The Casebook of a Residential Care Psychiatrist

Jul 01, 2007

The Casebook of a Residential Care Psychiatrist is knowledgeable, humorous, compassionate, and historical, with a strong plea that the mental health community become more involved in the rehabilitation of patients in RCFs.

The Haworth Clinical Practice Press, 2005
446 pages, $69.95 (hardcover)

Author: Martin Fleishman

Dr Fleishman, the American Psychiatric Association's winner of the 2001 Arnold L. van Ameringen Award in Psychiatric Rehabilitation, generously shares his wisdom and insights on treating serious mental illness in this wonderful book, which covers more than 40 years' experience in residential care facilities (RCFs). The book is knowledgeable, humorous, compassionate, and historical, with a strong plea that the mental health community become more involved in the rehabilitation of patients in RCFs.

The book provides a historical focus in the chapter "Life in the Prechlorpromazine Era of Nongeological Time," which graphically describes many of the conditions in state hospitals during the 1950s. Dr Fleishman received a PhD in psychology and his interest in treating the seriously mentally ill led him to a position at Napa State Hospital in California. He was so impressed with the effectiveness of the drugs introduced in 1953 that he decided to attend medical school. After graduating, he accepted a residency at Agnew State Hospital in California to continue treating serious mental illness. When state hospitals began to close in the late 1960s and early 1970s, he followed his patients to RCFs in San Francisco.

The book addresses the need for more RCFs and describes how to support and treat their vulnerable population. There has never been more lucid, comprehensive, and clinically compelling text on how to provide psychiatric treatment in RCFs. In Chapter 8, "How It Should Be Done: Space, Time, and Techniques," Dr Fleishman offers the "Ten Commandments of Residential Care Psychiatry," with witty vignettes and practical and useful advice. Chapter 19, "How To Fail in Psychology Without Even Trying," is hilarious-perhaps one of the funniest sequences that has ever appeared in a psychiatric text.

The book estimates that there are close to 160,000 patients with mental illnesses living in RCFs in the United States. There is little information, training, or encouragement for psychiatrists to make visits to RCFs, which is the primary goal of this informative, thoughtful gem of a book. It is a "how-to" on working with primary care physicians, social workers, case managers, pharmacists, and most important, administrators and staff of RCFs. One might call Dr Fleishman a "house call physician," but, instead of seeing one patient he sees many in each visit. He often states what we all know to be true: "Seeing a patient in their home gives a much better understanding of their functioning and their treatment needs."

The severity of the residents' illnesses, the book readily admits, is often a challenge, but the rewards include appreciative patients and staff, which far outweigh the challenges.

Dr Fleishman clearly shows in this book why the American Psychiatric Association chose to recognize his leadership and commitment to the care and rehabilitation of our most vulnerable population. The book succeeds as an excellent resource in reaching out to these patients and reveals Dr Fleishman's joy and personal satisfaction in his work. I hope that this book will be a model for other psychiatrists now and in the future.

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