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PubMed1994

Community psychiatry and deinstitutionalization in Jamaica.

Between 1960 and 1990, the population of Jamaica's single mental hospital was reduced by 58 percent, from more than 3,000 to less than 1,300. Services were reoriented from mental-hospital-based custodial care to rehabilitative, community-based care with no appreciable increase in the mental health budget. Despite several changes in government over the past 30 years, continuity of public policy and fiscal support has allowed ongoing development of the island's community mental health services. The national community mental health service, which had a case-load of about 14,000 patients in 1990, relies on specially trained psychiatric nurse practitioners who provide crisis management, medication management, and supportive psychotherapy; make home visits; and carry out treatment plans developed by the community psychiatrist. Community acceptance of mentally ill persons has been enhanced by public education programs and media coverage of advances in treatment.

Community Mental Health Services↗
PubMed1995

Deinstitutionalization.

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Community Mental Health Services↗
PubMed1995

Testing the limits of deinstitutionalization.

OBJECTIVE: From 1978 to 1993, under favorable administrative and political conditions and protected by a court-ordered consent decree, a comprehensive community-based mental health system was established in western Massachusetts that entirely replaced Northampton State Hospital. This paper examines that experience to describe the characteristics and comparative department of mental health expenditures on alternative treatment settings and to explore whether the need for state hospitals can be eliminated. METHODS: Data on distribution and department of mental health funding of services in western Massachusetts were compared with similar data from the rest of the state, where state hospital utilization remained relatively high. RESULTS: Between 1978 and 1992, department of mental health expenditures on noninpatient community services in western Massachusetts increased from 15 percent to 74 percent of total expenditures on adult mental health services. In 1992 per capita expenditures on such services in western Massachusetts and the rest of the state were similar. However, per capita expenditures for inpatient services constituted 27 percent of total expenditures in western Massachusetts, compared with 53 percent in the rest of the state. Western Massachusetts spent approximately twice as much per capita on residential and emergency services and one and a half times as much on case management services and support. Very few Northampton patients were transferred to nursing homes, and the inpatient census per 100,000 population supported by the department of mental health in western Massachusetts was one-third of that in the rest of the state. CONCLUSION: Under certain conditions, the role and functions of state hospitals can be completely replaced by a system of comprehensive community services.

Adult↗
PubMed1989

Ironies of inclusion: social class and deinstitutionalization.

This paper discusses changes in the social organization of mental institutionalization as they relate to developments in the wider social and economic environment. Despite dramatic changes in the system of inpatient psychiatric care during the last three decades, the historic division of labor between the private and the public system (with the latter treating the poor, the unemployed, and the nonwhite) has not ceased to exist. At the same time, under the influence of the postwar trend towards greater political integration of disadvantaged and marginal groups into society's central value systems, treatment of the mentally ill has become less segregated and more voluntary. An important implication of these two interacting trends--the changed legal position of the patient vis-à-vis the provider and the deteriorating economic position of the user of public psychiatric facilities--has been the exceeding irrelevance of one of the basic tenets of psychiatric care: that clinical treatment precedes social functioning. With two vignettes of chronic patients the article illustrates how symptoms and survival are fused in the contemporary, inclusionary system of care.

Adult↗
PubMed1985

A systems design developmental model for programs of deinstitutionalization: marketing base for follow-up care.

Devising plans to maintain individuals with a chronic mental disability in the community following a long-term hospitalization is a highly complex problem. One of the significant aspects of this problem is the availability of adequate living arrangements that promote individual growth and development, provide professional support and care, and elicit the concern of members in the community who will provide these living arrangements. Alternate living arrangements require social experimentation in efforts to ascertain and appraise which one(s) are most appropriate for any given community. This paper devises a method of sequential development of alternatives in which each arrangement is appraised as it emerges in the community in relation to cost, knowledge acquired and utilized, technology advanced, and other resources required. It was assumed that each living arrangement produces different results in development. It further assumes that each living arrangement learns in development to the best interest of the chronic mentally disabled. The result of this innovative systems design is that professionals can make decisions on placement based on knowledge, information, technology, and cost as it emerges in juxtaposition to the results such programs are having on those in need.

Aftercare↗
PubMed2002

Longitudinal study on the adaptive and challenging behaviors of deinstitutionalized adults with mental retardation.

Adaptive and challenging behavior changes associated with movement from Minnesota's state institutions to community homes were examined. Most of the 148 participants who moved had severe or profound mental retardation, significant challenging behavior, and several decades of institutionalization. Adaptive and challenging behavior were assessed in the institution and thereafter annually in the community. Relative to institutional levels, adaptive behavior declined among residents who moved to community ICFs/MR but was unchanged for the HCBS Waiver group. Challenging behavior tended to worsen initially but, except for internalized behavior, no longer differed from institutional levels by the second community assessment. Change in challenging behavior was unrelated to community residence type. Previous papers involving these participants showed consistent lifestyle enhancements and reduced service costs relative to the institution.

Activities of Daily Living↗