Abstract
Admission to a Mental Hospital implies that the admitted individual is in need of specialized care. Care involves a relationship between the “caretaker” and “cared for”. The type of care received depends on the type of relationship established. According to Paterson (1) “All forms of human relationship involve authority, and this authority is one or more of five forms, depending on the purpose of the group and its structuring of functions to achieve the goal of the group”, Authority being the entitlement to do something by reason of certain attributes or combination of attributes.
In the author's view, there are three main types of institutional care each involving differing types of relationship and therefore different types of authority. For our immediate purpose we can confine ourselves to three types of authority, Structural, Sapiential and Moral.
The three types of Care, Custodial, Moral and Therapeutic are defined in terms of authority, purpose and dangers. The administrative organization fulfilling each is outlined and changes that must be made in moving from Custodial to Therapeutic care are detailed. The reasons for these changes are discussed and their implications for the function of Nurses and Doctors are outlined. The institution of therapeutic care is difficult.
Our quandary is how to produce a social system in which the right and the good are the same and yet one in which we are able to introduce new techniques that are good for the patient without causing a value system conflict, i.e.; a conflict between what is right and what is good. It is relatively easy to introduce new physical treatments but difficult to introduce new inter-personal techniques because in the former the social values of the Nurses are not involved, whereas in the latter they are.
In broader terms in a stable and unchanging society, Tightness and goodness are largely interchangeable; in an unstable society there will be a wide distinction between Tightness and goodness and therefore a greater amount of conflict between the individual and society.
Two administrative techniques have been instituted in order to facilitate the continuation of this type of society: —
1) The Ward Staff Meeting:—The purpose of this meeting is to assist Nursing Staff to express their feelings about patients and inter-staff conflicts for without such expression, rational discussion of methods of handling the patient cannot be accepted and therefore applied.
2) Resolution of conflicts between individuals in order to avoid or correct the covert disagreement situation as defined by Stanton through the simple procedure of interviewing the protagonists separately to get their respective stories and following this with a joint interview at which the interviewer states the grievances of both parties and asks for their comments and discussion. Such interviews follow a consistent predictable pattern.