radio psychiatry talk shows as shallow, sen- sationalistic, and irresponsible. (4). ..... network via- bility. References. 1. Cave R: Dial Dr Tony for therapy. Time,.
then written tients.
and signed
by both
pa-
The religious issue was discussed in the third session, in which it was revealed that the compulsion to talk about religious issues was a direct result of the patient’s illness. She stated that the voices said, “If you don’t witness, you will go to hell,” and “You have a right to talk to others about God.” She became unable to control herself when options were suggested and refused to continue, stating, “I am not signing anything that says I can’t talk about God!” At this point the time allotted for the session was over. No other sessions were scheduled because the patients’ assessment period in the transitional housing was over. During
the
follow-up
Results with these patients suggest that an interest-based approach to solving conflicts has therapeutic value. Patients may gain insights about how their behavior affects others and about their own feelings. .
Conclusions It is commonly assumed that parties in mediation must be “rational.” This case presents evidence that
psychotic
patients
can successfully use mediation during lucid periods when sufficient support is available. Patients’ new
insights
about
how
their
behavior
affects
others suggest that interestmediation may have therapeutic value, in addition to its efficacy in resolving conflicts. The case raises based
Hospital
and Community
Acknowledgments The authors thank Alan King, Ph.D., andJohn Tyler, Ph.D., for helpful cornments.
References 1. Moore C: The Mediation Process. San Francisco, Jossey-Bass, 1986 2. Fairweather GW (ed): The Fairweather Lodge: A Twenty-Five Year Retrospective. San Francisco,Jossey-Bass, 1980 3. Beard JH, Propst RN, MalarnUd TJ: The Fountain House model of psychiatric rehabilitation. Psychosocial Rehabilitation Journal 5:47-53, 1982
Radio Psychiatry and Community Mental Health
interview
completed shortly thereafter, while the patients were still in the transitional setting, we were pleased to discover that they had continued the process for establishing the first two rules and had come to an agreement on the religion issue. They had internalized at least some of the interestbased mediation process. In addition, the patients reported that the sessions helped them understand how their roommate felt about the issues that had caused the conflict and that the increased level of understanding helped them control their impulses. One patient stated, “No one had ever talked to me about how I affected them.”
high-functioning
questions, which remain to be cxploned, about the generalization of. successful outcomes to other situations.
Psychiatry
Frederick W. Hickling, M.R.C.Psych.
D.M.,
The use of radio programs in community mental health has become popular in recent years. Cave (1) reported that the first radio psychiatry program in the U.S. was established in California in 1976. In 1981 Rice (2) commented on the growing populanity of radio psychiatry programs in the United States and elsewhere. Ruben (3) described a nationally broadcast radio call-in show that began airing on NBC Radio from New York in 1982. Some authors have criticized radio psychiatry talk shows as shallow, sensationalistic, and irresponsible (4). Both the American Psychiatric Association (5) and the American Psychological Ass iciation (6) have published ethical guidelines for psychiatnists and psychologists working with the communications media. The guidelines caution that there should be no attempt to make a diagnosis or to treat on the air. Radio psychiatrists should not cite their own cases, and most important,
Dr, Hickling is medical director of Psychotherapy Associates, 23 Connolley Avenue, Kingston 4, J amaica, and associate lecturer in psychiatry at the University of the West Indies in Kingston.
July
1992
Vol.
43
No.
7
should not exploit the caller for media purposes. However, most authors agree that call-in radio psychiatry programs can have a positive psychoeducational effect on listeners. This paperdescnibes acall-in radio show about mental health that aired in Jamaica between 1975 and 1984 and summarizes the demographic characteristics and problems presented by persons who called or wrote to the show over a four-year period. The call-in program In October 1975 the author established a radio psychiatry call-in program in cooperation with the Jamaica Broadcasting Corporation. The 45-minute program was broadcast once a week. The radio psychiatnist received telephone calls from persons all oven the island and answered questions raised in letters from listeners who did not have access to a telephone. The psychiatrist advised listeners about the possible causes of the problems they described, discussed social, psychological, and psychiatric themes raised by callers, and referred callers to agencies on therapists where they could obtain help. Listeners’ problems A total of 150 radio psychiatry programs that aired between March 1980 and the end of February 1984 were tape recorded and studied. A total of367 calls and 17 1 letters were
739
received during that period. Eightyone percent of the calls and letters were from women. The psychiatrist spent an average of 1 2 minutes with
spent The found
by the New York program. Jamaican radio psychiatrist that about 30 percent of prob-
lems
could
each caller, and more of calls were at least
and resolved on the air ifenough time was spent. The longest time spent with any one caller on the Jamaican program was 42 minutes. The cornmercial constraints affecting the production of radio psychiatry programs in North America may predude more in-depth discussion of mental health problems on the air.
than ten
50 percent minutes in
duration. The majority of callers were single, and most were domestic helpers,
unemployed
dents. group ing
persons,
or stu-
A total of 77 percent of the called about matters concerntheir
own
mental
Emotional lems were the (18
percent
health.
and self-image most frequent of
probthemes
inquiries),
Nor
followed
inquiries.
Questions
about
the
phen-
omenology of mental illness and about physical problems each accounted for 9 percent, and sexual difficulties 8 percent. Analysis by broad diagnostic categories revealed that about 3 3 percent of the problems described by callers and letter writers involved anxiety states and depression, 1 7 percent concerned physical disease, 13 percent were about personality disorders, 6 percent were about psychosexual disorders, and 6 percent were about psychotic disorders. About 37 percent of the callers were referred to psychiatrists,
and
23
percent
were
referred to general practitioners other medical specialists.
gram
Jamaica
was
to the program described (3), which aired from it
appeared
significantly
to
different
pro-
technically
be
by New
reaching
a
population.
The Jamaican callers were from a lower socioeconomic class and had more socioeconomic concerns and interpersonal conflicts than the callers in the U.S.
Although
the specific
men-
tal health concerns of the two sets callers were different, the distribu-
of
tion of diagnostic callers’ problems
fit
The
on radio
J amaica 740
average
categories that were similar. length
psychiatry was more
of time
interventions than twice
spent
in that
completely
the
very
discussed
Jamaican
upset
a caller
helped
them
resolve
Callers and
the
similar
a similar
to both
the Jamaican
the
program
U.S.
frequency
proreported
of symptoms
of
(33 percent in Jamaica and 25 percent in the U.S.), suggesting that despite differences in the socioeconomic and cultural charanxiety
and
acteristics
depression
of
callers, they psychopathology
the
two
presented and
ilar psychotherapeutic
referral.
In
psychiatrist
groups
of
with similar required simresolution
both
settings,
found
to callers
and
the
radio
it necessary the
scope
to cx-
of psychia-
try, the difference between the services of psychologists and psychiatrists, and the behavioral approach to parenting and child rearing. The author concurs with Ruben’s conclusions that radio psychiatry talk shows are a valuable way to destigmatize psychiatry, to market psychiatric services to the public, and to enhance
community
through
education.
mental A pilot
health survey
of
100 informants at the University of the West Indies conducted in 1985 suggested that the Jamaican radio psychiatry program had a long-lasting effect on the community and helped
a high
sons own
studied mental
July
1992
percentage
of the
43
million
people
(8-10).
This
ofthe
recorded
radio
psy-
chiatry programs indicated that a number of psychotherapeutic techniques, including mental status evaluation, contracting, ventilation, catharsis, confrontation, working through, and conflict resolution, were used with callers. The radio psychiatrist challenged strongly held myths and beliefsystems about mental illness and its causes and therapy to help callers and listeners gain insight. During the nine years the program aired, it explored religious, class, gender, political, and racial issues with Jamaican people who had lived through the historical conflicts of
colonialism,
many
of which
the
callers were not consciously aware of. The program openly encouraged individual change and social change at a national level and advocated the psychotherapeutic model as the paradigm for this change. The fact that the radio psychiatrist was “fired on the air” (1 1) suggests that the program gave insights into ways to achieve personal and political change that were threatening to oversensitive government officials who controlled
broadcast
of the
program.
A radio psychiatry talk show constitutes an approach to primary prevention that may be socially psychotherapeutic, especially ifthe program is aired for many years and the interventions with each caller are intensive, focused on process, and not restricted by commercial constraints of advertisements and network viability.
References
per-
in dealing with their health problems (7).
Vol.
2
number represented a total of58 percent of the national listenership, the highest sustained listenership for any 45-minute Jamaican Broadcasting Corporation program. Analysis
from
problems. gram
of
program
patients
air, as was done by the New York program. Callers on the Jamaican program were not screened, and cxtremely distressed callers were able to discuss their problems, often with discernible relief. Listeners often called in to say that they were satisfled by the explanation of a problem on the air and often felt that the working through of a problem with
plain
conclusions radio psychiatry
the
in
similar Ruben York,
or
and
Discussion Although
did
restrict
closely by socioeconomic problems (1 3 percent) and questions about the effectiveness of self-help and nontraditional therapies (1 2 percent). Conflict and power management problems and family problems each accounted for 1 0 percent of the total
be
Media surveys conducted in Jamaica in 1977, 1979, and 1981 indicated that the program had one ofthe highest listenerships ofall programs ofsimilar length and regularly reached audiences of 1 20,000 people, in an island with a total population
No.
1 . Cave R: Dial Dr Tony May 26, 1980
7
Hospital
and Community
for therapy.
Time,
Psychiatry
2.
Rice
B: Call-in
shrink
someone. pp 39-41
1981, 3.
4.
Ruben
HL:
atrist.
Hospital
atry
37:934-936,
therapy:
Reflections and
and
Today,
ofa
radio
Dec psychi-
Community
Psychi-
1986
C: Media and responsibilities. 1981, pp 26-27
psychology: new roles APA Monitor, Dec
Larson
5 . American
out
reach
Psychology
Psychiatric
Association
on
Affairs:
Commission
Public
Joint Guide-
lines for psychiatrists working with the communications media. American Journal ofPsychiatry 1 34:609-61 1, 1977 6. American Psychological Association: Ethical principles ofpsychologists working in the communications media. American Psychologist 36:633-638, 1981 7.
Johansen
M:
A Questionnaire
Survey
of
a Radio Psychiatry Program in Jamaica. BA thesis (mass communications), University of the West Indies, Mona, Jamaica, 1985 8. Jamaica 9.
Market
Media Survey, 1977. Kingston, Research Services, 1977
Jamaica Market
Media Research
10. Jamaica
Media
Market
Survey, 1979. Kingston, Services, 1979
Survey,
Research
Services,
1981 . Kingston, 1981
JC: Fired on the air. The
1 1 . Proute Kingston,
Jamaica,
Star,
Jan 3 1 , 1984
Letters
throughout the United States. Signs ofthis intensified interest can be seen in many forms. . Partial hospitalization has become a newsworthy topic, as reflected by recent articles in AHA News, Psychiatric News, and the APA Monitor. Psychiatric Hospitals devoted its entire Spring 1 99 1 issue to partial hospitalization. S The American Association for Partial Hospitalization (AAPH) is witnessing unparalleled growth in membership. AAPH is currently receiving nearly 100 requests per month from organizations interested
ited, active, and intensive treatment modality providing crisis stabilization or intermediate-term treatment. The growing acceptance of this definition is supported by similar requirements in both the Medicare and CHAMPUS partial hospitalization benefits. Defined in this way, partial hospitalization can be readily distinguished from psychosocial rehabilitation programs that typically provide less structured and less psychotherapeutically oriented services. While Hoge and associates cite declining public-sector funding for day treatment and day care pro-
in developing
grams,
becoming tion.
new
programs
members
Seminars
of the
and
and
in
associa-
conferences
on
program
development sponsored by AAPH have been well attended. . Partial hospitalization has enjoyed unparalleled acceptance by third-party payers. Managed care, as Hoge and associates point out, looks favorably on the mode. Equitable coverage can now routinely be pursued through established case management procedures. In 1987 5crvices rendered in hospital-based partial
hospitalization
programs
became
sociates (1) in the April issue concludcd that a review of recent trends suggests that “these are troubled times for the field ofpartial hospitalization.” Ironically, the authors draw their conclusions at a time when partial hospitalization is experiencing unprecedented growth and recognition
reimbursable under Medicare, and in 1991 Medicare coverage was cxtended to community mental health centers. In the past year, Prudential Insurance Company initiated coverage of partial hospitalization as a standard benefit. Similarly, after an exhaustive review, CHAMPUS will soon introduce coverage of hospitalbased and freestanding programs. These developments do not appear to reflect “troubled times” for partial hospitalization. Indeed, they appear to embody a realization of the very promise that Hoge and associates question. The authors cite the “absence of one clearly established definition” of partial hospitalization as “the major obstacle to the growth and acceptance of this modality.” To address this concern, in August 1991 AAPH released revised standards and guidelines offering greater specificity and comprehensiveness. AAPH has received close to 600 requests for the document from nonmembers since its release. The new standards define partial hospitalization as a time-tim-
Hospital
July
Letters from readers are wekomed. They will be published at the discretion ofthe editoras space perm its andwill be subject to editing. They shouldbe a maximum of500 words with no more than five references and should be submitted in duplicate, typed doubk-spaced. Letters should be addressed toJohn A. Talbott, M.D., Editor, H&CP, Amencan Psychiatric Association, Washington, D.C. 20005. Writers should include their title and affiliation.
Partial
Hospitalization
To the Editor: ing
article
by
and
The
thought-provok-
Michael
Hoge
Community
and
Psychiatry
as-
1992
Vol.43
No.7
they
have
underestimated
the
potential impact of the recent broadening of Medicare coverage to include CMHCs. As the single largest payer ofhealth care services in the nation, Medicare’s expansion of coverage to CMHCs, in our view, represents acknowledgment of its clinical and fiscal value in treating the acute phase ofa chronic disorder, and it has already encouraged the development of many new programs for the elderly and chronically disabled. Not
only
do
Hoge
and
associates
understate growth in a segment of the public sector, but they also overgeneralize from the public-sector chronic population to the privatesector acute population. In particular,
the
assertive
community
treat-
ment model they favor does not seem well suited to the needs of acutely suicidal, depressed patients who require intensive daily observation, structure, and treatment. Finally, Hoge and associates were admittedly limited by “imprecise data.” Therefore, they lacked the necessary information for a proper analysis
of the
current
status
of par-
tial hospitalization. For example, they do not distinguish between child, adolescent, and adult programs. Their data, as well as the alternative treatment modalities discussed, are specific to adult populations and do not necessarily generalize to child and adolescent programs. To remedy the paucity of current, reliable data, the AAPH undertook a national survey project earlier this year, targeting more than 4,000 potential partial hospitalization pro-
741
