Fairness During Group Games Treatment Facilities

 Fairness 

When playing group games in mental health and developmental disabilities treatment programs, the games are often improper or unfair. 

This is not as big an issue at the State Hospitals for adults, but it is more of an issue at day programs and private short-term care hospitals for adults. For children and adolescents, fairness is a vicious problem across the continuum of care.  

First off, staff should never be allowed to compete against or alongside service recipients, and staff vs. service recipient tournaments should be prohibited. It can be a safety issue when playing physical games, such as kickball, as a bad kick or throw from staff could cause injury to the service recipient. When staff participate in cognitive games, it can imbalance the ability level of each team due to cognitive deficits as a result of developmental disorders, mental illness, or the medications used to treat them.  

Staff should give everyone an equal opportunity to win. For instance, staff should not help one service recipient find a number on a bingo board and not provide the same assistance to others who ask for it. 

Teams should be divided equally by the number of players and ability levels, and never based on clinical criteria such as commitment status, diagnosis, or level of functioning. When this happens, it perpetuates stigma throughout the system of care that individuals with more severe diagnoses are not capable of winning a game, especially when medication impacts their participation. 

It is fitting that unfair games can contribute to resentment and deep-seated anger towards the entire field of psychiatry, which can cause other problems, such as high restraint and seclusion rates (for children, adolescents, and adults) and low treatment retention rates (especially for adults), among many problems that could potentially result from these feelings. 

First off, we need to assess the root cause of the problems associated with fairness. Then we have to fool around with solutions that might resolve the problems. After that, we need to create regulations that support those solutions.  

The State and the federal government need to design financial incentives for having fair games in treatment facilities. We need to research how unfair games impact the treatment of different types of service recipients.  A lot of service recipients will not make complaints about this because they think it is “too trivial” a complaint. Service recipients should have the right to fair games. It is just not therapeutic to have unfair games in the mental health and developmental disabilities treatment programs.

Please take a moment to comment to let me know what you were here and what you thought of my blog. 

Continuing Care Residential Facility

 I believe we need a non-institutional residential facility designed similarly to a continuing care retirement community with various levels of care that individuals may move through as their needs change; yet, continue to remain with the same treatment team, recommendations, diagnostic assessment, and a familiar environment for those with Autism and/or mental illness and challenging behavior. This type of facility should be run by a nonprofit provider agency or hospital network, not the State, to prevent it from becoming an “institution”. 

Levels of care at this type of facility should include: 

• Forensic Care Units: designed similarly to a therapeutic correctional facility for those with criminal charges
• Intensive Care Units: designed similarly to a forensic facility but with more of a focus on rapid tranquilization using antipsychotic medications and behavior modification, for those with extremely chronic, dangerous behaviors and who fail or get "kicked out" of less restrictive programs
• Inpatient and/or Dormitory Units: service recipients live in a large building with locked and unlocked units 
• Campus Residences: individuals live on a large piece of land in cottages or small dormitories 
• Supervised Apartments: service recipients live in individual apartments with 24-hour staff in a large disability-only apartment complex

This type of facility will increase continuity of care, as the same treatment providers will possibly follow service recipients throughout their time at the facility. It is intended for long-term, lifelong placement, and the individual will receive "Active Treatment." It should not be restricted to those with an IQ under 70, and higher-functioning and lower-functioning service recipients will be admitted to different sections of the facility to allow for appropriate treatment. 

Funding streams may come from the State developmental disabilities agency (possibly as an Intermediate Care Facility for Intellectual Disabilities [ICF/ID]), mental health agency (possibly through its own funds as Medicaid will not fund a psychiatric facility larger than 16 beds), Medicaid (possibly as an Intermediate Care Facility for Intellectual Disabilities [ICF/ID] or Skilled Nursing Facility [SNF]), and more. 

This will be ideal for those who do not succeed in group homes because of their behavior. However, we do not want to make this a prerequisite for admission to a continuing care facility like this. We do not want to wait until someone fails before considering them for a facility like this. 

When the individual receives treatment aimed at reducing challenging behaviors, their challenging behaviors may decrease, and they may move to a lower level of care within the facility. Yet, when there is a crisis or escalation of challenging behavior, they can easily move to a higher level of care without going to the hospital and without police intervention. 

This type of facility will also be ideal for those with primary mental illness (standalone or with a developmental disability) who are discharge resistant or who face significant barriers to discharge due to chronic higher-acuity behaviors, as an alternative to a State institution. Oftentimes, psychiatric hospitals and units only stabilize medications (not provide behavior modification). They only provide acute care, and these individuals have chronic behavioral problems. A facility like this could help supplement the care given in a psychiatric hospital or unit when a State Hospital is not appropriate, including for forensic service recipients. It is widely known that short-term psychiatric hospitalization only causes more disruptions in the lives of those with Autism or severe mental health challenges, and it is also known that short-term psychiatric hospitalization may reinforce the challenging behaviors that led to it. As of yet, there are no better alternatives. 

This type of continuing care facility is an alternative to resolve all these problems.