Fred J. Frese III (1940-2018).

Fred J. Frese III, called a "national treasure" by Mike Hogan, Chair of the President's New Freedom Commission on Mental Health, died July 16, 2018, at his home in Hudson, Ohio, surrounded by his family. Fred was an extraordinary human being who was diagnosed with paranoid schizophrenia and rose to become an influential and accomplished psychologist who inspired all he met.

Families and schizophrenia: the view from advocacy.

Historically, families of persons who have schizophrenia often were blamed for the development of the condition and subsequently might have been excluded from care. Now these notions, which never had much systematic empiric support, have been abandoned. Family involvement often is critical to the recovery process and must be engaged actively whenever possible.

Future involvement of siblings in the lives of persons with mental illness.

Siblings are considered logical replacements for aging parental caregivers of persons with severe mental illness. For workshops on future planning conducted with 400 elderly parents, 60 siblings answered a survey regarding their future caregiving expectations, anticipated difficulties, and need for help. Nearly all expected to be involved, but were more likely to provide social and emotional support than the instrumental support offered by their parents.

Evidence-based practices for services to families of people with psychiatric disabilities.

Family psychoeducation is an evidence-based practice that has been shown to reduce relapse rates and facilitate recovery of persons who have mental illness. A core set of characteristics of effective family psychoeducation programs has been developed, including the provision of emotional support, education, resources during periods of crisis, and problem-solving skills. Unfortunately, the use of family psychoeducation in routine practice has been limited.

Psychologists, psychiatrists, and psychosis: will turf battles trump treatment?

The roles of psychology and psychiatry are rapidly changing with respect to people with serious mental illness. The development of these roles will seriously impact the quality of care available for this vulnerable population.

What does "community" mean for persons with mental illness?

We need to develop living arrangements for persons with severe mental illness that are durable and available as long as needed and that provide a sense of community.

Helping parental caregivers and mental health consumers cope with parental aging and loss.

As persons with severe and persistent mental illness age, large numbers continue to live with their elderly parents or receive substantial social and economic support from them. Prospective studies suggest that when caregivers die, individuals with mental illness experience housing disruptions and potentially traumatic transitions. This paper describes the scope of the problem and addresses pragmatic and psychological issues involved in preparing both caregivers and patients for parental aging and eventual loss.

Families, culture, and mental illness: constructing new realities.

In Modern Western cultures, conceptual models of mental illness are interwoven with value systems of individualism, agency, internal locus of control, and fear of dependency. These values have translated into psychological theory and practice, affected families' relationships with the professional, legal, and consumer communities and have often exacerbated family burden. Culturally patterned attributions of individual accountability also affect family-patient interactions and may have an effect on relapse and prognosis.

Training professionals for rehabilitation teams.

Transformed treatment philosophies, egalitarian roles, crossover competencies, and engagement of consumers and families are essentials in training.

The family experience in cultural context: implications for further research and practice.

Cross-cultural studies of families' experience of mental illness are discussed, in terms of uniformities in and differences between belief systems and values, caregiving norms, perceived burden and distress, and expectations, with suggestions for further research and applications to practice.

The consumer recovery vision: will it alleviate family burden?

Research on families of people with severe mental illness has identified significant caregiving burden. Although professional interventions generally assume that families have a major role in the client's progress, the focus of the consumer movement on recovery through empowerment, peer supports, and consumer-run services may have important, as yet unquantified, effects. Keeping in mind the functional heterogeneity of individuals with mental illness, it is suggested that consumer emphasis on autonomy may provide the major relief for family burden.

A module for training residents in public mental health systems and community resources.

The authors describe a six-month training module in public psychiatry developed in 1991 at the University of Miami Medical School. The module is centered on weekly intensive site visits to a range of community and advocacy programs, including the state hospital, services targeted to different groups at various community mental health centers, substance abuse treatment programs, forensic sites, rehabilitation centers, and family and consumer groups. Preliminary evaluation results indicate that residents gain a better understanding of community services and of system linkages and barriers and appear to develop a more positive prognostic attitude.

Age and family burden among parents of offspring with severe mental illness.

Family burden reported by parents of offspring with severe mental illness was examined to determine whether burden increases with age. Older parents were troubled by cognitive dimensions of burden, while younger parents were distressed by their offspring's behavior, suggesting that interventions should vary according to parents' age as well as developmental stage of their child's illness.

Cultural beliefs about rape and victims' response in three ethnic groups.

Cultural definitions of rape were assessed among 101 African-American, Hispanic, and non-Hispanic white female rape victims and 89 nonvictims matched for ethnicity, age, marital status, and socioeconomic status. Hispanics scored highest and whites lowest both in perceived community victim-blaming and in victims' psychological distress. Social and treatment implications are discussed.

Potential risk factors for rape in three ethnic groups.

This article describes the frequency of possible risk factors that emerged during a cross-cultural study of psychosocial response to sexual assault among African-American, Hispanic, and non-Hispanic white women presenting for treatment at a major urban rape treatment center. Of 881 victims screened, 51% had no observable risk factors while 49% fell into categories of variables that previous research has associated with increased vulnerability. Included were mental disability (psychiatric or developmental), a prior history of rape or incest, tourist or visitor status (site unfamiliarity), and homelessness.

Expressed emotion: conceptual, clinical, and social policy issues.

Research on schizophrenia has suggested an association between relapse of patients and high expressed emotion (EE), defined as criticism, hostility, or emotional overinvolvement of at least one family member. In international studies, however, the majority of families of persons with schizophrenia demonstrate low expressed emotion. These families are described as empathic, calm, and respectful by EE researchers, who also reject the idea of family schizophrenogenesis.

Public-academic linkages for culturally sensitive community mental health.

This paper traces the sixteen year history of a unique community mental health center which has combined academic and service provider roles in delivery of culturally appropriate care. Initially an arm of a department of psychiatry and derived from an anthropological research project, the center model was based on seven teams serving discrete ethnic communities, with subsequent development of a network of neighborhood-based "mini-clinics" as well as centralized aftercare facilities. The team staff-social scientists, clinicians, and paraprofessionals all of matching ethnicity to the populations served-became a core of "culture brokers" with a service, teaching, and research role at the interface of the university, medical center, and community.

Culture and chronic mental illness.

The relationship of culture to chronic mental illness is reviewed in a cross-national and cross-ethnic perspective. The author critically examines the argument, based on differential prognosis for serious mental illness in developing and industrial countries, that chronicity is a cultural artifact. Key questions include whether cultural beliefs and practices that minimize social stigma, self-devaluation, and patients' assumption of the sick role are linked to better prognosis.

A basic residency curriculum concerning the chronically mentally ill.

In this paper a group of knowledgeable individuals with expertise in psychiatric education present their recommendations for a basic psychiatric residency curriculum concerning the chronically mentally ill. The proposed curriculum consists of knowledge, skill, and attitude educational objectives, as well as clinical experiences, faculty supervision, didactics and seminars, and evaluation mechanisms. Recommendations are also made concerning changes in the Accreditation Council for Graduate Medical Education's Special Requirements for Residency Training in Psychiatry, which would require residency programs to place more emphasis on training to meet the needs of the chronically mentally ill.