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[Psychiatric care policies and deinstitutionalization in South America].

INTRODUCTION: The process of restructuring psychiatric care in South America began in the 80's and increased in the 90's. This process had its landmark in the Declaration of Caracas (1990), which reinforced the need for alternative services to the mental hospital. OBJECTIVES: to analyse the current situation of the psychiatric care in South America, with special emphasis on Psychiatric Units in General Hospitals (PUGHs). METHODS: Two mail surveys were carried out. Questionnaires were sent to all Ministries of Health, Psychiatric Societies and key informants. RESULTS: All countries were represented in the returned questionnaires. In 7 countries there is a mental health plan. Material and human resources are inadequate in most countries. There has been a decrease in the total number of psychiatric beds over the last tem years. PUGHs were created in all the countries surveyed. CONCLUSIONS: All South America countries have a mental health program. A higher percentage of the programs is devoid of an evaluation system and almost all the countries lack budget estimates for mental health care. It was observed that the total number of psychiatric beds has been decreasing in most countries, and that the PUGHs and other decentralized centers were adopted as an alternative to the mental hospital.

Deinstitutionalization↗
PubMed2000

[Limits of deinstitutionalization--perspectives of relatives of psychiatric patients].

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.

Chronic Disease↗
PubMed2000

[Limits of deinstitutionalization: experience in England].

Psychiatric reform and the current system of mental health care in England are outlined, the system context of the National Health Service (NHS) is described. Recent institutional change in the NHS has introduced internal market elements. More than 90 mental hospitals have been closed. The TAPS study, a longitudinal study evaluating mental hospital closure is described. Results show a range of advantages of the post-discharge care arrangements. Studies evaluating services with a home treatment and community focus (DLP, PRiSM) suggest that community mental health care is feasible. Shortages and problems of the current system of care (acute beds, intensive residential and rehabilitation services) are outlined.

Community Mental Health Services↗
PubMed2000

[Comments on deinstitutionalization].

Following a historic introduction the development of the chronics' departments of the big psychiatric hospitals in Saxony since 1990 is described: the goal of ending the care of the chronic mentally ill younger than 65 years in these departments, the newly restructured care of the mentally ill in Saxony and the problems attached to these processes.

Adult↗
PubMed1992

Level of care for deinstitutionalized psychiatric patients.

The New York state Level-of-Care Survey (LOCS) was used in 1987-88 to assess the community care and social support needs of 936 mentally disabled community residents in Halifax, Nova Scotia. The cases were assigned an appropriate level-of-care by the computerized algorithm based on an 101-item questionnaire covering all aspects of the cases' physical and mental condition, needs and activities. Compared with their current setting, the algorithm assigned 60% of cases to the same level-of-care, 17% to a lower level, and 23% to a higher level-of-care. The net effect on social service costs of the reassignments would be a 7% increase. The increased costs for some cases ($1.5 million) would be partly offset by lowered costs for others ($900,000). The gradual shifting of 14 cases from the relatively expensive rehabilitation unit to more independent living at lower levels of care would compensate for most of the increases.

Aged↗
PubMed1992

Reclaiming the community: the strengths perspective and deinstitutionalization.

In the past decade, concern for the plight of severely mentally ill people has centered on such issues as mental illness among the homeless population, the burden placed on families who care for ill loved ones, and the impoverished quality of life experienced by those who attempt to survive on their own. Some have called for a rethinking of the abandonment of the asylum and a relaxation of civil commitment laws, while others have advocated for increasing community-based services that specifically target severely mentally ill people. This article discusses these issues and considers how the response to severe mental illness has overrelied on pathology-based models of helping. The strengths perspective provides an alternative. Although severe mental illness presents a formidable obstacle to the afflicted, mentally challenged individuals have strengths and abilities that can be tapped to foster their continued integration in community settings. This adjustment is best conducted through the use of naturally occurring community resources rather than specialized, segregated programs.

Community Mental Health Services↗