Families for Psychotics

Most mental health specialists think that there is no alternative to hospitalizing psychotics and other mentally disturbed patients whose actions endanger others--and often themselves. Honolulu Psychologist Patrick DeLeon takes an entirely different view. "The worst thing you can do to a patient," he says, "is admit him to a hospital." Instead, DeLeon has a theory which advocates placing small groups of chronic mental patients in "family living units" in which they live as brothers and sisters in rented private apartments, hold jobs if they can, and solve day-to-day problems with almost no outside guidance.

Last week, at a convention of the American Psychological Association in Honolulu, DeLeon described his own experiment with five "families" that consisted of some of the "worst" patients* he and his colleagues had encountered at Hawaii State Hospital and other institutions. Most of them had been hospitalized from one to eleven times and seemed in need of recommitment when DeLeon suggested to them that they might prefer a house to a hospital.

The patients were given food for the first weekend, but no support beyond that. They were told that money to pay living expenses would have to come from welfare, savings accounts and any jobs that they managed to find and hold. They got no advice except the admonition that "families should solve their own problems." For the first month, hospital staffers usually visited them twice a week; then the visits dropped to about one a week and finally to one a month.

At first, real and fantasied crises led the "brothers and sisters" to make frantic telephone calls to the hospital therapists. In one instance, when they asked what to do about a family member who was running around the house waving a knife, they were simply advised: "Do whatever you think right. Call the cops if necessary." Says DeLeon: "No one ever got hurt. Once a guy got drunk and busted up the whole house. The police picked him up, let him out the next day, and he went back and repaired the house." Eventually, each group took to solving most of its own difficulties. They held family councils and adopted a policy of talking things out with each other before crises could erupt.

After a year, only one family member had been rehospitalized, and then only for a few days on two occasions. The rest stayed out of real trouble, and some even gained so much confidence that they moved into apartments of their own. One woman, proud of her new stability, recently wrote DeLeon, "I just got an A in a religion course at the community college. Next semester I'm taking two courses."

The theory behind the idea for the experiment, which was originally proposed not by a professional but by a hospital aide, is that chronic mental patients are dependent personalities who do not have much motivation to change their behavior as long as they have other people to look after them. DeLeon's goal was not to cure their dependence but to transfer it to the family group. "Once you switch your attitude toward these people and assume they are in control of themselves," he says, "they no longer go out of control."

*Included in the group were an alcoholic drug addict, a suicidal male homosexual and psychotics of several types.

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