Outline of Issues in the Literature
Issues considered scandalous marked * ranging from perceived malpractices to neglect
I issues of social policy, the role of the state
A. locus of care
1.institution 2.community
responsibility for provision of care: 1.private/voluntary
or charity 2.state
C. responsibility to inspect, monitor, advise, license:
| all under state |
1.laymen including magistrates )
2.medical profession )
3.ad hoc agent or agency )
*D. legal regulation of process of confinement, preventing illegal or unnecessarily prolonged detention
11 issues of the manner of providing care A. management of the patient
1.custody and control
*a. use of restraint
i. mechanical (chains -19thC), tying, strait-jacket, locked wards, seclusion
ii. physical force: punching, kicking, whipping
sometimes resulting in death
iii. chemical: sedatives and tranquillisers iv. medically prescribed treatment: insulin shock(no longer used) ECT, neuro-surgery, electro-coagulation, brain implanted stim-oceivers.
*b. psychological techniques
i. induced fear: verbal threats, abuse, sarcasm, teasing
ii. constant surveillance iii. sanctions : withdrawal of luding meals, as example iv. classification: movement wards
2.Active treatment according to psychiatric ideologies a. somato-therapy
i. mechanical restraint (as above)
ii. chemotherapy by drugs (as above)
iii. medical treatments(l8th-19thC- emetics, purges, blistering of scalp, swinging, shock by water) 20thC- as l.a.iv above
*there may be irregularities in the prescribing, administering and recording of the use of the above
b. psycho- and sociotherapies
i. occupations to fill time, occupational and industrial therapy, domestic chores 19thC moral treatment for working class
ii. recreational and educational activities, rehabilitation, DT, PT, speech therapy, school, visits, dances, swimming, films 19thC moral treatment for middle class
iii. talk: one-to-one psychotherapy, psychoanalysis,
group therapeutic community, milieu therapy iv. assessment by clinical psychologist or OT, individualised progamme
*B. Standards of physical conditions
l. care of patients: standards of food, clothing, personal hygiene and health, sexual abuse and exploitation
2. environment: amenities, sanitation, overcrowding, cleanliness, furniture, decor, toys, personal possessions
3.staffing: a. staff/ patient ratio
b. nature of the nursing task
i, task-oriented
ii. patient-oriented
III issues of organisational management
A. fraud, corruption, irregularities with hospital or patient’s property, including money
B. administrative structure
1.leadership by medical superintendant or consultant
2.multi-disciplinary team
C. administrative structure of NHS
1.centralist/managerialist perspective
2.role of HFlCs, AHAs, RHAs/RHBs, central department
D. inspection and complaints procedures, advice
l.19th Century licensing, role of magistrates, Metropolitan Commissioners, Commission in Lunacy
2.20thC: HAS, Development Team, Nat’l Development Group CHCs, Health Service Commissioner, Davies Com.
IVissues which are a hidden agenda on official reports
the medicalisation of deviance: medical or ecological paradigm of causation/care B. social class differences in treatment of patients