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PubMed · 114875

Deciphering deinstitutionalization: complexities in policy and program analysis.

Abstract

Deinstitutionalization as a public policy promised to be a major departure from previous psychiatric practice. Decrying traditional "medical paradigms" and the custodial "warehousing" of mental patients, policy makers advanced a "bold new approach" for care in the community. Progressive humanitarian reform could go hand in hand with fiscal conservatism. Community Mental Health Centers were to be the heart of a new national effort. But the rhetoric of reform failed to coalesce the activities among competing federal and state interests and systems. Intended beneficiaries may have become unfortunate victims.

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S M Rose. 1979. Deciphering deinstitutionalization: complexities in policy and program analysis.. https://pubmed.ncbi.nlm.nih.gov/114875/

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["Case manager" in district psychiatry. A review of the concept].

During the past 20 years, the "case manager" has become a central expression in district psychiatry in USA. The case manager is a person who has the main responsibility for coordination and to a varying extent granting of the district psychiatric contributions to persons with prolonged psychoses. This function was introduced because the previous system with many administrative and physically separate offers appeared to be uncoordinated, mutually competitive and ineffective. The case manager acts as a supplementary "ego" for the patient on his own terms and has an active supportive function. Whereas, coordination was previously the central task, it became considered to an increasing extent more suitable that a multidisciplinary team of case managers supply the district psychiatric therapy themselves. Investigations reveal that the results are just as good or even better than those of the previous combination of hospitalization and outpatient treatment and that the patients are more satisfied. Many hospitalizations can be avoided but the employment of resources is probably not reduced on account of expenses for the case manager function and housing. The number of patients per case manager varies between four and 50, depending on the therapeutic needs of the patient group and, in particular, the tasks which the case manager must perform (all over the treatment or coordination of treatment administered by others). On account of the close contact by the case manager and his supportive activity, there are reasons for particular attention to ethical problems concerning personal choice and exchange of information. Utilization of the American experience with case managers is recommended simultaneously with avoidance of administrative practical splitting of district psychiatry which would make the total therapy ineffective.

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