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PubMed2005

The place of people with intellectual disabilities in Bandung, Indonesia.

This report is an attempt to 'make visible' people with intellectual disabilities in Bandung, Indonesia, who have been rendered invisible due the stigmatization of disabled bodies in Indonesian society. The Western concept of deinstitutionalization is not appropriate to the contemporary culture of Indonesia. Returning to the 'special schools' following completion of secondary education resolves some of the problems of social exclusion, while reinforcing other exclusionary aspects of Indonesian society. Institutionalization is seen as a privilege in the Indonesian context, as only the better off can afford the cost of placing people with intellectual disabilities in institutions.

Cultural Characteristics↗

PubMedDate not supplied

The Swedish mental health system. Past, present, and future.

In sum, the evolution, strengths, and weaknesses of the Swedish mental health system are quite similar to mental health systems in other Western countries; early reliance on stand-alone, state psychiatric hospitals, followed by deinstitutionalization and development of largely ambulatory, community mental health care. This evolution has been complicated in Sweden by the multiple levels and system components, the state, the county councils and the municipalities. Unlike the United States, but similar to Britain, community mental health care in Sweden is provided by two systems; treatment (and forensic services) by the county councils' mental health providers, and generic services by the municipalities' social welfare system. The resulting division of roles and responsibilities creates a strong need for collaboration and coordination of activities on behalf of consumers. It can also have the unintended disincentives to serving more difficult consumers. All these difficulties not withstanding, the Swedish mental health system has made major stride in providing quality, appropriate care.

Deinstitutionalization↗

PubMedDate not supplied

Police officer attitudes and use of discretion in situations involving the mentally ill. The need to narrow the focus.

Research to date has very effectively highlighted the fact that the mentally ill are vulnerable to systematic criminalization. The reasons cited for this range from decreasing mental health resources, to restrictive civil commitment statutes, to increased numbers of mentally ill citizens in the community as a result of deinstitutionalization. However, the research has also shown that the presence of a criminalization phenomenon is not yet generalizable. The prevailing research emphasizes a macro-level approach, using either archival data or large groups of police-citizen contacts without regard for factors intrinsic to the police-citizen exchange. This article examined two such variables (police-citizen contact type and police officer type) to illustrate the need to narrow the focus in the research. We contend that our emphasis moves the criminalization debate forward and helps provide a more comprehensive understanding of the interaction between the police and the mentally ill. Further, we submit that by controlling for these two variables, research findings will more likely be generalizable and replicable.

Attitude↗

PubMed2000

Caring for the patient with mental retardation in the emergency department.

There are approximately 6 million individuals with a diagnosis of mental retardation in the United States. Because of deinstitutionalization of patients with mental retardation, coupled with an increase in their life expectancy, emergency physicians are increasingly encountering and managing patients with mental retardation in the emergency department. Many emergency physicians are uncomfortable when interacting with individuals with mental retardation, which often carries over to the assessment and management of these patients in the ED. The purpose of this review is to aid the emergency physician in understanding the patient with mental retardation, their comorbid conditions, and the approach to evaluating and managing these patients in the ED.

Attitude of Health Personnel↗

PubMed1996

The association between objective and subjective caregiver burden.

Major consequences of the deinstitutionalization movement of the 1960s are the objective and subjective burdens for caregivers of individuals with chronic mental illness. The purpose of this report is to describe the association between the objective and subjective caregiver burdens. Objective caregiver burden is comprised of those tasks required to care for the client, whereas subjective caregiver burden indicates the extent to which the caregiver "minds" performing these tasks. The design is a longitudinal, quasi-experimental study over a 3-year period, i.e., three waves of data were collected between 1991 to 1994. Data were collected via a telephone interview schedule. Both quantitative and qualitative data are reported. The association between objective and subjective burdens is complex. Findings show that although there are many tasks required in the taking care of the client, the caregiver accepts these tasks. The problem occurs with the uncooperative nature of the client in allowing the caregiver to carry out the tasks. The caregiver-client conflict involving excessive demands and embarrassment results in increased subjective burden.

Activities of Daily Living↗

PubMed1997

Down syndrome: a review of the literature.

This review of the literature on Down syndrome focuses on various systemic anomalies and oral anomalies, its clinical manifestations, and recommendations for persons with Down syndrome. From the time Down syndrome was diagnosed by phenotype to the present when karyotyping distinguishes chromosomal subgroups, increasingly sophisticated tests and treatments have influenced the lives of Down syndrome patients. Medical advances, special educational programs, and increasing social acceptance of disabled people in the community have resulted in current trends of normalization and deinstitutionalization of these patients. Once a dentist is familiar with a patient's medical history and takes needed precautions, these patients can be treated routinely in a dental office.

Abnormalities, Multiple↗

PubMed2000

'Building up safe havens... around the world': users' experiences of living in the community with mental health problems.

Deinstitutionalization moved the focus of psychiatric care away from hospital institutions to community settings. Mental health services are no longer driven by a policy of illness containment, although detention and coercion retain legislative and cultural legitimacy, because the conceptual and practical focus of caring for people in the 1990s is built around journeys to(wards) ordinary 'independent' living. This paper draws upon the experiences of people with enduring mental health problems to explore the positions, roles and therapeutic benefits established by socio-spatial networking in the community. Social isolation and community integration are polar extremes, two very different 'locations' on a 'theoretical' rehabilitation pathway shaping mental health policy and community care practices. The paper assesses these two locations and searches for the middle-ground in practice. It draws on the concept of normality to compare service user and professional perspectives on the rehabilitation process. The paper argues, with optimism, that spaces of rehabilitation are being found 'in the community' but notes that until mental illness is de-stigmatised and society celebrates difference, creating space for 'Mad Pride', the post-asylum landscape must continue to evolve in search of models of good community care practice and potential landscapes of caring. The research presented in the paper was carried out with Rehabilitation and Community Care Services (RCCS) in Nottingham (1994-1997), and is based upon fieldwork observations and in-depth interviews with RCCS staff and 25 service users.

Activities of Daily Living↗

PubMed2000

Interpreting the 'hidden social geographies' of mental health: ethnographies of inclusion and exclusion in semi-institutional places.

This paper critically evaluates, through use of covert ethnographic materials, an inner-city drop-in as a semi-institutional place where the identities of people with mental health problems are influenced by social processes of inclusion and exclusion. It is demonstrated, through an in-depth interpretative approach, that it is possible to understand more about the micro-geographies which make up deinstitutionalized landscapes, and about the social relations which characterise these. Key to this paper are findings which indicate that people with mental health problems cannot be understood as a straightforwardly homogeneous 'excluded' grouping, and that mainstream processes of boundary maintenance are in operation among these constructed 'others'.

Anthropology, Cultural↗

PubMed2000

Risk and protection: the discourse of confinement in contemporary mental health policy.

Confinement has regained respectability in the discourses of contemporary UK mental health policy. This development reflects concern about violent offences by people with mental health problems and is rooted in claims about the 'failure' of community care. Confinement is presented as a strategic response to the risks and dangers posed by particular fractions of the population of mental health service users. Using two key policy statements issued by the Department of Health and associated discussions in the health services management press, the confinement theme is explored and assessed. The paper notes its emergence as a consequence of the spatial impacts of deinstitutionalization and its specific origins in response to violent offences by people with mental health problems. The notion that the growing emphasis on confinement presages a return to the asylum is considered and rejected. Rather, the paper stresses the importance of discourses of protection, safety, risk and dangerousness in understanding the turn to confinement.

Commitment of Persons with Psychiatric Disorders↗

PubMed1997

Behind the crumbling walls; the re-working of a former asylum's geography.

This paper attempts to examine the effects of deinstitutionalization on a former asylum's human and physical geography, through a case study of St Lawrence's Hospital, Bodmin, UK. It researches the inevitably impermanent geography of an asylum in the process of being 'run down'. The paper includes an empirical account of the rationalization of a former asylum, reconstructing an east to west migration of activities across the site. It deals with St Lawrence's as a 'stigmatized' place unable to escape the mark of its asylum past, and as a place that staff and local people cannot imagine being used for anything other than land uses associated with 'mad people' or other marginal groups in society. The paper deals with how St Lawrence's is regarded by some as a 'community', people who recall with a measure of affection how the asylum used to be a 'home' as well as a 'workplace', a nostalgia which rebounds into suspicion about the dismantling process. Fundamentally, the paper aims to tease out and work through the hopes and fears that now surround the former asylum's environment.

Community-Institutional Relations↗

PubMed1998

The geography of mental health in Dunedin, New Zealand.

The process of deinstitutionalization of people with chronic mental disabilities in Western countries has often produced a spatial concentration of ex-psychiatric patients, and of mental health services, in inner city urban neighbourhoods. In this paper, the geography of mental health services and patients in Dunedin is examined, and it is shown that a concentration does exist in one neighbourhood. The history and characteristics of this neighbourhood are described. The key factors in contemporary New Zealand that have generated this spatial pattern are then considered, and Dunedin's centralized mental health geography is contrasted with the North American "zone of dependence" phenomenon. The paper concludes by considering to what extent Dunedin's emergent geography of mental health provides a supportive environment for people with mental illnesses, and exploring the policy implications for health care planners and service providers.

Community Mental Health Centers↗

PubMed2001

Symptom severity and personal functioning among patients with schizophrenia discharged from long-term hospital care into the community.

Twenty recently deinstitutionalized residents of a 24-hour staffed community residential unit were assessed using measures of symptoms and functioning on two occasions one year apart. Overall inter-clinician agreements in ratings were good, but clinicians agreed more in their ratings of positive than of negative symptoms of schizophrenia. Levels of symptoms (measured with the Positive and Negative Syndrome Scale) and functioning (measured with the Multnomah Community Ability Scale) were similar to those of comparable groups of patients, and were moderately related, sharing approximately 50% of variance. For the whole group, mean measures of symptoms and functioning were generally unchanged at one year, with retest measures of symptoms more stable than measures of functioning.

Adult↗

PubMed2002

Community forensic psychiatry: restoring some sanity to forensic psychiatric rehabilitation.

OBJECTIVE: To review clinical and legal paradigms of community forensic mental health care, with specific focus on New Zealand, and to develop a clinically based set of guiding principles for service development in this area. METHOD: The general principles of rehabilitating mentally disordered offenders, and assertive community care programmes were reviewed and applied to the law and policy in a New Zealand forensic mental health setting. RESULTS: There is a need to develop comprehensive community treatment programmes for mentally disordered offenders. The limited available research supports assertive community treatment models, with specialist forensic input. Ten clinically based principles of care provision important to forensic mental health assertive community treatment were developed. CONCLUSION: Deinstitutionalization in forensic psychiatry lags behind the rest of psychiatry, but can only occur with well-supported systems in place to assess and manage risk in the community setting. The development of community-based forensic rehabilitation services in conjunction with general mental health is indicated.

Community Mental Health Services↗

PubMed1989

Private-sector care for chronically mentally ill individuals. The more things change, the more they stay the same.

Two profit-making industries, nursing homes and board-and-care homes, care for about one million chronic mental patients. This care is primarily custodial and probably not very different from the care patients received in the public sector prior to deinstitutionalization. Moreover, certain characteristics of privately owned facilities encourage poor patient care so as to maximize profit. The problem could be ameliorated if chronic mental patients were strong and informed consumers or if the public sector strongly regulated proprietary care. However, neither of these two conditions now hold. Perhaps the apparent difficulties in significantly improving care for chronically mentally ill individuals despite seemingly major changes in policy reflect a fundamental problem in overall social policy--a reluctance to care for chronically indigent individuals of all kinds.

Chronic Disease↗

PubMed1992

Why the gap? Practice and policy in civil commitment hearings.

The failure of civil commitment procedures to meet statutory requirements is one of the more reliable findings in the applied social sciences. Most states now require specific legal procedures and behavioral standards for involuntary hospitalization. Nonetheless, empirical studies have demonstrated that commitment hearings are rarely adversarial and clinical concerns continue to take precedence over legal issues. These findings are analyzed in the context of three related issues: the grounds for commitment that are used in civil commitment hearings, the particular difficulties of recommitment hearings, and the shortcomings of the national policy of deinstitutionalization. The authors conclude that a primary cause of the gap between legal standards and actual practice is the absence of viable, less restrictive alternatives to inpatient treatment.

Commitment of Persons with Psychiatric Disorders↗

PubMed1993

The role of psychologists in the treatment, management, and prevention of chronic mental illness.

In addition to suffering from the severe psychiatric symptoms of chronic mental illness (CMI), people with this type of disorder suffer from a variety of secondary disabilities and face societal obstacles that interfere with their ability to maximize their personal, social, and vocational potentials. Following the deinstitutionalization of long-term psychiatric patients in recent decades, many different understandings of the etiology, treatment, and management of CMI have evolved, including those derived from the biological, vulnerability, cognitive, case management, rehabilitation, and psychoeducational models. Because psychologists are trained in a wide range of psychological theories and a broad repertoire of applications, they have unique contributions to make within each model, particularly, as discussed here, to prevent, treat, and manage CMI through research, assessment, and intervention.

Chronic Disease↗

PubMed1993

Institutional racism: an analysis of the mental health system.

Institutional racism is defined and its conceptual application to the institution of psychiatry and the mental health system is described. Data on changes in the patient population and the provision and utilization of mental health services since deinstitutionalization are examined. Mental health policy and diagnostic and treatment issues are identified as areas in which institutional racism affects minority groups.

Deinstitutionalization↗

PubMed2000

BIOMED-MEROPE project: service provision for adults with intellectual disability: a European comparison.

The aim of the present paper is to describe and compare services for adults with intellectual disability (ID) and mental health needs in five European countries: Austria, England, Greece, Ireland and Spain. A framework and structure for collecting information about service provision was designed. This information was collected through a mixture of interviews with service providers, questionnaires and a review of the research literature within each country. Information was collected on historical context, policy, legislation, assessment, treatment and the structure of services for people with ID and mental health problems. Overall, the needs of those with additional mental health needs have not been specifically addressed at a national level with perhaps the exception of England and Ireland, although there are still gaps in services in these nations. Normalization has been adopted in each of the five countries, and there are moves toward deinstitutionalization, integration and inclusion. Families and self-advocacy groups have grown. The pace of this change varies between and even within countries. The main findings of the study include: unclear policy, trends for legislative changes, increased prevalence of mental health problems, inadequate generic service provision, a need for specialist mental health services, a need for improved interconnections of services, and a need for training developments. Policy and legislation in the five European countries under consideration tend to separate the disability aspects of people with ID from their mental health needs. Consequently, the service needs of this group remain largely invisible. This might be a direct reflection of policy clarity and legislation, or could be the result of a failure to implement existing guidelines. This has a detrimental effect on the lives of people with ID, and their families and carers.

Adult↗