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PubMed1990

A comparison of civil patients and incompetent defendants: pre and post deinstitutionalization.

There has been a great deal of speculation that deinstitutionalization has resulted in the criminalization of the mentally ill. Using two samples of defendants found incompetent to stand trial (IST) and two samples of civil patients randomly selected from five states, pre and post deinstitutionalization, this research compares changes in their mental health and arrest histories. After deinstitutionalization, fewer and less dramatic differences in the arrest and mental health histories were evident between ISTs and civil patients. Both patient samples displayed significant increases in prior hospitalization and arrest histories. Among the civil patients there was a significant increase in the frequency and seriousness of criminal activity. There was no evidence that IST commitments are being expanded to hospitalize the nondangerous mentally ill no longer subject to civil commitment.

Civil Rights↗
PubMed1977

Deinstitutionalization of mental health services in rural areas.

While the deinstitutionalization movement in both urban and rural areas has been plagued by problems, the author feels that they are exaggerated in rural communities and are complicated by such factors as the essentially urban nature of the deinstitutionalization model, the unique demographic conditions of rural America, and the lack of anonymity in rural communities. However, rurality also has several advantages for the deinstitutionalization movement, including the existence of a strong sense of community, and the increased opportunity for the therapist to know personally the patient, his family, and his friends and thus to make more humane decisions concerning his treatment.

Community Mental Health Services↗
PubMed1988

The Community Placement Scale: an adaptation of the Community Competence Scale for placement of the deinstitutionalized mentally ill.

The Community Placement Scale (CPS), an abbreviated form of the Community Competence Scale (Anderten, 1979) suitable for placement of deinstitutionalized mental patients in the community, was developed in a combined sample of 87 subjects placed in the community in California and Missouri. Although the Community Competence Scale has shown considerable promise as a placement instrument with the deinstitutionalized mentally ill, a briefer measure is needed in order to increase acceptance by both patients and professional staff. Other improvements sought were determining the acceptability of items to placement personnel nationwide, eliminating nondiscriminating items, and heightening internal consistency reliability of subscales. In a series of discriminant analyses, remaining subscales were used to predict community placement with minimal and maximal degrees of structure. From these analyses, a measure that consisted of 5 subscales and 41 items and required approximately 20 minutes to administer was selected. This short form has many similarities to and a few important differences from the previously published short form.

Adult↗
PubMed1979

Unexpected consequences of deinstitutionalization of the mentally disabled elderly.

An unexpected consequence of the rapid deinstitutionalization of state mental hospital patients has been a sharp rise in posttransfer mortality among the elderly. Considerable evidence suggests that outcome is mediated by two factors. Elderly patients with certain characteristics - especially physical frailty and severe cognitive impairement - comprise a high-risk subgroup for whom relocation is likely to be fatal. Among other elderly persons, environmental, personality and personality-environment congruence are associated with posttransfer prognosis. The studies reviewed indicate that the therapeutic value of deinstitutionalization for mentally disabled elderly persons is problematic.

Aged↗
PubMed1982

Criteria for success in deinstitutionalization: perceptions of nursing homes by different interest groups.

Studies of deinstitutionalization often use a limited set of criteria by which to judge success. Social integration and recidivism, for example, are particularly popular criteria. Yet such criteria may not reflect the diverse settings in which community care occurs, nor the diverse views of success held by different interest groups. The present study presents a methodology for developing more comprehensive criteria for evaluating social programs, including deinstitutionalization. The methodology is illustrated by analyzing the perceptions of different interest groups about the nature of successful care for mental patients in nursing homes.

Attitude of Health Personnel↗
PubMed1986

The community competence scale in the placement of the deinstitutionalized mentally ill.

Little systematic research has been directed towards the determination of appropriate residential placements for deinstitutionalized psychiatric patients. A previous study suggested that the Community Competence Scale (CCS), a 124-item multiscale instrument, had potential utility for community placement decisions. In the present study, the CCS was administered to 52 deinstitutionalized patients placed in an urban boarding home, a rural boarding home, and urban apartments. No significant differences on the CCS occurred attributable to urban vs. rural setting; accordingly, the urban and rural boarding home groups were combined. The CCS discriminated between patients placed in boarding home and apartment settings after variability between the groups associated with age and diagnosis had been removed. The CCS discriminated more effectively between the groups than did prior hospitalization, subsequent rehospitalization, or the Social Competence Scale (SCS). The CCS was significantly positively correlated with the SCS and significantly negatively correlated with previous hospitalization and age.

Adult↗
PubMed2002

Costs of deinstitutionalization in a rural catchment area in The Netherlands.

BACKGROUND: In contrast to many other countries, The Netherlands left the initiative in deinstitutionalizing mental health care to the traditional providers of mental health services. The goal of this study is to determine the effect of this policy on the allocation of mental health care resources to services. METHOD: All 20- to 64-year old users and their use of community- and hospital-based services between 1990 and 1999 were retrieved from the Groningen case register. Service utilization was combined with the direct unit costs of these services for the 1999 price level. Changes in the population as to size and age were taken into account. RESULTS: In 1999 the direct costs of mental health care were Euro 268 per adult inhabitant of the register area, which is 9% higher than in 1990. Costs increased most in the early 1990s before deinstitutionalization policy took effect. From 1993 and onwards the reduced length of stay in the hospital was the main cause for the decreased costs of in-patient care. These savings equalled the increased expenditures for day-treatment, sheltered residences and home-treatment, even though the unit costs of these types of community care are much lower than the unit costs of admissions. This was not caused by an increasing number of new clients, but was a result of longer periods of care during a larger number of years. CONCLUSIONS: These findings are in accordance with Dutch mental health care policy, which aims at prolonged care and aftercare outside the hospital whenever possible.

Adult↗
PubMed2003

Schizophrenic patients in different treatment settings during the era of deinstitutionalization: three-year follow-up of three discharge cohorts in Finland.

OBJECTIVE: We investigated differences in psychosocial and clinical characteristics, as well as the use of services, of schizophrenic patients in different treatment settings three years after their discharge from a psychiatric hospital. Furthermore, we examined secular changes in these phenomena during the era of rapid deinstitutionalization in Finland. METHOD: Three nationally representative samples comprised 3257 schizophrenic patients who had been discharged in 1986, 1990 and 1994. The patients were interviewed three years after discharge by each district's psychiatric professionals using a structured interview schedule specifically designed for the purposes of the present study. Psychosocial functioning was assessed on the Global Assessment Scale and on a modified version of the Medical Research Council Practices Profile. RESULTS: In the 1990s, more patients with a poor clinical and psychosocial state were transferred from hospital to alternative outpatient facilities, such as sheltered workshops or supported residences. In successive cohorts, the proportion of patients who had dropped out of treatment decreased and the psychiatric and somatic state of the drop-outs improved. CONCLUSION: In general, the psychiatric treatment system has worked well for most deinstitutionalized patients. In the future, however, it is important that the quality of care and adequate resources in the alternative outpatient facilities are ensured.

Adolescent↗
PubMed2006

[Deinstitutionalization of long-stay psychiatric patients in upper Austria -- utilization of healthcare resources and costs of outpatient care].

OBJECTIVE: The study was intended to evaluate the therapeutic and healthcare services utilized by 116 former long-stay patients after an average of 42.9 months of deinstitutionalization during a follow-up time of (1/2) year and to calculate the costs thus incurred. METHODS: 116 patients and their caregivers were interviewed during a period of 6 months using the German version of the Client Sociodemographic and Service Receipt Inventory. RESULTS: On average, 3.3 institutions/facilities were contacted per patient, most often by younger patients living in group homes and least often by patients in psychiatric nursing homes. During the 6-month follow-up time costs of euro 14,665 were incurred per patient. Of these costs, 87.2 % were for the residential facilities. The costs of outpatient care accounted for 41.4 % of the costs that would have been incurred for inpatient care in a psychiatric hospital. CONCLUSIONS: Deinstitutionalization of psychiatric long-stay patients in Upper Austria provided for considerable reductions in costs while maintaining a high quality of care.

Adult↗
PubMed1987

Deinstitutionalization of the mentally ill: oversimplification of complex issues.

Deinstitutionalization is the predominant public mental health policy in most states. An analysis of this policy in one state from a political-economic perspective gives support to the hypothesis that deinstitutionalization results in a two-class system of mental health care based upon the client's ability to pay. Inequalities exist in opportunities for care that are appropriate for the pathology suffered by the chronically mentally ill, and patients' basic needs are often unmet. Corporate actors involved in developing mental health policy overpower clients as well as nurses in the distributive process. The impact of this policy on quality of care and nursing is significant.

Deinstitutionalization↗
PubMed1995

The effects of deinstitutionalization on adults with learning disabilities.

We compared a group of people with learning disabilities who have been deinstitutionalized with a control group remaining in an institution on measures of adaptive and maladaptive behaviour, community living skills, social skills, and quality of life. In general, there was no change over 30 months for the control group. Changes for the experimental group were either not seen or were generally modest in scale, and tended to occur within 6 months of moving, the measures staying relatively stable thereafter. Implications for detailed examination of the effects of deinstitutionalization were discussed.

Activities of Daily Living↗
PubMed1981

Death and deinstitutionalization.

Death rates during a period of rapid deinstitutionalization of a state mental hospital population showed consistent reductions that were statistically significant in the elderly patient population 65 years and older. These reductions were most marked for deaths due to pneumonia; there was a moderate decrease in cardiac deaths, and essentially no change in cancer death rates. The findings suggest that through a variety of mechanisms deinstitutionalization may have had a beneficial effect on the mortality of elderly patients who remained hospitalized. Moreover, the resultant increased need for beds for these patients dramatizes the importance for program planners to base their projections for hospital use on a continuing analysis of trends rather than on static data.

Adolescent↗
PubMed1990

Second-generation deinstitutionalization, I: The impact of Brewster v. Dukakis on state hospital case mix.

A 1978 consent decree affecting one region of Massachusetts mandated a drastic reduction of census at its state hospital, where considerable deinstitutionalization had already occurred over the prior two decades. The transfer of patients from hospital to community was to be accomplished through the unprecedented expansion of community resources. This second-generation deinstitutionalization effort achieved substantial census reduction but less than was envisioned. It was most effective in discharging geriatric and mentally retarded patients but far less effective with longterm and new chronic patients, many of whom continue to require repeated hospitalizations despite the availability of a comprehensive array of community-based services.

Adolescent↗
PubMed1980

The impact of deinstitutionalization on the general hospital psychiatric emergency ward.

To delineate the role of a general hospital emergency ward in the treatment of deinstitutionalized patients, the author analyzed the demographic and clinical characteristics of a systematic sample of 663 patients appearing for emergency ward treatment over a four-year period between 1972 and 1976. Yearly comparisons of the data were made to identify changing trends in the patient population. Variables studied generally remained constant from 1972 through 1975, but by 1976 several important changes were noted, among them an increase in the number of patients previously hospitalized in state facilities, a marked decrease in patients with no previous hospitalizations, and an increase in patients exhibiting psychotic behavior. The author considers the factors that may have contributed to the delay in the arrival of deinstitutionalized patients at the emergency ward. She also emphasizes the need for general hospitals to develop and implement comprehensive programs for the management of the increasing numbers of sicker patients appearing for treatment.

Adult↗
PubMed1981

The effects of deinstitutionalization on general hospital psychiatry.

As deinstitutionalization has proceeded, it has left in its wake a variety of basic changes in patterns of service delivery to chronic mental patients. Although all components of the psychiatric service system have been affected by the diminishing utilization of state mental hospitals, changes are perhaps most marked in the psychiatric services of general hospitals. The effects of deinstitutionalization on general hospital psychiatry are examined, and some future implications are discussed.

Deinstitutionalization↗
PubMed1982

Promoting community involvement in deinstitutionalization planning: the experience in one community.

The presence of large numbers of former mental patients in the community has forced municipal governments to become aware of the deinstitutionalization process. Many, such as in Asbury Park, New Jersey, have voiced strong criticism of the process and have resisted the influx of patients. In 1979 the city was selected by the state mental health authority to work with the Urban Health Institute, a nonprofit health care consulting firm, in a project designed to encourage local planning and resource development for deinstitutionalized mental patients. The authors describe how the project, using traditional community organizing techniques, worked to reduce conflict and to create an atmosphere in which positive local planning for these patients became possible.

Community Mental Health Services↗
PubMed1983

Deinstitutionalization: the data demythologized.

Many past studies of data on deinstitutionalization have used an overly simplistic and often misleading approach, which has led to a number of "myths" of deinstitutionalization. The authors present data on the changing mental health service system collected by the Division of Biometry and Epidemiology of the National Institute of Mental Health, and they analyze the data to reveal trends that disprove a number of the commonly accepted myths. Through their analysis they show that outpatient care has not replaced inpatient care, that public institutions, particularly state mental hospitals, have not been replaced by community-based facilities, and that private resources have not replaced public ones as the bearer of the cost of caring for the mentally ill. They conclude that the availability and quality of mental health services and the effect of these services on patients and their communities are difficult issues for future research.

Community Mental Health Services↗
PubMed1983

Deinstitutionalization and the private general hospital inpatient unit: implications for clinical care.

Deinstitutionalization has led to a rapid shift from reliance on state hospitals to use of community-based inpatient psychiatric services. While these inpatient units were initially envisioned as an integral part of the community mental health system, a number of sociopolitical and clinical pressures have caused general hospitals to respond to their new responsibilities in different ways. The authors review trends in deinstitutionalization, the diverging interests of public and private general hospitals, and problems in patient care that result. Based on a discussion of how Beth Israel Hospital, a nonprofit private general hospital in Boston, has dealt with such issues, they describe adaptive responses in four areas: admission criteria, patient management approaches, aftercare planning, and staff training.

Aftercare↗