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PubMed2000

Utilization of local jails and general hospitals by state psychiatric center patients.

The idea that the deinstitutionalization of state psychiatric centers has resulted in increased utilization of general hospitals and correctional facilities by people with severe and persistent mental illness is widely held. This hypothesis of trans-institutionalization was tested by examining hospitalization and incarceration rates of people who had been or would be institutionalized in state psychiatric centers in 16 upstate New York counties. The results do not support the hypothesis of trans-institutionalization. Assumptions underlying the hypothesis are examined, potential explanations for the observed patterns are discussed, and areas for further research are suggested.

Cohort Studies↗
PubMed1993

Developing community-based program alternatives for the seriously and persistently mentally ill elderly.

The deinstitutionalization movement in the United States has traditionally neglected the rehabilitation potential of the seriously mentally ill elderly. With the proliferation of the elderly population, unique programs and community-based settings must be created and expanded to meet the mental health needs of this population in a cost-effective and humane manner. The mental health continuum presented is a model composed of programs that target the seriously mentally ill elderly in a variety of community placements including residential treatment facilities, nursing homes, retirement homes, and permanent housing.

Aged↗
PubMed1990

Synthesis of research on the costs of institutional and community-based care.

Cost studies in the long-term care field are reviewed, with emphasis on those relating to people with developmental disabilities. Studies frequently stressed the cost-effectiveness of community programs but often had significant methodological problems. Among the predominant findings in the literature were: 1) the generally lower average costs per client in community programs versus institutional programs; 2) unexplained wide cost ranges in similar community programs; and 3) significant cost shifts among federal, state, and local governments associated with deinstitutionalization initiatives. The implications of these findings for public officials and the advocacy community are discussed.

Community Mental Health Services↗
PubMed1992

Comprehensive care of pregnant mentally ill women.

Since the onset of deinstitutionalization, there has been an unanticipated and dramatic increase in pregnancies among women with chronic mental illness, with no specific planning for how to address the unique clinical needs of this high-risk population. Shortcomings in delivering care to mentally ill women within general health care systems are reviewed, including failure to assist with family planning, failure to observe worsening mental health during pregnancy, inadequate planning for child custody, lack of access to services, and omitted pelvic examinations. Necessary components of a system to provide comprehensive and coordinated care for pregnant mentally ill women are described. These include assessment of adaptation to pregnancy and competency to care for an infant, somatic and psychotherapeutic treatment, parenting skills training, family planning services, outreach, and close liaison with obstetric services. A Chicago-based collaborative program is described as an example of providing comprehensive, specialized care with limited financial resources.

Chicago↗
PubMed2001

From long-stay psychiatric hospital to Community Care Unit: evaluation at 1 year.

BACKGROUND: In the context of deinstitutionalization of psychiatric services, Community Care Units (CCUs) were developed to provide accommodation, clinical care and rehabilitation for patients discharged from the long-stay open wards of a large psychiatric hospital that was in the process of closing. CCUs are 20-bed units built in suburban locations and staffed on a 24-h basis by multidisciplinary clinical teams. METHOD: An initial group of 125 hospital patients was assessed at 1 month pre-move, 1 month post-move, and again at 1 year, on range of measures covering clinical status, personal functioning, quality of life, residential preferences, aggressive behaviour, and social networks. Staff attitudes, relative and carer perceptions and preferences, and residential environments were also assessed. RESULTS: Most of the transferred patients were still resident in their CCU at 1 year. The clearest result was that patients showed improved quality of life in relation to their living environment. Comparison of the hospital and CCU environments showed that the latter were significantly less restrictive and regimented. Most relatives and carers also preferred the CCU. On average, symptom and disability levels were little changed at 1 year. CONCLUSIONS: Our results suggest that the CCU is an appropriate form of service delivery for most long-stay hospital inpatients, but that both more and less supervised settings are also required. While symptoms and disability were little changed at 1 year, it is possible that further follow-up may detect delayed or slow changes. Given the widespread replacement of psychiatric hospitals with community-based services, the future role of the CCU needs to be reviewed.

Adult↗
PubMed2005

The context of caretaking in rural areas: family factors influencing the level of functioning of seriously mentally ill patients living at home.

After the deinstitutionalization of psychiatric hospitals, many families became primary caregivers for seriously mentally ill individuals. Mental health services became further reduced with the advent of managed care and reductions in health and mental health care. The dearth of community-care options often results in psychiatric patients being quickly stabilized in hospital units and discharged to live with their families. The lack of community resources is particularly acute in rural areas. Given these realities the current study sought to determine if family caretaking variables are related to patient outcomes. Family factors including the perception of burden, expressed emotion (EE), and primary caregivers' social support were tested in a model of caretaking that examines the relationship between these factors and patients' symptom expression and social and occupational functioning. The sample includes 49 predominantly African American families living in a rural area and with a chronically ill family member who had been previously diagnosed with a psychotic disorder. Primary caregivers and patients were interviewed using adapted measures of burden, EE, and social support. Patients were administered a revised version of the Brief Psychiatric Rating Scale. Results suggest less perceived burden, increased caregiver support and, to a lesser extent, EE explain approximately one-fifth of the variance in patient functioning. These results support previous research demonstrating the importance of family factors for seriously mentally ill patient outcomes. Results are discussed in terms of implications for assisting families in the current era of diminished resources.

Activities of Daily Living↗
PubMed2006

Does systems integration affect continuity of mental health care?

Continuity of care is a concern for mental health clients in the post deinstitutionalization era of community care. A proposed solution is systems integration. This paper reviewed research on systems integration, focusing on continuity of care outcomes. A positive association between systems integration and client continuity of care was consistently demonstrated. Better results were obtained in systems characterized by stronger management arrangements, fewer service sectors, and system wide implementation of intensive case management and centralized access to services. Future research should evaluate a wider range of systems integrating mechanisms, using client-based measures that more directly represent continuity of care experiences.

Case Management↗
PubMed2006

Clinical characteristics and objective living conditions in relation to quality of life among community-based individuals of schizophrenia in Hong Kong.

Quality of life (QOL) has gained importance as an outcome measure for people with schizophrenia living in the community following deinstitutionalization. This study aims at exploring the effects of clinical characteristics and objective living conditions on QOL. In this study, 201 community-based individuals with schizophrenia were recruited from five different types of objective living conditions comprising long stay care home, halfway house, supported hostel/housing, living with family, and living alone. Clinical characteristics including cognitive abilities, symptom levels, and community/social functioning were assessed by the Allen Cognitive Level Screen, the Scales for the Assessment of Negative Symptoms and Positive Symptoms, and the Chinese version of the Multnomah Community Ability Scale respectively. The outcome measure of QOL was measured by the Chinese version of the WHO Quality of Life Measure. Analysis of covariance showed significant differences in community/social functioning, cognitive abilities, and negative symptoms; but not in QOL under different objective living conditions. Further simultaneous multiple regressions found out that community/social functioning was the robust significant predictor of QOL. Yet caution should be noted in making the conclusion with the objective living condition of long stay care home, as it provides a protective element for the perseverance of QOL.

Adult↗
PubMedDate not supplied

The feasibility of suicide rates as an evaluation criterion in community psychiatry: methodological problems.

Over the last 30-40 years the reform of psychiatric care in many countries has led to deinstitutionalization and treatment of many patients in community psychiatric services. There is an ongoing discussion on whether this process may lead to a higher suicide rate. There are only a few studies addressing this issue, and empirical data are scarce. Several methodological problems make it difficult to use suicide rates as an evaluation criterion for community psychiatry. These problems are briefly discussed.

Berlin↗
PubMed1984

A chance-constrained multiobjective model for mental health services planning.

Mental health services planning, and particularly the planning for deinstitutionalization, is a very complex problem. This paper suggests a chance-constrained goal programming (CCGP) approach to mental health services planning. The CCGP approach is based on the sequential solution of a linear programming formulation, allowing efficient solution of large-scale planning problems using commercially available linear programming computer codes. The procedure is demonstrated with a case example and implementation of the approach is discussed.

Deinstitutionalization↗
PubMed1985

Client progress toward referral for discharge to the community: an illustration of an evaluation technique.

Data on referral and discharge from a short-term habilitative facility are used to illustrate the "survival analysis" of the rate at which institutionalized mentally retarded persons are released to the community and regression analysis of factors which help predict time to release. These techniques can be used to assess the degree to which habilitative facilities and community agencies achieve their stated goals, to help community agencies plan placement requirements, to compare the progress of various subgroups of clients, and to assess the overall benefit of deinstitutionalization efforts for the entire population at which it is aimed.

Adolescent↗
PubMed1982

Community acceptance of residential programs for developmentally disabled persons.

Deinstitutionalization and the ensuing establishment of residence programs for developmentally disabled persons has stimulated both community support and opposition. The present study considers changes in the levels of community acceptance after residence programs are established, sources of program support and opposition, and strategies used to overcome community opposition. The data are based upon responses to a survey of all community residence programs in New York (n = 459). The findings indicate marked and consistent shifts toward the acceptance of established residence programs.

Adult↗
PubMed1985

The Lifestyle Satisfaction Scale (LSS): assessing individuals' satisfaction with residence, community setting, and associated services.

Satisfaction of mentally retarded persons with their quality of life is an important outcome measure of deinstitutionalization. The Lifestyle Satisfaction Scale (LSS) was developed to assess mentally retarded persons' satisfaction with their residence and its community setting and associated services. An acquiescence subscale makes it possible to correct satisfaction scores for acquiescence bias. Empirical data indicate that this experimental version of the LSS has internally consistent subscales and good test-retest and interrater reliabilities.

Adult↗
PubMed1990

Modeling the growth of long-stay populations in public mental hospitals.

Long-stay, chronic patients have been a problematic subpopulation in public mental hospitals for over a century. Despite three decades of deinstitutionalization and a major shift toward shorter episodes of hospitalization, there continues to exist a group of patients who experience lengthy hospital stays. As the number of such patients increases in a facility, its ability to provide acute care may be compromised, and the size of this subpopulation must therefore be anticipated. This paper examines the length-of-stay patterns of a sample of public mental hospital admissions through the use of life table analysis, and develops a dynamic modeling algorithm using sample survival function values. Life table analysis revealed a declining hazard function, indicating a diminishing probability of discharge with increased hospital stay. The dynamic model showed that, after 2 years of operation of a hypothetical facility, current length-of-stay patterns would generate an inpatient population 40% of which had been hospitalized for over 6 months. Goodness-of-fit tests comparing the algorithm's forecast with actual hospital utilization data showed its predictions to be reliable. The authors discuss the use of this methodology to anticipate the effects of programmatic or other types of changes in mental hospitals, and also suggest other types of settings where such modeling techniques might profitably be applied.

Algorithms↗
PubMed1994

A nurse-managed inpatient program for patients with chronic mental disorders.

The deinstitutionalization movement has left a legacy of need for appropriate care for inpatients with chronic refractory mental illness. This article describes a nurse managed program for such patients based on the principles of a therapeutic milieu. The program was formally defined for a 6-month period with an effort to include outcome measures for program evaluation. Multidisciplinary treatment team planning with a psychiatric nursing clinical specialist as team leader provided a format for putting therapeutic concepts into practice. The nurse clinical specialist and two nurse practitioners served as case managers as well as primary care providers. Program evaluation showed that cost-effective quality care could be achieved with a reduction in polypharmacy and overall neuroleptic usage. The notion of a restraint appropriate environment, with the goal of minimizing restraint use, was introduced and put into practice.

Adult↗
PubMed1987

Wyatt v. Stickney: a consent decree.

On September 22, 1986, Judge Myron Thompson issued a consent decree in the Wyatt v. Stickney litigation. The settlement occurred 14 years after Judge Frank M. Johnson, Jr. rendered his landmark decision in this case. The consent decree included termination of the court's active supervision of the state's mental health system, termination of the receivership, and termination of the court monitor's powers. The state agreed to adhere to Wyatt standards, maintain Title XIX accreditation, continue deinstitutionalization efforts, and develop an internal advocacy and quality assurance program. Mechanisms are also to be put in place to apprise the plaintiffs' attorneys of progress in these efforts.

Alabama↗
PubMed1992

Behavior analysis of residential program development.

When institutions are viewed not as locales but as forms of organizing and regulating human behavior, we see that we "deinstitutionalize" by changing the way we organize and regulate, not necessarily by moving people about. This paper examines residential program development as a process of designing and developing community learning environments. The paper asks "What are the essential behaviors of designing community environments?", that is, what do residential program developers do? Six essential dimensions of program development are identified, and each dimension is critiqued in terms of contemporary practices and needs for innovation. The paper concludes that behavior analysts can play an important role in changing the nature of human service organizations.

Activities of Daily Living↗
PubMed2005

Acquiring medical services for individuals with mental retardation in community-based housing facilities.

As a result of deinstitutionalization, individuals with mental retardation (MR) were moved into the community and primary care practices. Residential agency directors now routinely determine health care decisions. Understanding of issues involved in acquiring services and the clinical decision-making experiences of 13 service agency directors representing 1,400 individuals with MR were investigated. This descriptive study with a qualitative exploratory design included structured interviews that were content analyzed. Four themes describe the barriers encountered, which resulted in the delay or denial of appropriate health services. These themes include effects of stigma, knowledge limitations, resource deficits, and inconsistent decision making. Knowledge of these experiences will assist nurses in problem solving and advocating for the holistic competent care of individuals with MR.

Community Health Services↗