Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Deinstitutionalization”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 451 records · Page 25Linked to original sources
PubMed1979

Paradoxes in programming for chronic patients in a community clinic.

In attempting to build a successful program for chronic patients at the Somerville (Mass.) Mental Health Clinic, the authors first found it necessary to uncover, address, and resolve six fundamental paradoxes engendered by deinstitutionalization that were stressful to mental health clinic staff and inhibited effective programming. The paradoxes involve issues relating to community mental health ideology, clinicians' sources of self-esteem and professional ability, and clinicians' views of chronicity and the deinstitutionalization movement in general. Resolution of the paradoxes requires major value changes, which can be brought about by effective clinical leaders who serve as role models and teachers, and who set the tone for patient care.

Attitude of Health Personnel↗
PubMed1985

Regulation and consultation in community care facilities.

Residential community care facilities for deinstitutionalized patients are severely criticized for providing poor-quality care. Yet deinstitutionalization occurred without adequate planning or funding, and facility administrators were left on their own with virtually no regulation and no involvement with the mental health profession. Mental health professionals must focus on improving their understanding of the problems experienced by the community care industry, build alliances with facility administrators, and collaboratively design regulatory and consultative interventions that will help administrators reintegrate the mentally ill into the community. The author uses regulatory and consultative approaches implemented in California and Virginia as case examples.

California↗
PubMed1986

The paradoxes of reform: reevaluating Italy's mental health law of 1978.

Recent data on Italy's mental health law of 1978 delineate a more complex picture of deinstitutionalization than that suggested by the first wave of enthusiastic writings on the law's implementation. In violation of the law's original intent, many Italian regions depend heavily on newly established hospital-based units, while development of community services has been uneven. Factors affecting implementation include both ambiguous and unenforceable provisions in the law and unwillingness at the national and local levels to fund necessary community alternatives. Recent proposals to "reform the reform" may move Italian psychiatry even further away from the legacy of successful deinstitutionalization in cities such as Trieste and Arezzo.

Commitment of Persons with Psychiatric Disorders↗
PubMed2000

Downsizing psychiatric hospitals: needs for care and services of current and discharged long-stay inpatients.

BACKGROUND: With the psychiatric deinstitutionalization movement in its fourth decade, questions are being raised concerning its relevance for long-stay inpatients with severe disabilities and the risk that those discharged into the community may be abandoned. METHODS: A random sample taken in 1989 of long-stay inpatients at Louis-H Lafontaine Hospital made it possible to examine 96 pairs of patients. Each pair included 1 patient discharged between 1989 and 1998 and 1 patient hospitalized. Pairs were matched for sex, age, length of stay, and level of psychiatric care in 1989. Patients and staff were interviewed using standardized questionnaires, and case notes were reviewed to assess symptoms, daily living skills, residential status, quality of residential setting, and clinical and social problems and needs. RESULTS: The investigation revealed that discharged patients moved to highly supervised settings, which included professionally supervised group homes, supervised hostels, and foster families. About 20% went to nursing homes owing to loss of autonomy from physical disorders. Only 4 discharged patients were lost to follow-up, of whom 2 were probable vagrants. Both those discharged and those remaining as inpatients presented with major clinical problems and daily living skill deficits. The care needs of discharged patients were generally met, and placement in the community was considered appropriate. Of those who had remained hospitalized, over one-half could be moved to supervised settings immediately, or after 1 to 2 years' preparation in a discharge unit, while 13% could be moved to nursing homes. Over 25% required intensive, individualized rehabilitation treatment targeting engagement, psychotic symptoms, withdrawal, and dangerous and socially embarrassing behaviours. CONCLUSION: Deinstitutionalization in the largest Canadian psychiatric hospital did not lead to patient abandonment in the community.

Activities of Daily Living↗
PubMed1994

A thirty-year retrospective study of hospitalization among severely mentally ill patients.

This study examines the effects of deinstitutionalization policies on psychiatric hospitalization rates over a thirty-year period. It is based on a retrospective study of successive hospitalizations in severely disabled patients. The data indicate that in any five-year period these patients still spend over 20% of their time in hospital. For patients who have stayed for a total of more than one year every five years in hospital, the average length of stay has been decreasing far less rapidly in the last fifteen years than it had previously. Patients who were first admitted after 1971 spent proportionally as much time in hospital as those whose first stay was earlier. These results show that the groups primarily affected by deinstitutionalization are those who were first hospitalized prior to the 1970s and those who are the heaviest hospital users. However, the data from the patients admitted since the seventies seem to reveal that the process of change may have reached its limits.

Adolescent↗
PubMedDate not supplied

Normalization and boarding homes: an examination of paradoxes.

Boarding homes have emerged throughout the nation as places where many deinstitutionalized psychiatric patients, and others, reside. They represent one type of congregate living arrangement which is expected to facilitate social policy goals of enabling chronically mentally ill people to live in the most appropriate, least restrictive environment possible. This paper presents a study of ten boarding homes in New Jersey which suggests that instead of being empowered as consumers, residents have become commodities; instead of gaining additional freedoms, deinstitutionalized persons have been abandoned. The paper also presents problematic issues concerning the provision of treatment and rehabilitation services to boarding home residents.

Community Mental Health Services↗
PubMed1998

Mortality among Pennhurst class members, 1978 to 1989: a brief report.

Pennhurst Center closed in 1987, and the closure was one of the most intensely studied of all deinstitutionalizations. Because of recent interest in mortality after deinstitutionalization, we examined all deaths from 1978 to 1989 among the people who had resided at Pennhurst in 1978. During the period from 1978 to 1989, every person moved from Pennhurst to a community home. Relocation literature would suggest that this might be a time of high risk of mortality. However, the actual mortality rates were considerably lower than what would have been expected if Pennhurst had remained in operation, even though the stress of relocation was present. Movement to community homes appeared to improve survival for the Pennhurst people.

Cohort Studies↗
PubMed2005

Longitudinal changes in adaptive behaviors of movers and stayers: findings from a controlled research design.

Reviews of research on deinstitutionalization show that investigators have focused primarily on adaptive behavior changes of "movers," while paying minimal attention to "stayers." Analysis of their research also revealed some methodological problems. We assessed 150 movers and 150 stayers in 1994, before deinstitutionalization began in 1997. We matched samples on seven distinctive variables, which were again assessed at similar intervals of 3, 15, and 27 months after movement. Movers made significant gains in independence and household skills, while stayers incurred losses in social skills and cognitive competencies. Teaching domestic skills and high autonomy were the best predictors of final self-care and multicognitive competencies, after controlling for initial baseline scores.

Activities of Daily Living↗
PubMed2006

A clinical alternative to the public health approach to mental illness: a forgotten social experiment.

In the last half of the 20th century, the community mental health movement, based on a public health model, came to dominate patterns of care for mental patients. In the process, brutal deinstitutionalization of very ill patients took place, at least in the United States. These events were not inevitable. In 1949, the Menningers of Topeka, Kansas, began administering Topeka State Hospital, which was in deplorable condition. By concentrating expenditures on clinical personnel, the Menningers humanely deinstitutionalized many patients before chlorpromazine, before the entitlement programs of the U.S. federal government such as Medicaid (1965), and before the community psychiatry movement got under way. Topeka State Hospital furnished a model of mental health care that centered a whole system on a last-resort, large, specialized state mental hospital. This inadvertent social experiment suggests that a clinical approach to mental health care offers a hard-headed alternative to present arrangements.

Deinstitutionalization↗
PubMed1980

Mentally retarded hepatitis-B surface antigen carriers in NYC public school classes: a public health dilemma.

The placement of retarded children who have been institutionalized and are asymptomatic hepatitis-B surface antigen carriers into public school classes for the retarded has caused controversy and presented the New York City Health Department with an unusual medical-ethical dilemma. In this situation, the cost of interfering with deinstitutionalization, an important social advance, must be balanced against the benefit of controlling the unquantified but real risk of transmitting a potentially serious disease. The Health Department guidelines for managing this problem recommended serological surveillance, promotion of classroom hygiene where possible, and teaching of carriers in classes separate from their susceptible peers. A federal court disallowed the cohorting provisions of these guidelines. Changing policies and practices towards the mentally retarded, such as deinstitutionalization, raise important public health issues which will have to be faced by the involved communities.

Carrier State↗
PubMed1981

The mental patients' rights movement and mental health institutional change.

The mental patients' rights movement has added to the widespread critique of institutional psychiatry and provided leadership in opposing treatment methods such as electroshock, psychosurgery, and overdrugging, which are dangerous and regressive not only to patients, but to the expanded population of non-institutionalized persons as well. The movement has had some success in court cases for democratic rights, such as the right to treatment, the right to refuse treatment, patient labor, and commitment law. At the same time patients' rights demands have been partly coopted by mental health administrators. In a number to cases, mental health officials supported patients' rights litigation because it enabled them to speed up their deinstitutionalization programs. Overall, the conjuncture of the movement with economic impetus toward deinstitutionalization has allowed mental health planners to use the patients' rights issues to justify their essentially fiscal policy. Providers and administrators have set up advocacy offices, posted patients' bills of rights, and incorporated ex-patient representatives on advisory boards. Yet mental health administrators are generally opposed to a broad application of patients' rights.

Attitude of Health Personnel↗
PubMed1984

The young adult chronic patient: review and critique of the literature.

The deinstitutionalization movement has given rise to an increasing number of young adult chronic patients in the community, a situation that poses a serious problem for both psychiatry and society. It invites a reassessment of both the policy of keeping patients in the community and the manner in which it has been managed up to this point. In recent years, a number of articles dealing with the young adult chronic patient have appeared. This article will review and offer a critique of some of that literature in an effort to place "the young adult chronic" patient in better perspective in relation to the deinstitutionalization phenomenon.

Adolescent↗
PubMed2000

[Housing for psychiatric patients inside and outside of hospitals].

The reform of psychiatric services started in Germany in 1975 with the publication of the governmental "Enquete"-Report. In the area of housing for chronic patients the recommendations made 1975 have not been fulfilled. A greater number of chronic patients as planned live in institutionalised homes with little access to the community and shortcomings in the area of individual self determination. The process of deinstitutionalization of the old chronic patients from psychiatric hospitals has created new problems. Some 60,000 patients have been deinstitutionalized, but in some parts of the country to a considerable degree just by renaming parts of the hospital into a home for the disabled. There is a need for research on who lives where and how and efforts have to be made to change this situation by the development of more community centered and individualised forms of living as shown by many successfully working regions in the country.

Chronic Disease↗
PubMed2000

[Problems in the treatment of mentally ill offenders--a problem of general psychiatry?].

The special position of psychiatry among the various medical disciplines is determined not least by the phenomenon of violent behaviour of some of its patients and the possibility of coercive measures against patients. The worldwide process of deinstitutionalization since the last decades is characterized by a substantial reduction of inpatient treatment and the expansion and improvement of increasingly specialized community care offers. Yet, at the same time paradoxically we are confronted with an increasing neglect of the special care requirements of a certain group of difficult-to-place patients (mostly severely chronically ill with high rates of comorbidity). Despite different social and legal conditions this has uniformly led to an increasing shift of these patients into the forensic system which is illustrated by a comparison of international and Austrian data. Forensic psychiatry is hardly able to cope with this development because of structural and personal deficits existing and is in danger of being misused primarily as an instrument of social control. From the position of forensic psychiatry the limits of deinstitutionalization are set by the feeling of responsibility of general psychiatry for a subgroup of troublesome and difficult to treat patients.

Austria↗
PubMed2000

From psychiatric hospital to rehabilitation: the Nordic experience.

Deinstitutionalization and decentralization in psychiatry have by now been the first items of the agenda for more than 30 years. A theory of social psychiatry with social rehabilitation and reintegration was the underlying basis for the activities which should make the change from mainly inpatients to community-based outpatients treatment possible. By means of the National Danish Psychiatric Case Register this paper shows how the process mostly has concentrated on the deinstitutionalization (or reinstitutionalization?) of the old long-stay psychiatric patients. A new but smaller group of long-stay patients has appeared in the statistics. The average age of this group is 40 years compared to the old long-stay patients' average age of 60 years. It is also shown that the readmission rate during the first year after the discharge following the hospitalization during which the schizophrenia diagnosis was given for the first time ever is almost unchanged (with a small increase) for both males and females. So, in Denmark it is on average between 45% and 50% for females and males respectively. A break down on these data on counties shows that the situation varies broadly from a little over 30% for the best (mainly rural counties) to a maximum of 54%. It seems as if social psychiatry in the Nordic countries mainly concentrate on social care and only to a less degree on network, employment and other basic rehabilitation and reintegrative social work. A basis for a successful social integrative work must be a treatment initiated as early as possible with an antipsychotic treatment and maximum of compliance.

Adult↗
PubMed2000

[Hope and deficiency: community mental health and severe mental disorders].

Over the second half of the twentieth century, the way in which Canadian society treats people with mental challenges has changed radically, from exclusion and containment in asylums to reintegration and maintenance in the community. Now that deinstitutionalization is practically complete, the objective has increasingly shifted from reintegrating people with severe mental challenges in their communities to upholding their rights and ensuring that they have access to resources allowing them to assume their responsibilities and roles as citizens. This change of vision results in a completely different set of issues for community mental health. Given the prejudices surrounding mental illness, the capacity of community mental health professionals to play a mediating and facilitating role becomes a determining factor in successfully reestablishing and re-empowering people with severe mental challenges. The advances that have clearly been made give cause for hope, but in the context of the unwanted effects of deinstitutionalization and unfavourable socioeconomic conditions, significant obstacles still need to be overcome before people with severe mental challenges can participate fully in the life of the collectivity.

Canada↗
PubMed1992

[Psychiatric diseases among the homeless in Funen County].

The purpose of the study was to investigate whether deinstitutionalization of psychiatric patients had produced a clientele of homeless mentally ill people which is not treated. During week 47, 1990, 94 of the 129 residents 73%) in the institutions for homeless people in the County of Funen (population 459,000) were examined for mental illness by a psychiatrist. Diagnoses were made using the ICD-8 classification. Social data were recorded. Eighty-nine per cent were men, 59% were aged 30-49 years, 93% were single, and source of incomes for 80% were public assistance or disability pensions. More than half had been sentenced for crime at least once. The majority suffered from severe psychosocial strain. In 91% a psychiatric diagnosis was established, the most frequent being alcoholism (73%) and personality or character disorder (70%). Psychoses were found in 10 cases or 11%. About 29% required psychiatric treatment. The conclusion was that deinstitutionalization in the County of Funen had not resulted in influx of psychotic persons to institutions for the homeless people.

Adult↗
PubMed1991

Life in the community: four years after the closure of an institution.

Life experiences of 18 people 4 years after deinstitutionalization were examined. The ecological approach included observation in people's homes, interviews with the 18 individuals and people in their social networks, and a survey of other service providers. Because this research was a follow-up to an earlier study of the process of closing an institution, the findings are particularly significant for future institution closures and individual planning practices. Three major implications were noted: (a) the need to treat deinstitutionalization as a process; (b) the need to pursue alternatives to the 4- or 5-bed group home, which currently dominates community residential services; and (c) the need for community-based support services to develop new, more effective approaches to community integration.

Adult↗