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PubMed1978

A conceptual approach to deinstitutionalization.

Many serious problems in deinstitutionalization result from conceptual oversights or confusion. Understanding deinstitutionalization as a process and a philosophy, as well as a fact, permits planning that will accommodate the variety of patient populations that are the products of the deinstitutionalization movement. The role and possible contributions of the state hospital in caring for chronic patients must be assessed objectively. Effective program planning for chronic patients during this period of deinstitutionalization depends on a careful and realistic definitiin of what individuals are to be treated in the community. Such planning must not only attempt to match patients and appropriate treatment settings but must aim at enhancing rehabilitation, where feasible, through a skills training approach.

Community Mental Health Services↗
PubMed1991

Attitudes of nursing and rest home administrators toward deinstitutionalized elders with psychiatric disorders.

The administrators of 92 nursing homes and rest homes in western Massachusetts were surveyed on their experiences with elderly residents with a history of psychiatric hospitalization and their willingness to admit such individuals in the future. A majority of those who had admitted deinstitutionalized elders with chronic psychiatric disorders reported having experienced severe problems with them. Most of the problems involved the resident going into crisis or producing some highly disruptive behavior. Although two-thirds of the facilities had admitted elders who had been deinstitutionalized from a public psychiatric hospital, only one-quarter clearly planned to do so in the future. Three quarters of the administrators reported that they did not have the support services that the deinstitutionalized elders in their facilities needed. A comparison of the services reported to be important and those reported to be available suggest that simply increasing the availability of psychiatric support services would probably not influence administrators to admit elders with chronic mental illness in the future.

Administrative Personnel↗
PubMedDate not supplied

Psychiatric deinstitutionalization: the possibilities and the reality.

There is a substantial research data base which indicates that the majority of the chronically mentally ill can function outside of institutional settings. A number of community support programs have been implemented and positively evaluated. However, despite this evidence, large-scale deinstitutionalization of these patients has not occurred. Instead, patients have been relocated to new institutional placements such as nursing homes and single-room only hotels (SRO's). The role of Medicaid and Supplemental Security Income (SSI) in mental health care appears to have contributed to limited placement options. In addition, deinstitutionalization has created ambiguity around the degree of dependence and social role status of these patients. Recommendations are made to provide the deinstitutionalized mentally ill with a viable social role using existing financial resources.

Activities of Daily Living↗
PubMed2004

The effect of deinstitutionalization on the longitudinal continuity of mental health care in the Netherlands.

BACKGROUND: Deinstitutionalization has been accompanied by a decreasing continuity of care in a number of countries. This study evaluates the effects of the Dutch model for deinstitutionalizing mental health care. METHODS: Details of users and their use of community- and hospital-based services between 1990 and 1999 were retrieved from the Groningen case register. The time between discharge from the hospital and the first subsequent community-based contact was the primary indicator for changes in continuity of care. RESULTS: The total proportion of discharges from hospital-based mental health care followed within 6 months by community-based care increased by 11% due to the improved availability of day treatment and home treatment. In terms of median survival time, aftercare in the years 1998/1999 was delivered more than twice as fast as in the years 1990/1991. CONCLUSIONS: Study results supported the hypothesis in Dutch deinstitutionalization policy that the continuity of mental health care would benefit as to its longitudinal dimension.

Community Mental Health Services↗
PubMed1999

Deinstitutionalization and psychiatric reform in Spain.

The transformation of psychiatric care which has been carried out in Spain since the 1980s, under the name of "Psychiatric Reform", had produced as it most significant achievements: (i) the development of a new organizational structure for mental health care, (ii) the integration of psychiatric patients in the general health care system, (iii) the creation of an extensive community network of mental health centers, and (iv) the adoption by the general public of more positive attitudes towards mental illness and its treatment and the passing of legislative measures aimed at improving the civil rights of these patients. However, the application of the Psychiatric Reform has followed an uneven course in Spain as a whole, with marked differences between the different autonomous communities. The main deficiency has been in the development of intermediate community services and programs to rehabilitate and resettle patients in the community. With regard to deinstitutionalization, the results have also been insufficient and it is still possible to observe a strong tendency, within the system, to maintain the old mental hospitals for both long-term and short-term illness care. Finally, the analysis of the Spanish experience has revealed that (i) many of the criticisms leveled at deinstitutionalization are not aimed at its "conceptual core" but stem from its inadequate implementation, and (ii) it is wrong to equate deinstitutionalization and psychiatric reform with closure of psychiatric hospitals, without the awareness that this process is far more complex.

Deinstitutionalization↗
PubMed1999

Has deinstitutionalization gone too far?

Modern social psychiatry is aiming at integration of the mentally disordered in the community instead of institutionalization--with or without institutions. No doubt, the majority of mentally disordered patients have benefitted greatly from deinstitutionalized psychiatry. Unfortunately, in the implementation of deinstitutionalized psychiatry, there has widely been a gap between the closure of the mental hospitals and the building up of the decentralized services. Instead of organizing decentralized services and then gradually reducing the capacity of hospital treatment, things happened in many places the other way around. With data from the nationwide Danish Psychiatric Case Register, the author documents a series of negative indicators that have appeared parallel with the deinstitutionalization process. * 100% increase in standard mortality rate of suicides for non-organic psychotic patients * an exponential increase of 6.7% annually in number of criminal mentally disordered * increase in coercive activities in the wards several hundred per cent for some of the measures * increase in bed occupancy rate from approximately 80% to 100% * Acute admission rates between 85% and 90% * No signs of reduction in 1 year readmission rate of first time diagnosed schizophrenics from the very stable 45%-50% which has been seen for almost 20 years. Beyond any doubt, social psychiatric rehabilitation is needed. An increase in the capacity in the psychiatric services and fitting of the treatment models to the patients' needs so that the negative aspects we have seen can be properly handled must be on top of the agenda in the next few years.

Acute Disease↗
PubMed1998

Deinstitutionalization and schizophrenia in Finland: I. Discharged patients and their care.

Finland has experienced one of the most rapid psychiatric deinstitutionalization processes in the world. Since 1980, the use of psychiatric beds has decreased about one-third. The effects of this deinstitutionalization were studied in the national Discharged Schizophrenia Patient Project. The study used three representative samples of patients with schizophrenia who were discharged from mental hospitals in 1982, 1986, and 1990, and followed them for 3 years. Patients with schizophrenia discharged at the beginning of the 1990s were older and more disturbed, and had been ill for a longer time than patients discharged at the beginning of the 1980s. The use of outpatient care increased and that of hospital care decreased, but because of the increased residential outpatient care, the total amount of residential care did not change during the study period. However, readmissions to the hospital increased. In patients with a long duration of illness, the increase in readmissions was exceptionally high; these patients also seemed to be losing their share of the residential outpatient services. On the whole, from the point of view of the psychiatric treatment system, deinstitutionalization seemed to have proceeded fairly successfully. The system proved able to redirect and use the available resources more effectively and to modify the structure of services according to the changing needs of patients discharged from hospitals. The well-developed social services have also supported this adaptation to the decreasing use of mental hospital beds.

Adolescent↗
PubMed1985

Attitudes of superintendents of institutions for the mentally retarded towards deinstitutionalization: a cross-cultural perspective.

A cross-cultural study was conducted on the attitudes of superintendents of institutions regarding deinstitutionalization in the United States and in Israel. The attitudes of 29 superintendents from Israel were compared with the attitudes of 181 American superintendents. The most general finding was that in spite of important legislative and demographic differences, in both countries the attitudes were neither highly in favor nor strongly against deinstitutionalization. Most respondents in both countries believed that the parents of the mentally retarded do not generally support deinstitutionalization.

Administrative Personnel↗
PubMed1979

Linking deinstitutionalization of patients with hospital phase-down: the difference between success and failure.

Deinstitutionalization of patients is an inevitable forerunner of hospital phase-down or closure, but if the two processes are carried out at the same time, they will be counterproductive. An evaluation of the combined deinstitutionalization and phasing down of a state hospital in Pennsylvania indicated conflicts in the areas of case management, community and political support, and administrative flexibility. A substantial problem was that deinstitutionalization is time-consuming and must be flexible enough to allow for the development of essential community supports and for largely unpredictable reactions from patients, families, communities, and service providers. Conversely, hospital consolidation must be relatively quick and inflexible to permit the orderly redisposition of staff and patients, reduce unnecessary staff resistance and anxiety, and withstand changing political pressures.

Community Mental Health Services↗
PubMed1979

Deinstitutionalization in the absence of consensus.

The process of deinstitutionalization began almost unnoticed in 1955 as state hospital populations started to decline, and it proceeded without adequate planning and without development of a social consensus. The inevitable result was strong criticism, severe personal dislocations, and, with rare exceptions, programmatic chaos. The authors trace and describe the reasons for the growing polarization about deinstitutionalization among such groups as mental health professionals, public officials, families, advocacy groups, citizens, and unions. They also note that between 1950 and 1970 the total institutionalized population in the U.S. was not reduced but simply shifted. Deinstitutionalization should focus not on the location of care but on the broader problem of improving the lot of persons with chronic illness, regardless of its cause or time of onset, the authors suggest. They outline the basic elements of a service and financing system to meet both the daily-living and the specifically medical needs of the chronically ill.

Aftercare↗
PubMed1979

Deinstitutionalization: avoiding the disasters of the past.

The reasons for the problems created by deinstitutionalization have only recently become clear; they include a lack of consensus about the movement, no real testing of its philosophic bases, the lack of planning for alternative facilities and services (especially for a population with notable social and cognitive deficits), and the inadequacies of the mental health delivery system in general. Providing care for the chronically ill and preparing for future deinstitutionalization means that the issue must be reconceptualized not as one of where people should be housed but as the need to provide the full range of treatments and services that are available in a total institution. Attitudinal and institutional biases and discriminatory practices must be combated, planning for community facilities and services must be improved, and funding for both institutional and community services must be provided during the phasing down of institutional services. The author proposes a set of ten commandments or basic rules to guide future deinstitutionalization activities.

Community Mental Health Services↗
PubMed1981

What did we really expect from deinstitutionalization?

Long-term, severely disabled psychiatric patients are almost by definition a marginal population. Yet the expectations of deinstitutionalization are often expressed in such terms as "helping them become a part of the mainstream of our society" and "normalization." Although only a minority of long-term patients can realize these expectations, the programs that receive the most attention are those geared to the higher-functioning minority. When scrutinized, proposed "solutions" to the problem of deinstitutionalization are found to be simplistic and unrealistic. Deinstitutionalization will have accomplished a tremendous amount if the mentally ill can live lives of dignity and a reasonable amount of comfort in the community, a good that will require increased investment of both effort and funds in their living arrangements. The private sector, given sufficient financial incentives and proper supervision and support, can provide quality services to chronic patients on a large scale.

Activities of Daily Living↗
PubMed1981

Facilitating deinstitutionalization: a comparative analysis.

The purpose of the paper is to highlight issues related to deinstitutionalization and community care of the mentally ill by using a comparative approach. Through a comparison of the trends in the U.S.A. and Israel, an attempt is made to account for factors which promoted deinstitutionalization. The paper focuses on specific policies and programs which were crucial in reducing the rate of resident population in mental institutions and facilitating the development of community care for the mentally ill in the U.S. It points out the environmental conditions, social, political, legal and organizational, which may be conducive to legislative and administrative actions in order to facilitate deinstitutionalization.

California↗
PubMed2004

Forty years of deinstitutionalization of psychiatric services in Canada: an empirical assessment.

OBJECTIVE: To empirically analyze the implementation of the policy of deinstitutionalization of psychiatric services over a 40-year period. METHOD: We assessed the policy of deinstitutionalization in terms of the following components: 1) population-based psychiatric beds, days of care in psychiatric hospitals (PHs); 2) days of care in psychiatric units in general hospitals (GHs); and 3) per capita expenditures on psychiatric services. RESULTS: There was a rapid closure of beds in PHs in the 1970s and 1980s, but this was associated with an increasing rate of days of care in psychiatric units in GHs (that is, transinstitutionalization). It was not until the 1990s that the overall days of inpatient care began to decrease. Per capita expenditures on community-based psychiatric services increased throughout this period. CONCLUSIONS: Standardized rates reveal tremendous variation among the provinces in the timing and intensity of deinstitutionalization.

Canada↗
PubMed1994

[Deinstitutionalization of severely mentally retarded patients: impact on prescription of neuroleptics].

The neuroleptic medication prescribed over a period of 12 years for three groups of severely developmentally handicapped patients is analyzed retrospectively. The average daily doses prescribed for two groups of patients, deinstitutionalized either to foster homes or group homes, are compared to those prescribed for a third group of patients who were not deinstitutionalized. The results show that deinstitutionalization had no impact on the prescribing of neuroleptics, regardless of the type of residence: group home or foster home. The results show, moreover, that for the three groups of patients, time spent without medication decreased significantly over the 12 years of this study. These results are discussed in relation to the problem of the patients' social reintegration into the community.

Adult↗
PubMedDate not supplied

[Deinstitutionalization and psychiatric reform in Spain].

The transformation of psychiatric care which has been carried out in Spain since the 1980s, under the name of < >, had produced as it most significant achievements: i) the development of a new organizational structure for mental health care, ii) the integration of psychiatric patients in the general health care system, iii) the creation of an extensive community network of mental health centers, and iv) the adoption by the general public of more positive attitudes towards mental illness and its treatment and the passing of legislative measures aimed at improving the civil rights of these patients. However, the application of the Psychiatric Reform has followed an uneven course in Spain as a whole, with marked differences between the different autonomous communities. The main deficiency has been in the development of intermediate community services and programs to rehabilitate and resettle patients in the community. With regard to deinstitutionalization, the results have also been insufficient and it is still possible to observe a strong tendency, within the system, to maintain the old mental hospitals for both long-term and short-term illness care. Finally, the analysis of the Spanish experience has revealed that, i) many of the criticisms leveled at deinstitutionalization are not aimed at its < > but stem from its inadequate implementation, and ii) it is wrong to equate deinstitutionalization and psychiatric reform with closure of psychiatric hospitals, without the awareness that this process is far more complex.

Deinstitutionalization↗
PubMed2000

[Satisfaction of relatives with the process of deinstitutionalization].

During the last eight years we arranged an extensive process of change in Eckardtsheim, a part of Bethel in the city of Bielefeld. As part of the process of deinstitutionalization we tried to change institutional needs into the needs for help and support of the individuals. One important part of this process was working with family members of our clients in a variety of intervention strategies. We evaluated the relatives within the concept of customer orientation in different viewpoints. All family members got a mailed questionnaire (n = 1,068) in which they were questioned on their expectations and satisfaction with the most important aspects concerning the cooperation between family members and the treatment of the patients. We implemented support programs for the family members and asked them to judge these programs and the general process of change in the institution. 42% answered, mostly brothers and sisters. We received general support for our programs with a lot of individual criticism to certain parts of the process. Brothers and sisters were sceptical about deinstitutionalization of patients who had been institutionalized for decades. Working with families in these situations demands different ways of intervention, like information about the hospitalized family members and about the institutional change process as well as individualized support for the family members themselves. Services for the family members of long term hospitalized patients are extremely important and necessary for a positive outcome in the process of deinstitutionalization.

Adult↗
PubMed1992

Psychiatric deinstitutionalization and its cultural insensitivity: consequences and recommendations for the future.

Despite the plethora of models and strategies for addressing issues that surround the chronically mentally ill, there remains a paucity of literature that addresses the specific implications of deinstitutionalization on racial minorities. Racial minorities comprise a significant number of the homeless, jailed, and geriatric mentally ill. History and current reality suggest the reasons why some chronically mentally ill blacks and their families have feared the impact of deinstitutionalization. This article examines the Ohio State Department of Mental Health's response to these issues as a possible prototype for statewide coordination for deinstitutionalization.

Black or African American↗