient has the right (usually with a public defender) to dispute or to contest the decision for conservatorship.
For his academic degree work, Adolph wrote a research study paper “Key Factors of Medication Compliance Among the Mentally Ill.” The LPS law assumes and requires that the patient with severe mental illness stay on anti-psychotic medication. The patients studied were in the Fresno, CA area. We discussed the 4 main research questions, namely: 1) does substance abuse make a difference on whether a person with schizophrenia can remain compliant with medication, 2) does having family support make a difference with medication compliance, 3) does being involved in a structured outpatient program make a difference with compliance, and 4) does one’s personal insight into mental illness make a difference with compliance with medications. Levels of care were explained.
The most restrictive level of care is the state hospital, the locked psychiatric hospital setting. Next, there are locked community housing facilities. After that there are “board and care” homes. Lastly after LPS conservatorship ends, then the patient may move to a “room and board” where the person has independent living skills, and lacks that psychotic negativism. At the board and care the staff administers medications, and in contract at the “room and board” the patient has much independence. Medications here refers the the “anti-psychotic” dopamine blocking agents.
The highlights Adolph found included the following: 1) that even with recent history of substance abuse the patients were able to keep taking their medications; and over 80% were satisfied with the use of medications. Also, 2) over 80 % of the patients / clients had some form of contact with blood relatives / family members. It was important that the quality of time spent with the family was generally safe, and stress free; and 3) over 80% agreed that they needed to keep taking medications. The data supports the idea that having insight into the mental illness correlates with ongoing use of the medications. Lastly, 4) the day treatment programs’ benefits were reviewed, and participation in those programs has a positive impact upon medication compliance. Adolph talked about some local Fresno area day treatment programs in specific.
Dr Ken comments that there is a spectrum of illness, symptom severity, and disfunction in schizophrenia. It seems to be well justified to use the anti-psychotic medications with the folks who have functionally disabling symptoms. The reason here is to reduce the intensity of the psychotic experiences. A confusing part of psychosis is negativism. That is a technical term defined as the patient’s lack of drive or initiative to plan things, or to actually do one’s plans, or to interact with other people.
The negativism can adversely affect the “bridge of rapport” which is that connection between the person living with schizophrenia and his / her caregivers. Adolph discussed methods to keep that bridge open: 1) family support groups for the mom / dad / caregiver; 2) educational activities for them to better understand “psychotic negativism,” psychosis, and other features of the condition; 3) get accountability-support to maintain the best attitude toward the loved one living with schizophrenia, and as Adolph says about the odd or difficult behaviors, or the so-called acting out: “don’t take it personally.” Additionally, there may be a need for an assessment by the “case manager” when the family / caregivers should take a break or a vacation from contact with the loved one living with schizophrenia.
Adolph concluded by recommending and highlighting the importance of insight, trust, and relationship between the mom / dad / caregivers and the person living with schizophrenia. We also ended by recommending the following technique: empathize with their distressing reactions to the “symptoms” while at the same time avoid validating those symptoms.
Links
NAMI Website: www.NAMI.org
Prior HOPE podcast episodes on the following:
Laws during the hospital stay, Episode #03
http://drkencampos.com/understanding-laws-during-a-hospital-stay-with-dr-marcella-wilson/
NAMI with Suzette Southfox, Episode #09
http://drkencampos.com/nami-the-national-alliance-on-mental-illness-with-suzette-southfox/
Rapport Building, Episode #14
http://drkencampos.com/rapport-bridge-building-for-the-caregivers/
Dr Ken’s support and accountability Face Book Group to assist mom / dad / caregivers grow into and embody the “new normal” attitudes and behaviors while living with and supporting their loved one living with schizophrenia, an open public group:
S-Project
