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PubMed1981

Nursing homes and chronic mental patients.

Nursing homes play an important and controversial role in the community-based care of chronic mental patients. Confronting the reality of this role can help us recognize problems in the rationales for deinstitutionalization and community care. Problems with three concepts that were central to deinstitutionalization are examined--the total institution, institutional neurosis, and social reintegration. Furthermore, two concepts are presented that were overlooked in the haste to initiate deinstitutionalization--custody, asylum, and treatment functions in society; and the role of patient expectations. Finally, suggestions are made about how nursing homes can play a more constructive role in mental health policy.

Chronic Disease↗

PubMed1995

Adaptation to group home living for adults with mental retardation as a function of previous residential placement.

Changes in adaptive functioning subsequent to a group home placement was assessed for deinstitutionalized and previously non-institutionalized adults with mental retardation. Results indicated that both groups experienced a significant increase in overall adaptive functioning subsequent to group home placement. The results also indicated that neither group experienced a significantly greater increase in adaptive behaviour compared to the other. Additionally, it was found that the deinstitutionalized group functioned at a higher adaptive level overall than did the previously non-institutionalized group. These results are consistent with previous research regarding the benefits of a group home placement on deinstitutionalized individuals. This research extends previous research by demonstrating that group home placements also have a significant impact on the adaptive behaviour of previously non-institutionalized individuals.

Adaptation, Psychological↗

PubMed2000

Community placement of long-stay psychiatric patients in northern Finland.

Rapid deinstitutionalization occurred in Finland in the 1990s, a decade later than in many other Western countries. A four-year follow-up study in northern Finland examined community placements of 253 long-stay psychiatric inpatients after deinstitutionalization in 1992 and at follow-up at the end of 1995. About 70 percent of the patients were discharged. Only 15 percent were able to live outside the hospital without continuous support. No patient was homeless at follow-up. Being unmarried, living in the city of Oulu, and having greater severity of illness were associated with hospitalization at follow-up. The results showed that long-stay patients are dependent on considerable support. Alternative residential facilities have made deinstitutionalization possible.

Adult↗

PubMed1991

[A review on mental health and psychiatric services in England].

Psychiatric care in Japan has received criticism not only within Japan but from other parts of the world. By contrast, the services for mentally ill in England is considered to be superior and is therefore presented briefly to benefit the development of better community psychiatric care in Japan. The history of psychiatric services in England is described briefly. After World War II, deinstitutionalization has been occurring and the in-patient rate per 100,000 population which was 354 in 1954 and has decreased to 120 in 1990. Despite a decrease in the in-patient rate, the admission rate per 100,000 population has been increasing gradually during this period. Deinstitutionalization process and the development of community care services are summarized. Among these are alternative services such as primary care, day care and residential services in the community which are considered to be important elements. Problems associated with deinstitutionalization process are also discussed. In developing community care services in Japan, lessons can be learned from the success and failures of England's attempt over the last 30-years to build a better, more community-based system.

Adolescent↗

PubMed1987

'Mental' in 'Southie': individual, family, and community responses to psychosis in South Boston.

The deinstitutionalization of psychiatric patients is a deeply cultural as well as political task. It entails the sharing of responsibility for human distress with family and community. Consequently, the locus of social control has also shifted from psychiatric and medical expertise to community and legal institutions. Diagnosis and treatment models must be more compatible with lay explanatory models. This paper explores the various meanings of "going 'mental"' and "being 'mental"' in the white, working class, ethnic neighborhood of South Boston. The data are extracted from a study of the impact of deinstitutionalization on a cohort of middle-aged, psychiatric patients discharged from Boston State Hospital in the attempt to return them to community living. Individual, family, and community responses to, and interpretations of, the symptoms of mental distress are discussed. The study indicates that even seriously disturbed individuals are sensitive to cultural meanings and social cues regarding the perception, expression, and content of psychiatric episodes. While madness invariably disenfranchises, it does not necessarily deculturate the individual.

Alcoholism↗

PubMed1986

A hospital-based mental health court.

Deinstitutionalized chronically mentally ill patients face the prospect of homelessness, insufficient community services, and the possibility of criminalization. Further, many communities do not have a mechanism for recognizing the special problems many of the chronically mentally ill have when they enter the legal system. The following is a description of a hospital-based mental health court, a nontraditional, highly effective program intended to identify chronically mentally ill persons in the community, as well as recognize and correct inadequacy in services available to the deinstitutionalized.

Chronic Disease↗

PubMed1991

The community competence scale as a measure of functional daily living skills.

Competence assessment is of growing interest to administrators and clinicians who work with deinstitutionalized psychiatric and geriatric populations. A new instrument, the Community Competence Scale (CCS), is a multiscale structured interview administered in a similar manner to the Wechsler Intelligence Scales. The CCS requires the subject to answer questions and perform tasks which are proximal corollaries of daily living skills. The psychometric properties of the CCS are reviewed. Results of studies involving administration of the CCS to deinstitutionalized psychiatri patients and geriatric patients are presented. The available data suggest that the CCS has considerable value as a preplacement screening instrument for determination of residential settings for chronic psychiatric patients. Since the original CCS requires between 60 and 90 minutes for administration, several recent studies have focused upon development of a short form. The results of this research effort are described. In sum, the CCS appears to demonstrate considerable value as a tool to aid decision making about community placement, social skills training and clinical competence determinations.

Activities of Daily Living↗

PubMed1991

Mental health crisis in California.

Over the last 30 years, California dejure (legislated) mental health policy has been based on deinstitutionalization and outpatient care through community mental health systems. But by the end of the 1970s, there was a growing concern over whether deinstitutionalization had successfully occurred, whether community mental health systems had failed and whether mental health systems had ever been adequately funded. In a national study released in 1990, California was named one of four states where mental health delivery has regressed in the past two years. A review of current California mental health policies indicates dejure and defacto policies are not the same. Most mental health dollars are going to state hospitals and community acute inpatient facilities. Budgets for community mental health have been steadily eroded, and the current mental health system is in crisis. Implementation of mental health policy is dependent on intergovernmental financing, and each level of government tries to avoid costs. Definitions of which clients are to be served remain unclear while pressures for more social control mount. Mental health remains segregated from physical health policy-making and continues to operate at a political disadvantage in general fund budget battles.

California↗

PubMed2004

Violent victimization in schizophrenia.

BACKGROUND: We investigated the 3-year prevalence, and the sociodemographic and clinical correlates of violent victimization in a large and unselected nationwide sample of deinstitutionalized patients with schizophrenia. METHODS: The sample comprised 670 schizophrenic patients aged 15-64 years, who had been discharged from psychiatric hospitals in Finland in 1994. Comprehensive data were collected from psychiatric case records on the patients' sociodemographic factors and psychiatric history, as well as the patients' overall level of functioning. The patients were interviewed 3 years after discharge by each district's psychiatric professionals using a structured interview schedule specifically designed for the purposes of the present study project. RESULTS: The prevalence of self-reported violent victimization during the 3-year follow-up was 5.6%. In the multivariate analysis, a poor financial situation, alcohol abuse and being a perpetrator of a violent or some other crime were associated with violent victimization. CONCLUSIONS: The prevalence of violent victimization among schizophrenic patients in Finland was markedly lower than that reported on patients in the United States or Great Britain, but correlates were similar. Patients with a poor financial situation and a history of alcohol misuse, as well as of violent behaviour, seem to have an increased risk for violent victimization, and constitute a vulnerable subgroup in this respect. This subgroup of deinstitutionalized patients with schizophrenia may need additional care and protection from the danger posed to them from other members of the society.

Adolescent↗

PubMed1985

A point prevalence study of alcoholism and mental illness among downtown migrants.

Since the 1960s the bulk of America's mentally ill have been deinstitutionalized to the community. A number of these people now live in the downtown areas of large cities in close association with the established vagrant culture which includes a significant portion of alcohol abusers. The bizarre and impoverished nature of the lives of these formerly institutionalized mentally ill citizens, coupled with their propinquity to government and business establishments, creates a social policy dilemma. A point prevalence study design was used to ascertain the demographic, physical, mental illness and alcohol abuse characteristics of a sample of a vagrant population which inhabits the downtown area of an American Northwest urban community. Analysis of the data of a sample of vagrants who frequent an emergency shelter and a single residence occupancy hotel demonstrated that the two groups were similar. Participants were predominantly male, white and in their mid thirties. Forty percent had never married and over 50% were high school educated and possess labor skills. Grouped data indicates that, in view of the dearth of literature describing the relationship of mentally illness and alcohol abuse, the psychiatric and alcohol use behavior of deinstitutionalized populations requires further study.

Adult↗

PubMed1987

Psychiatric emergency services: evolution, adaptation and proliferation.

This paper traces the dramatic rise of psychiatric emergency services (PES) and crisis intervention services over recent decades. It examines three processes--the evolution of such services, their adaptation to diverse settings, and the striking increase both in the number of programs and their utilization. PES first evolved along three disparate lines--makeshift psychiatric emergency care in the emergency room of the general hospital, ad hoc after-care services in the psychiatric hospital, and the community mental health movement. Community mental health legislation of the 1960s not only provided funds for PES but led to the merging of the three lines. PES have adapted to and are found in a great variety of settings. The latter include small general hospitals and huge medical centers; county, state, and private mental hospitals; free clinics; telephone hot-lines, and others. Their adaptability appears due to their flexible personnel requirements and lack of need for an elaborate technology. Although fewer than 160 facilities were known to offer PES in 1963, their number exceeded 2000 by the early 1980s. Available piecemeal data indicate constantly increasing utilization of PES. This is a result of many factors, including deinstitutionalization. Although PES were initially visualized as resources for acute mental health care and continue to serve as such, they have become increasingly chronicized, consequent on the deinstitutionalized abandonment of many chronically ill persons. Changes are also occurring in the social and demographic characteristics of persons utilizing PES and in the ways in which the services are perceived and utilized. The early development of unlabeled and makeshift psychiatric emergency care in the general hospital's emergency room and the psychiatric hospital were instances of 'evolutionary planning'.(ABSTRACT TRUNCATED AT 250 WORDS)

Community Mental Health Services↗

PubMed2000

Contracting opportunities: interpreting post-asylum geographies of mental health care in Auckland, New Zealand.

In New Zealand, the process of deinstitutionalization is continuing to unfold as a specific manifestation of welfare state restructuring rather than as a discrete process within the health care sector. In this paper we consider the geography of mental health care in Auckland, New Zealand's only metropolitan city. Here, a highly fluid and competitive housing market has profoundly (re)shaped the opportunities for community care. We report on findings from a survey of representatives of the key agencies providing mental health care in central Auckland. We argue that the re-placing of mental health care into the community has often involved the separation of residential and treatment issues, to the detriment of the communities, institutions and (especially) individuals involved. We trace this fragmentation back to the primacy of the ideology of restructuring over the philosophy of deinstitutionalization. We build our argument around a discussion of the Mental Health (Compulsory Assessment and Treatment) Act 1992 and the apparent subordination of the Act to the emerging of a 'contract state' and broader legislation, such as the Resource Management Act 1991, the Privacy Act 1992 and the Commerce Act 1986, which underpins the re-regulation of New Zealand society.

Community Mental Health Services↗

PubMed1996

Assessing psychiatric care settings. Hospitalization versus outpatient care.

This paper presents a discussion of the historical development of deinstitutionalization in the United States, including the political, ideological, and social origins of that policy. The outcomes of deinstitutionalization are considered, including the impact of the policy on the quality of life of people with severe mental disorders. The authors also provide a brief review of the literature on the efficacy and cost-effectiveness of hospitalization versus outpatient (community) care. Recent developments in the use of involuntary hospitalization are discussed, along with a number of important trends in the delivery and financing of services for persons with severe mental disorders.

Commitment of Persons with Psychiatric Disorders↗

PubMed2001

Emerging issues with mentally ill offenders: causes and social consequences.

Persons with mental illness and co-occurring substance abuse disorders are incarcerated at disproportionately high rates in comparison to the general population. Reasons may include high standards for involuntary commitment, an overall increase in substance abuse and the policy of deinstitutionalization. However, one significant reason may be that psychiatric institutions serve a social control function, which has not been appreciated by policymakers and program developers since deinstitutionalization. This paper presents provider views of the population and issues of concern for clients, families, and the agencies. Discussion includes service-provider response to the population, new program models, and implications for policymakers.

Deinstitutionalization↗

PubMed2002

[Subgroups and Prognosis of "Difficult-to-Place" Schizophrenic Long-Stay Patients: Distinguishing "Hard Core" Patients].

Long-standing processes of deinstitutionalization often display processes of selection that result in groups of patients with marked disability profiles left in hospital. According to the literature socially deviant and unacceptable behaviour are a main obstacle to living in the community. Therefore, a group of "remnant" chronic schizophrenic patients was analysed by means of a latent class analysis with indicators of social behaviour and compliance. Three different subgroups were found, one of which had an extremely poor level of adaptation. However, prognosis of staff with regard to patients' ability to live outside the psychiatric hospital, and the rates of patients being moved into the community in the course of subsequent deinstitutionalization were not different among the three groups. Characteristics of "most-difficult-to-place patients' " as discussed in the literature are called into question on the basis of the results of this study.

Adult↗

PubMedDate not supplied

Changing demand for mental health services in the emergency department of a public hospital.

OBJECTIVE: Deinstitutionalization and mainstreaming may have contributed to increased attendance in public emergency departments by people with mental health problems. This study describes changing patterns of attendances by patients with mental health problems to the emergency department (ED) of a public teaching hospital in Adelaide, South Australia. METHOD: Records from a 10-year period from the ED were examined to identify changes in the number of, and diagnoses for, patients attending for primarily mental health concerns. Admission rates, detention and length of stay (LOS) were also examined in an attempt to identify trends. RESULTS: A tenfold increase in the number of patients attending the ED with primarily mental health problems has occurred over the 10-year period. This is within the context of relatively stable total ED presentations. The increase has been observed in all diagnostic categories although the greatest increase, by percentage, has been for psychotic disorders. A lesser increase was observed for patients presenting with overdose. People presenting with psychotic disorders are also more likely to be detained and admitted. LOS in the ED has also increased along with increasing demand. CONCLUSIONS: Reasons for the increased demand are likely multifactorial. While deinstitutionalization and mainstreaming have contributed, the closure of the ED at the local psychiatric hospital does not account entirely for the change. Insufficient community-based mental health services may also contribute to the reasons why people present to the ED and lack of inpatient beds contributes to the increasing LOS experienced in the ED.

Cross-Sectional Studies↗

PubMedDate not supplied

Aftercare treatment for schizophrenics living at home.

The authors review aftercare for schizophrenic individuals who have been discharged as a result of deinstitutionalization. The article focuses on the nature of the problems caused by deinstitutionalization, the professional response, various aftercare milieus, family treatment modalities, and the clinical process. Psychoeducational interventions and professionally guided self-help groups are recommended for the parents and spouses of schizophrenic patients living at home.

Aftercare↗

PubMed2002

Managed behavioral health care in the public sector: will it become the third shame of the States?

Managed behavioral health care is increasingly being used in public mental health systems. While supporters cite potential benefits, critics describe dire consequences for individuals with serious, long-term mental illness. The situation has parallels with the major changes resulting from deinstitutionalization some four decades ago. Believing that analyzing history may prevent repeating some of its mistakes, the authors compare the antecedents, benefits, and negative effects of deinstitutionalization with those of the public-sector managed behavioral health care systems being developed today. Lessons learned from the earlier era include the need for careful general and technical planning; for assignment of responsibility, including monitoring, to the public sector; and for a focus on clients and the special needs generated by severe mental illnesses.

Consumer Behavior↗