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DISTRICT BRANCH NEWSLETTER - VOL.3 NO.4 DECEMBER1963

Arthur P. Burdon, M.D., Editor 3720 Prytania St., New Orleans, La. 70115 William A. McBride, M.D., Associate Editor

COMMUNITY PSYCHIATRY? The LPA is currently concerned with

its role in State planning for community mental health. The problems that this effort is directed toward resolving are well known to all of us. The following notes taken from a discussion by Dr. Gerald Caplan of the Harvard School of Public Health on community psychiatry are germane to this issue. Dr. Caplan spoke at an NIMH sponsored Training Institute in Community Mental Health.

Dr. Caplan outlined, in evolutionary format, the complex role of the commun-ity psychiatrist. (In this case a psychia-trist in a college community. His re-marks, however, are applicable to any well defined community or segment thereof.)

The pyschiatrist upon entering the community initially sees indivduals for diagnosis and treatment. As his experi-ence continues he begins to shift some of his effort toward a delineation of the social forces and environmental pres-sures contributing to the production of mental disorder among the individuals in the community, his goal being to at-tempt a modification or modulation of these forces and pressures for both therapeutic and preventive purposes. He soon seeks to identify other disturbed people in the community who don't come to his attention; that is, rather than wait-ing for the individual to find him he sets about finding the individual. He soon is consulting with and enducating adminis-trators and other key personnel relative to the intra-community forces contribut-ing to the mental disturbance within it. As regards the power structure in his relationships, there is a gamut ranging from superior in individual relationships to equal when he functions as a consult-ant to other professionals to less power as a member of a medical unit under the direction of a physician other than him-self.

He inevitably concludes that his com-munity responsibilities cannot be dis-charged in toto within the one to one

doctor-patient relationship model. Nor can they be discharged by using a wait-ing list, referring patients to other treat-ment resources (since they probably have waiting lists of their own) or re-commending the discharge of the suffer-rs from the community. He is faced with a dilemma requiring

for its resolution his partially or com-pletely changing his operational model or image of himself.

Now, in effect, numbers must become more important to him than individuals and he must make use of epidemiology and biostatistics as well as that other knowledge which he brought into his job. His practice now is a public health practice encompassing such efforts as preventive psychiatry, community or-ganization and program planning, and mental health consultation. Of course, depending on his own inclinations, he may also continue to practice within the framework of the one-to-one or one to small group model.

The analogy between this very brief description of a community psychiat-rist's evolution and our own current situation I think is obvious. We are now in fact faced with the realization that our responsibilities as psychiatrists, if we conceive of them as having commu-nity-wide scope, are not being completely discharged nor can they be by continu-•ing to use just the one-to-one or one to small group model.

There are important implications in Dr. Caplan's remarks relative to the current planning in mental health for the State and the LPA'S role in this program.

It is obvious that enlarging existing facilities, building new ones, increasing services, training more personnel, et al., offers no guarantee that in a short time there will not be that many more waiting lists. Such efforts although offering tran-sient relief will not only aggravate and intensify the problems that have already arisen out of this system. Changing the

(Continued on page 3)

J C

MARVIN MIlLER, M.D.

Mary is a transplanted Yankee, hav- ing been born and raised in Illinois. His wife, Shiffy, (director of a local nursery school and children maintain a small community on Coliseum Street in New Orleans. He received his undergraduate training at the Universities of Chicago and Illinois and his M.D. from the State University of Iowa in 1949. Followtng his internship in San Francisco and residency training in the United States Public Health Service in Lexington, Ky. he spent a year in Europe as the psychia- tric consultant to the Bureau of Foreign Quarantine. In 1955 he was transferred

(Continued on page 4)

LPA ANNUAL Mm.wLNTER MEETING

JANUARY 17, 18, AND 19, 1964 LAKESHORE MOTEL,

BATON ROUGE REGISTRATION

COUPLES SEND $25.00 TO HENRY OL1VIER,

ARR. CHAIRMAN, 3888 GOVERNMENT STREET,

BATON ROUGE

Page Two LOUISIANA PSYCHIATRIC ASSOCIATION December, 1963

LOUISIANA PSYCHIATRIC ASSOCIATION EXECUTIVE COUNCIL HAROLD I. LIEF, M.D., President

New Orleans ALVIN COHEN, M.D., President-Elect

New Orleans W. SIDNEY EASTrERLING, M.D., Vice-

President, Pineville HENRY R. OLIVIER, M.D., Vice-President

Baton Rouge VANN SPRUIELL, M.D., Secretary

New Orleans KENNETH A. RITTER, M.D., Treasurer

New Orleans ARTHUR P. BURDON, M.D., Newsletter

Editor, New Orleans GENE L. USDIN, M.D., Past President

New Orleans

COORDINATING CHAIRMAN MARVIN F. MILLER, M.D., New Orleans EDWARD C. NORMAN, M.D., New Orleans CHARLES A. FEIGLEY, M.D., Baton Rouge

MINUTES OF THE MEETING AD HOC COMMITTEE ON MENTAL

HEALTH PLANNING

Present: Doctors Caruso, Easterling, Feigley, Gonzalez, Harris, Knight, Nor-man, Torre, Wiedorn, Weisler.

Absent: Doctors Sugar, Super, Vail. Communications: From the recent

open L.P.A. meeting, the Committee was informed of a desire for recommenda-tions relative to the existing framework in the State, as well as long range ideas. A suggestion was made that Ken Ritter contact the State Attorney General to clarify the confidentiality of records. (A true copy of the reply is appended, Ap-pendage No. 1).

Old Business: There was a brief re-discussion of the last meeting, with em-phasis on the need for a strictly medical nature of the public cilnics.

New Business: Ed Norman emphasized that old child guidance approach is now outmoded and stressed the idea of a psychiatrist being a pure consultant, per-haps teacher, to the various ancillary mental health personnel. This would en-counpass consultations with nurses, so-cial workers attendants, aides, pastor-al counselors. Sid Easterling told of a similar plan in effect in his area. Patients from geographical areas are kept in the hospital, with social workers and psy-chiatrists continuing contact post dis-charge and coodinating various agency efforts. He also stressed the psychia-trist as a coordinator-consultant with pncillary mental health personnel. Erle Harris stressed our need to pay atten-tion to the ill patient per se, whi.le Mot-tram Torre favored 'Community Psy-chiatry,' a prophylactic and preventive approach.

Ed Knight advocated more time being

spent with teachers, ministers and the Courts. He also wanted to clarify the role of the Treatment Center Psychiatrist and raised the question of whether the budget of the Center should be focused on preventive and educative services or on direct service to the patient per Se. Bill Wiedorn and Erie Harris re-empha-sized the patient-oriented approach and to gether with Easterling commented on needless hospitailization of patients. They and George Caruso pointed out that many of the 'Community Psychiatry' philosophies are a function of any good physician; the latter assumes these res-ponsibilities routinely.

It was generally agreed that these positions should be discussed further in the L.P.A. Newsletter. Mottram Torre agreed to take the side of Community Psychiatry, as it were, and to discuss how much time, energy and money should be directed by a public facility (perhaps also the efforts of the prrivate practitioner) towards prophylaxis, pre-vention of mental illness. John Gonzalez agreed to discuss the needs of the sick person and how therapy per se could be improved upon.

Comment: This meeting has further extended our efforts in clarifying our ideas re prevention versus treatment-which should be emphasized most?—the role of the psychiatrist and our inter-related activities with agencies, ancillary personnel?

The Chairman wishes to re-state that many of the Community Psychiatry ideas —working with teachers, being consult-ants to the courts and agencies, lecturing before interested groups—should be on a checklist of yearly activities for all of us. It also has occurred to me that it is not inconceivable that the State might take over Public Mental Health, Preven-tive 'Community Psychiatry' and all that is entails, as a full time activity. The other thought is that treatment could conceivably be entirely in the pro-vince of the physician. Both are tradi-

(continued on page 4)

NEWS FROM THE STATE DEPARTMENT

OF HOSPITALS Dr. William C. Thompson has been ap-

pointed psychiatrist for the state mental health program in Baton Rouge. He confers a minimum of one day per week with the state hospital director, mental health personnel in the state office and local units of the mental health program. The department feels it is fortunate in having the services of a person with Dr. Thompson's background which in-cludes general psychiatry, child psychia-try, psychoanalysis and extensive con-sultation experience in public clinics and hospitals and in private practice.

Organization of the 9 mental regions into 3 mental health districts has been effected. There is a northern, southwest and southeast district, each containing 3 mental health regions and a state mental hospital. A qualified psychiatrist will be in charge of each of these districts and all mental health activities will be under his immediate directon. He will supervise the mental hospital, the region. ai mental center and various other phases of the mental health program. Dr. Arthur L. Seale has been named Director of the northern district and Dr. Paul Pratt, Director of the southeast district. A Director for the southwest district has not been named but Dr. 'rank Silva serves as part-time consult-

ant. Districting the state in this manner

will greatly enhance administration of local mental health services. It is inef-fective to try to administer programs from Baton Rouge on a state wide basis. The state office will work almost entire-ly with the district directors who will have full responsibility for mental health services and programs at the regional and local level.

Reorganization of the state office fiscal units has been accomplished resulting

(Continued on page 4)

DE PAUL HOSPITAL est. 1861

New Orleans, Louisiana by the

DAUGHTERS OF CHARITY OF ST. VINCENT de PAUL Extends All Good Wishes for

A Happy Christmas and a Blessed New Year Sister Mary Alice McCarthy, FACHA

Administrator

December, 1963 LOUISIANA PSYCHIATRIC ASSOCIATION Page Three

MID-WINTER MEETING IN BATON ROUGE Friday, January 17, 1964 7:30 - 9 P.M. Banquet (Members

5 - 7 P.M. E a r 1 y Registration - and wives) Lakeshore Motel, Baton Rouge 9 P.M. Dance

"COMMUNITY PSYCHIATRY?" (Continued from page 1)

location of treatment from the hospital to the mental health center in the pa-tient's home community does not imply the practice of community psychiatry. Moving one's office from a medical office building to a community clinic building does not mean that one is now a com-munity psychiatrist. Nor does the State's supporting such efforts mean that its obligations relative to community mental health planning and its implementation are being met.

An approach using different conceptual models is needed, rather than one that attempts to answer all questions and resolve all problems extant by squeezing them into the limited and limiting one to one model.

It is the indivdual psychiatrist's res-ponsibility to acknowledge his areasof expertness. It is an important if not more so that he define the limits to which this can be stretched.

Beyond this point the models and ex-perience of others in the subspecialty of community or public health psychiatry must be sought and used. The same can be said, of course, for other professionals now participating in State planning whose operational models are likewise limited and limiting.

The LPA's responsibility to the com-munity of Louisiana lies in this area at this time.

MARVIN MILLER, M.D.

ANNOUNCEMENT: Daniel Blain, President-Elect of the A.P.A., will deliver the Annual Leo S. Well Lecture of Touro Infirmary at 8 P.M. on January 13, 1964 in the new Auditorium of Tulane Medical School, 1430 Tulane Avenue. New Orleans. Dr. Blain will speak on "The New Look in American Psychiatry." All LPA members and their wives are In. vited.

7 - 8:30 P.M. Dutch Treat Cocktail Party 8:30 P.M. Members and wives plan own Dinner Parties with the assist-ance of the Baton Rouge members.

Saturday, January 18, 1964 9 A.M. - 5 P.M. Registration continues 8:30 A.M. - 9:30 A.M. Council Breakfast with Dr. Robert Garber, Speaker of the Assembly of District Branches of A.P.A., Medical Director of The Carrier Clinic, Belle Meade, New Jersey. 10 A.M. - 12 A.M. Address to LPA by Dr. Garber 'The Workings of the American Psychiatric Association" (Wives and Guests are invited)

12-1:30 P.M. All L.P.A. Committee meetings at luncheon. Note that each committee member of the LPA is expected to meet with his committee chairman for a luncheon and busi-ness meeting. Reports of these com-mittee meeting will be in the after-noon business meeting. (Closed Meet-ings). 12 - 3 P.M. For the Ladies—Luncheon and Style Show. 2 P.M. Opening of the Mid.Winter Meeting, by Harold Lief, presiding. Addresses and Business Meeting.

3:30 P.M. Panel on Psychological Aspects of Fees in Psychotherapy, Moderator, Dr. Alvin Cohen

Dr. Ed. Knight Dr. Bill McBride Dr. Ron McNlchol Dr. Charles Feigley

(Restricted to Members only.) 6:30 to 7:30 P.M. Courtesy Cocktail Party, Lakeshore Motel

Sunday, January 19, 1964 9:30 A.M. Breakfast (Members and Wives) Windup Session

Please register in advance by sending $25.00 to Henry Oliver now. This is needed to make necessary deposits on expenditures. You will get a bargain for your money; the Banquet for yourself and wife, plus the Dance, plus the Break-fast Sunday Morning. The Baton Rouge membership of L.P.A. also hopes to ar-range a Tour of the new Governor Man. sion.

Henry Olivier, M.D., Chairman Arrangement Committee

3888 Government St., Baton Rouge

Iiw Jl4!tItS Promotion: Dr. Thomas E. Fulmer,

formerly a Staff Psychiatrist, has been appointed Clinical Director at the South-east Louisiana Hospital at Mandeville.

* * * * * Alvin Cohen participated in a panel

discussion on "The Maladjusted Child" at the Louisiana Teachers' Association meeting in Baton Rouge on November 26, 1963. Al also spoke before "Parents Without Partners" at the YMCA in New Orleans last month.

* * * * * Participating in the program of the

Southern Medical Association meeting in New Orleans last month were: Homer D. Kirgis, Chairman of the Section on N. and P. and author of a paper on "Prob-lems Encountered in the Investigation and Treatment of Compensation Patients with the Lumbar Disc Syndrome"; Gene Usdin, speaker on "Psychiatric Evalua-tion of Criminal Responsibility"; Arthur Burdon, on "Emotionally Disturbed School-failing Boys Treated in an Out-patient Clinic School"; and Max Sugar, on "Relationship Processes in the use of Drugs." A panel discussion of "Psy-chiatric Problems in General Practice" was moderated by Ted Watters and featured Lucio Gatto, Francis I. Nicolle, and Lawrence J. O'Neil.

* * * * * Bill Wie'dorn spoke before the La.

Group Psychotherapy Association meet-ing in December, his topic was 'Psycho-therapy of The Core Problem in Schizo-phrenic Families."

(Continued on page 4)

DEVEREUX SCHOOLS A private non-profit, nonsectarian residential treatment and educational

center. For boys and girls with potentially average and superior intelligence, needing remedial tutoring, psychotherapy and an individualized educational program.

For children and young adults who are slow jelarners, with or without neurological impairment or physical handicaps. Students are grouped homo-genously according to age and abilities in specialized programs including vocational rehabilitation.

For information write: MR. RICHARD D. GRANT, Registrar The Devereux School of Texas P. 0. Box 2269, Victoria, Texas

I I 7-A NS Visit the NEWSLETTER Desk at the LPA meeting in Baton Rouge, (1) to check on your correct mailing address, (2) to suggest others in your town to whom the NEWSLETTER should be sent, (3) to furnish stirring prose or terse verse for publication, (4) to gripe at and criticise your Editors, and (5) to visit and meet our wives.

We most cordially invite all of you to be there. Until Friday night January 17th, we want to wish you and yours a most pleasant and refreshing Chritmas season and a most happy and success-ful New Year.

OPAL AND BILL Mc BRIDE

J.o JANE AND ARTHUR BURDON

Page Four LOUISIANA PSYCHIATRIC ASSOCIATION December, 1963

MINUTES OF THE MEETING (Continued from page 2)

tional viewpoints, and it may be well to re-emphasize them.

Respectfully submitted,

CHARLES A. FEIGLEY, M.D. Chairman, Ad Hoc Committee on Mental Health Planning

* * * * *

APPENDAGE No. I CONFIDENTIALITY OF RECORDS While the medical records of state

institutions are quasi public records, they are exempt from the normal perusals of public records by virtue of R.S. 44:7 which we quote, to wit:

"S7. Hospital records "The charts, records, reports, docu-ments and other memoranda pre-pared by physicians, surgeons, psy-chiatrist, nurses and employees in the public hospitals of Louisiana to record or indicate the past or present condition, sickness or disease, phy-sical or mental, of the patients treated in the hospitals are exempted from the provisions of this Chapter, except when the condition of the patient is due to an accident, poison-ing, negligence or presumable negli-gence resulting in any injury, assault or any act of violence or a violation of the law. *The governing board or commission of each public hospital administered by such a body, or the chief medical, surgical or psychiatric officer or similar body of administrators, may be exhibited by copies by or for per-sons legitimately and properly inter-ested in the disease, physical or men-tal or in the condition of patients.* Previously interpreting this section is

an opinion of this office rendered on June 29, 1941 (Opinions Atty. Gen. 1940-42, page 3239), which indicated:

"In view of the above provisions of law, it is the opinion of this Depart-ment that you should secure the pre-mission of the nearest relative or re-latives shown in the commitment proceedings affecting the patient in the hospital, or his or her legal representative, before furnishing any information to other persons, official or otherwise, as to such patient or inmate, except when the condition of the patient is due to an accident, any injury, assault or any act of vio-lence or a violation of the law, as above provided."

Information Provided by WELDON A. COUSINS, Assistant Attorney General

BIOGRAPHICAL SKETCh (Continued from page 1)

to the Public Health Service Hospital in New Orleans where for 2 years he was Chief of the Psychiatric Service.

In 1957 he accepted an invitation to join the faculty at the Louisiana State Uni-versity Medical School and currently is Associate Professor in the Department of Psychiatry and Neurology in charge of the undergraduate program.

A Diplomate of the American Board in Psychiatry since 1956, Marvin is a Fel-low of the A.P.A., and a member of the Southern Psychiatric and the American Ontoanalytic Association. He serves as a consultant to the Traveller's Aid Socie-ty, the Social Service Department of Charity Hospital, and the Bureau of Employees' Compensation, with which agency he is engaged in a study of Fe-deral employees injured on the job. Marvin is also involved actively in a long term clinical research project at Carville studying the psychological aspects of Hansen's disease. His studies of prob-lems of body image using photography continue at L.S.U.

Marvin is very active with our LPA Executive Council, and is deeply com-mitted to service for the welfare of the community. He is on the Executive Boards of the Social Welfare Planning Council of New Orleans and the Com-mittee on Alcoholism of Greater New Or-lean. A member of the Budget Commit-tee of the United Fund, he is also on the Adolescent Study Committee of the Jewish Welfare Federation, and a mem-ber of the La. Civil Liberties Union.

Mary loves music—classical and cool —and plays golf every chance he gets.

THE EDITOR

NEWS FROM THE STATE DEPARTMENT OF HOSPITALS

(Continued from page 2) in a new position, Chief of Administra-tive Services, which replace the old fis-cal officer's job. Mr. Robert L. Allen, former assistant to Dr. Arthur Scale, is the new Chief of Administrative Services. His background as a professional admin-istrator made it possible to reorganize budget preparations, accounting proce-dures, and reporting expenditures. The department now knows at any time what funds have been allotted to each item of the budget, amount spent during the month, amount spent to date, amount encumbered, amount of free balance and where each budget will stand at the end of the fiscal year. This has ,greatly en-hanced the operation of mental health programs and the handling of several mental health budgets.

WINBORN DAVIS Acting Director

NEWS ITEMS Genesis: Volume 1, Number 1 of "The Louisiana Quarterly Journal on Alcohol-Ism," a publication of the State Dept. of Hospitals and the La. Commission on Alcoholism, was distributed in Novem-ber. It featured an article by Don Gallant and B. Story entitled, "The Therapeutic Value of Patient Government on an Al-coholism Treatment Service."

Along with Curtis Steele and their asso-ciates at Jackson, Don has published a paper on "A Controlled Evalution of Trifloperidol: A New Potent Psycho-pharmacologic Agent," Curr. Ther. Res., September 1963.

Marvin Miller, on "Problems of Early Teen-age," and Malcolm Latour, on "Problems of Middle-age," spoke recent-ly at the Unitarian Fellowship Church in New Orleans.