The implementation and evaluation of the Finnish National Schizophrenia Program (I98I-7) concerning treatment and rehabilitation of long-stay patients is described. The results of the Program were evaluated by (I) national statistics, (2) questionnaire data sent to leading workers of hospital districts and (3) placement data of a follow-up sample consisting of I30 long- stay schizophrenic patients. The Finnish National Schizophrenia Program was a success in the sense that its rehabilitation models were widely applied and accepted during the I0-year period. The number of long-stay patients was greatly reduced and the majority was successfully placed in the community. Because of the comprehensiveness of the Program there is no clear way of estimating the 'real' effects of the Program from the 'natural' development without the Program. The problems of evaluation of comprehensive programs are discussed.
Get full access to this article
View all access options for this article.
References
1.
Alanen, Y.O., E.E. Anttinen, A. Kokkola, K. Lehtinen, M. Ojanen, K. Pylkkänen and V. Räkköläinen (1990a) 'Treatment and Rehabilitation of Schizophrenic Psychoses. The Finnish Treatment Model', Nordic Journal of Psychiatry, Suppl. 22, Vol. 44.
2.
Alanen, Y.O., R.K.R. Salokangas, M. Ojanen, V. Räkkölainen and K. Pylkkänen (1990b) 'Tertiary Prevention: Treatment and Rehabilitation of Schizophrenic Patients-Results of the Finnish Programme', in D. Goldberg and D. Tantam (eds) The Public Health Impact of Mental Disorder. Toronto: Hogrefe and Huber.
3.
Almond, R. (1974) The Healing Community. New York : Jason Aronson.
4.
Anthony, W.A., G.J. Buell, S. Sharrat and M.E. Althoff (1972) 'Efficacy of Psychiatric Rehabilitation', Psychological Bulletin78: 447-56.
5.
Anthony, W., M. Cohen and M. Farkas (1990) Psychiatric Rehabilitation. Boston, MA: Center for Psychiatric Rehabilitation.
6.
Bellack, A.S. and K.T. Mueser (1993) 'Psychosocial Treatment for Schizophrenia', Schizophrenia Bulletin19: 317-36.
7.
Bellack, A.S., R.L. Morrison and K.T. Mueser (1992) 'Behavioral Interventions in Schizophrenia' in S. M. Turner, K. S. Calhoun and H. E. Adams (eds) Handbook of Clinical Behavior Therapy pp. 135-54. New York: Wiley.
8.
Bleuler, M. (1978) The Schizophrenic Disorders. Long-term Patient and Family Studies. New Haven, CT: Yale University Press.
9.
Bowling, A. (1991) Measuring Health. A Review of Quality of Life Measurement Scales. London: Open University Press.
10.
Carling, P.J. and P. Ridgway (1989) 'A Psychiatric Rehabilitation Approach to Housing' , in M. D. Farkas and W. A. Anthony (eds) Psychiatric Rehabilitation Programs Putting Theory into Practice. Baltimore, MD: The Johns Hopkins University Press.
11.
Christian, W.P., G.T. Hannah and T.J. Glahn (1984) Programming Effective Human Services. Strategies for Institutional Change and Client TransitionNew York : Plenum Press.
12.
Ciompi, L. and C. Muller (1976) Lebensweg und Alter der Schizophrenen. Berlin: Springer-Verlag.
13.
Corrigan, P.W., R.M. Davies-Farmer and H.B. Lome (1988) 'A Curriculum-Based Psycho-educational Program for the Mentally Ill', Psychosocial Rehabilitation Journal12: 71-3.
14.
Cowen, E.L. (1978) 'Some Problems in Community Program Evaluation Research', Journal of Consulting and Clinical Psychology46: 792-805.
15.
Cronbach, L.J. (1990) Essentials of Psychological Testing, 5th edn. New York: HarperCollins.
16.
Edelson, R.I. and G.L. Paul (1976) 'Some Problems in Use of "Attitude" and "Atmosphere" Scores as Indicators of Staff Effectiveness in Institutional Treatment', Journal of Nervous and Mental Disease162: 248-77.
17.
Endicott, J., R.L. Spitzer, J.L. Fleiss and J. Cohen (1976) 'The Global Assessment Scale', Archives of General Psychiatry33: 766-71.
18.
Farkas, M. D. and W. A. Anthony , eds (1989) Psychiatric Rehabilitation Programs. Putting Theory into Practice. Baltimore, MD: The Johns Hopkins University Press.
19.
Glick, I.D. (1990) 'Improving Treatment for Severely Mentally Ill: Implications of the Decade-Long Italian Psychiatric Reform', Psychiatry53: 316-23.
20.
Harding, C.M., G.W. Brooks, T. Ashikaga, J.S. Strauss and A. Breier (1987a) 'The Vermont Longitudinal Study of Persons with Severe Mental Illness. I. Methodology, Study Sample, and Overall Status 32 Years Later', American Journal of Psychiatry144: 718-26.
21.
Harding, C.M., G.W. Brooks, T. Ashikaga, J.S. Strauss and A. Breier (1987b) 'The Vermont Longitudinal Study of Persons with Severe Mental Illness. II. Long-term Outcome of Subjects Who Retrospectively Met DSM Criteria for Schizophrenia', American Journal of Psychiatry144: 727-35.
22.
Jones, M. (1952) Social Psychiatry: A Study of Therapeutic Communities . London: Tavistock. Kiesler, C.A. and A.E. Sibulkin (1987) Mental Hospitalization. Myths and Facts about a National Crisis. Newbury Park, CA: Sage.
23.
Kuehnel, T.G., R.P. Liberman, D. Sorzbach and G. Rose (1990) Resource Book for Psychiatric Rehabilitation. Elements of Service for the Mentally Ill, 2nd edn. Baltimore, MD: Williams & Wilkins.
24.
Lamb, H.R. (1982) Treating the Long-term Mentally Ill. Beyond DeinstitutionalizationSan Francisco, CA: Jossey-Bass .
25.
Liberman, R.P., W.J. DeRisi and K.T. Mueser (1989) Social Skills Training for Psychiatric Patients . Boston, MA: Allyn and Bacon.
26.
Ludwig, A.L. (1971) Treating the Treatment Failures. The Challenge of Chronic SchizophreniaNew York: Grune & Stratton.
27.
McGlashan, T.H. and J.O. Johannesen (1996) 'Early Detection and Intervention with Schizophrenia: Rationale', Schizophrenia Bulletin28: 201-22.
28.
Manning, N. (1989) The Therapeutic Community Movement: Charisma and Routinization. London: Routledge .
29.
Mendel, W.M. (1989) Treating Schizophrenia. San Francisco, CA: Jossey-Bass.
30.
Moos, R.H. (1974) Evaluating Treatment Environments. A Social Ecological Approach. New York: Wiley.
31.
Ojanen, M. (1984) 'The Sopimusvuori Society: An Integrated System of Rehabilitation', International Journal of Therapeutic Communities5: 193-207.
32.
Ojanen, M. (1988a) Skitsofrenisen pitkäaikaispotilaan kuntoutuminen: PSP-projektin seurantatulokset. (English Summary: Rehabilitation of Long-term Schizophrenic Patients: Follow-up Results. Helsinki: Reports of Psychiatria Fennica. Report No. 82.
33.
Ojanen, M. (1988b) Työ-ja hoitoilmapiiri pitkäaikaispotilaiden hoitoyksiköissä . (English Summary : Work and Treatment Climate at Treatment Units of Long-term Schizophrenic Patients.) Helsinki: Reports of Psychiatria Fennica. Report No. 83.
34.
Ojanen, M. (1989) 'Fighting Custodialism and Bureaucracy: Principles of the Sopimusvuori Community', Psychosocial Rehabilitation Journal13: 57-70.
35.
Ojanen, M. and H. Seppälä (1996) Assessment of Psychosocial Capabilities of Persons with Developmental Disabilities. Instructions for Presentation and InterpretationHelsinki: Finnish Association on Mental Retardation-FAMR Research Unit.
36.
Overall, J.E. and D.R. Gorham (1962) 'The Brief Psychiatric Rating Scale', Psychological Reports10: 799-812.
37.
Overall, J.E., B.W. Henry and J.R. Markett (1972) 'Validity of an Empirically Derived Phenomenological Typology', Journal of Psychiatric Research9: 87-99.
38.
Paul, G.L., ed. (1986) Assessment in Residential Treatment Settings. Principles and Methods to Support Cost-Effective Quality OperationsChampaign, IL: Research Press.
39.
Paul, G.L. (1987) The Staff-resident Interaction Chronograph. Observational Assessment Instrumentation for Service and ResearchChampaign, IL: Research Press.
40.
Paul, G.L. and R.J. Lentz (1977) Psychosocial Treatment of Chronic Mental Patients Milieu Versus Social-Learning Programs. Cambridge, MA: Harvard University Press.
41.
Paul, G.L. and A.A. Mendito (1992) 'Effectiveness of Inpatient Treatment Programs for Mentally Ill Adults in Public Psychiatric Facilities', Applied & Preventive Psychology1: 41-63.
42.
Paul, G.L., M.J. Mariotto and J.P. Redfield (1986) 'Assessment Purposes, Domains, and Utility for Decision Making', in G. L. Paul (ed.) Assessment in Residential Treatment Settings. Principles and Methods to Support Cost-Effective Quality Operations, pp. 1-25. Champaign, IL: Research Press.
43.
Spiegler, M.D. and H. Agigian (1977) The Community Training Center. An Educational-Behavioral-Social Systems Model for Rehabilitating Psychiatric PatientsNew York: Brunner/Mazel.
44.
Stein, L.I. and M.A. Test (1978) Alternatives to Mental Hospital Treatment. New York: Plenum Press.
45.
Szilagyi Jr, A.D. and M.J. Wallace Jr (1980) Organizational Behavior and Performance, 2nd edn. Santa Monica, CA: Goodyear.
46.
Tessler, R.C. and H.H. Goldman (1982) The Chronically Mentally Ill: Assessing Community Support Programs. Cambridge, MA: Ballinger/Harper & Row.
47.
Tsuang, M.T., R.F. Woolson and J.A. Fleming (1979) 'Long-term Outcome of Major Psychoses, I: Schizophrenia and Affective Disorders Compared with Psychiatrically Symptom-free Surgical Condition', Archives of General Psychiatry36: 1295-1301.
48.
Tuori, T. (1994) Skitsofrenian Hoito Kannattaa. (Treatment of Schizophrenia Is Effective) Sosiaali—ja terveysalan tutkimus—ja kehittamiskeskuksen raportteja 143. Helsinki: STAKES .
49.
Warner, R. (1985) Recovery from Schizophrenia. Psychiatry and Political Economy. London: Routledge & Kegan Paul.
50.
Wortman, P.M. (1983) 'Evaluation Research: A Methodological Perspective' , Annual Review of Psychology34: 223-60.
