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PubMed1982

The impact of schizophrenia on families: one mother's point of view.

The practical consequences of deinstitutionalization upon the families of the mentally ill are discussed. Not only is adequate care frequently lacking for the ill family member, but the families of the mentally ill often find themselves alone in their caretaking roles. The growing importance of consumer-advocacy groups may be a harbinger of increasing cooperation among all those concerned with the impact of schizophrenia on both affected individuals and their families.

Adolescent↗

PubMedDate not supplied

A model project for families of the chronically mentally ill.

As a result of deinstitutionalization, families are frequently the primary caretakers of chronically mentally ill relatives. These families report a variety of stresses. La Frontera Center, Inc., a comprehensive community mental health center in Tucson, Arizona, is currently addressing the needs of these families through the Family Support Project. Families in this project have learned how to enhance the lifestyles of their ill family members as well as their own lifestyles by working in groups and focusing on distinct goals.

Arizona↗

PubMed1983

Economic costs of schizophrenia: a postdischarge study.

Measurement of the costs of health care and work loss of chronic mental patients is a vital link between clinical care and political decisions. If costs associated with poor outcomes of deinstitutionalized patients are identified, the margin for investing in programs that could improve outcomes without raising overall costs is also identified. This study analyzed direct and indirect costs in the first year after 119 chronic schizophrenics, drawn from public and voluntary hospitals serving Manhattan's upper West Side, were discharged from the hospital. The main elements in direct costs were community aftercare, rehospitalizations, and general medical care. Wage loss was used as the measure of indirect costs and was based on comparison with national figures for similar age/sex/ethnic groups. The risk of rehospitalization is the principal factor affecting direct costs. Wage loss because of unemployment was substantial. Because use of vocational rehabilitation services was low, these findings suggest the importance of developing employment opportunities and appropriate work environments.

Adolescent↗

PubMed1990

Psychiatric patients' views of their lives before and after moving to a hostel: a qualitative study.

This study focuses upon the experiences of a group of 10 long-stay psychiatric patients as they moved from a large institution to a staffed community hostel. The residents were interviewed 2 weeks prior to moving and again 6 weeks after the move. Areas identified in the first set of unstructured interviews were followed up in the second set. Qualitative analysis of the interviews revealed seven recurrent themes that are discussed in relation to other research studies that consider how people experience the effects of institutionalization. The study tests the feasibility of unstructured interviews as a means of collecting accounts of the perceptions and experiences of a client group from which other research methods have failed to elicit detailed information. Unstructured interviews proved successful when undertaken by a researcher who was well known and accepted by the residents. Familiarity with the residents and the context of the interview was also found to be important in analysing interviews qualitatively and the study casts doubt upon the value of primary qualitative analysis of interview transcripts by researchers who have not also participated in the interviews. The methodological implications for future deinstitutionalization studies are discussed.

Adaptation, Psychological↗

PubMed1987

The American mental retardation service system.

Significant changes have occurred in the United States in the last 30 years relative to the delivery of services to mentally retarded people. This paper explores the development of community service options in the United States since the late 1950s. The development of these new services is viewed relative to concerns with both deinstitutionalization and normalization. From the vantage point of the mid-1980s, the paper also explores the importance of information on the continuum of care cycle of mentally retarded individuals throughout the life cycle as an important guide to the understanding of how the American mental retardation service system functions.

Deinstitutionalization↗

PubMed1990

Evaluation of a parent training programme for teaching mentally retarded children age-appropriate restaurant skills: a preliminary investigation.

A programme designed to train parents to teach their mentally retarded children age-appropriate restaurant skills was developed and evaluated. After participating in a brief training programme, three mothers attempted to facilitate greater independence in their developmentally delayed children during meals at a fast-food restaurant. The programme was evaluated by assessing the mothers' and children's performance in restaurants using a multiple-probe design. The results indicated that the parents' teaching interactions were influenced by the training programme and that their children's restaurant skills were enhanced. The results were discussed in the context of the normalization principle and deinstitutionalization movement.

Behavior Therapy↗

PubMed1993

Mental illness-mental retardation in the United States: policy and treatment challenges.

The purpose of this paper is to present an overview of current trends in the field of dual diagnosis in the United States. Policy, programme, diagnostic and treatment issues are reviewed. The paper will examine the effects of the social policy of deinstitutionalization on people who have a dual diagnosis and will offer policy ideas for ameliorating some of the significant obstacles facing this population. Exemplary programme models are briefly discussed to illustrate the development of effective services. The challenges of assessing psychopathology in people with mental retardation are addressed. Several therapy and treatment modalities that have proven to be effective with people who have a dual diagnosis are also discussed. Lastly, this paper mentions a new community ideology driven by the values of consumers choice and satisfaction.

Combined Modality Therapy↗

PubMed2004

General practitioners' educational needs in intellectual disability health.

BACKGROUND: The community general practitioner (GP) has a central role in the provision of primary health care to people with intellectual disability (ID) as an indirect result of deinstitutionalization in Australia. This population, however, continues to experience poor health care compared to the general population. The current paper describes results from a questionnaire that aimed to identify the perceptions of practising GPs on the standards of health care for people with ID, the adequacy of prior training, and their interest in further education in relation to nine health care areas. METHOD: A questionnaire was posted to a selective sample of 1272 practising GPs in Victoria selected from a database from the Centre for Developmental Disability Health Victoria and the Victorian Medical Directory of GPs registered with the Australian Medical Association. Data were available for 252 respondents with a response rate of 28.5%. RESULTS: The health areas in which many GPs reported to be inadequately trained were the same as those areas that were perceived as being of a poor standard. These areas were behavioural or psychiatric conditions, human relations and sexuality issues, complex medical problems, and preventative and primary health care. Ninety four per cent of respondents were interested in further education in at least one of the nine health care areas, with the most frequently nominated areas being behavioural or psychiatric conditions, syndrome-specific medical problems, human relations and sexuality issues and collaboration with government services. General practitioners did not nominate complex medical problems or preventative and primary health care for further education as frequently as they identified care in these areas to be substandard and their prior training inadequate. CONCLUSIONS: The findings from the current research are discussed in relation to the implications for development of educational programmes based on learning needs identified by the GP. The most frequently nominated health care areas in all three questions were behavioural or psychiatric conditions and human relations and sexuality issues. Reasons for incongruence between the frequency of responses for complex medical problems and preventative and primary health care are explored.

Behavior Therapy↗

PubMed2004

Return to the asylum: the search for clients with enduring mental health problems in Italy.

Deinstitutionalization and community care were the most influential movements in the field of mental health in the last 30 years. In 1978 Italy was the first country to pass laws that would eliminate mental hospitals and replace them with community-based services. Italian ideas about community care provided inspiration for care in the community legislation when this was introduced in the UK. In order to be able to fairly assess and describe the benefits of Italian mental health care, the author visited a range of care facilities in a prescribed region in the north of Italy. In the course of investigation, the author sought to discover if the implementation of what were regarded by some as radical community attitudes in the care of people with mental health problems had led to innovative approaches when dealing with patients/clients requiring long-term care and treatment. Although the Italian approach is enlightened in many areas of care, the system still has to face up to the problems presented in caring for clients/patients with enduring mental health problems. The circumstances relating to care were unexpected and caused the author to revise his opinion of the Italian approach to community care.

Chronic Disease↗

PubMed1998

Community care systems for the mentally ill in Japan: can we switch hospital-based care to community based one?

Many Western countries have tried to reduce the number of psychiatric beds by providing effective rehabilitation and care in the community. Many Far East countries have had many fewer psychiatric beds than they have in Japan. Community care in these countries seems to complement the shortage of beds. Compared with other countries, Japan is unique in that they try to develop community care for the mentally ill without a deinstitutionalization policy.

Community Mental Health Services↗

PubMed1994

The burden of care of schizophrenia in Malay families.

Deinstitutionalization has shifted much of the burden of care of chronic schizophrenia from mental institutions to the family. The aim of this study is to asses the prevalence of mental disorders among 210 primary carers of Malay schizophrenic patients, explored the burden and hardship experienced by them. This is a two-stage psychiatric screening procedure. All the cases suspected from initial screening with WHO Self-Reporting Questionnaires (SRQ-20) were called for clinical interview. Patients' behavioural problems and the burden of relatives were assessed by the Social Behaviour Schedule and the Interview Schedule respectively. It was found that about 23% of the carers developed neurotic disorders resulting from the stress; nearly half of them had neurotic depression. Despite their burden, they do not complaint about it. Neurotic carers compared with non-neurotic carers had significantly more subjective burden and distress related to the product of active psychosis. The carers were generally able to tolerate the negative symptoms of schizophrenia. The number of problem behaviours and previous admissions were significantly correlated with the severity of burden.

Activities of Daily Living↗

PubMedDate not supplied

Preventing dental disease for people with special needs: the need for practical preventive protocols for use in community settings.

People with disabilities have more dental disease, more missing teeth, and more difficulty receiving dental care than other members of the general population. Because of the deinstitutionalization movement during the later 20th century, many formerly institutionalized people now reside in community settings, which lack oral health services. Even individuals who were not institutionalized have barriers to oral health services. These realities underscore the importance of preventing dental disease in people with special needs by establishing preventive dental disease protocols.

Adolescent↗

PubMed1980

Toward a public policy on the chronic mentally ill patient.

This paper outlines the problems posed by the chronic mentally ill, which have become a national disgrace. The historical background of deinstitutionalization is reviewed, issues critical to an understanding of the problems of the chronic mental patient are examined, solutions are suggested, and a public policy on the chronic mental patient is proposed.

Chronic Disease↗

PubMed1982

The new mendicancy: homeless in New York City.

An ethnographic study of the homeless poor in New York City suggests that significant changes have taken place in the size and composition of that population during the past 15 years. Among the disenfranchised, the mentally disabled figure prominently, many of them casualties of state deinstitutionalization and restricted admission policies. This paper argues that in the absence of safe and accessible shelter, rehabilitation efforts are doomed to failure. It is suggested that clinicians could play a critical advocacy role for an approach that sees therapeutic and social needs as intimately linked.

Chronic Disease↗

PubMed1987

Does the community mental health movement have the momentum needed to survive?

The current community mental health movement, struggling under the misnomer "deinstitutionalization," is a worthy effort that can succeed if given adequate support and unburdened of pessimism and scapegoating. Existing and emerging programs for the severely mentally ill have the potential for success but will require renewed commitment and advocacy on the part of mental health professionals.

Attitude of Health Personnel↗

PubMed1981

General hospital psychiatry: overview from a sociological perspective.

The role of the general hospital within the psychiatric service delivery network has undergone profound changes in recent years. Current issues in general hospital psychiatry revolve around questions concerning boundaries, target populations, appropriate services, structural characteristics, and deinstitutionalization. Decisions in general hospital psychiatry derive from a series of influences that originate at varing distances from day-to-day hospital operations. Planning should ideally be filtered through the hospital's internal decision-making process in order to ensure a "bottom-up" rather than a "top-down" emphasis in service policy.

Deinstitutionalization↗

PubMed1982

Effect of length of inpatient treatment for chronic schizophrenia.

Brief hospitalization policies have accompanied the deinstitutionalization movement, yet length of inpatient stay in facilities under state and local administration remains quite varied. A 1-year study of 119 chronic schizophrenic patients hospitalization in New York City between 1977 and 1979 revealed that length of inpatient stay bore no relationship to subsequent hospitalization, treatment compliance, or clinical or social functioning in the community. Rather, a patient's postdischarge experiences with treatment and significant others in the community were critical in determining subsequent use of inpatient services. This finding points to the need for wider application of briefer hospitalization policies for the dischargeable chronic schizophrenic patient.

Adolescent↗

PubMed1983

Patients' perspectives on community alternatives to hospitalization: a follow-up study.

Few studies of deinstitutionalized patients in the community have focused on the quality of the patients' lives. The authors interviewed 31 patients discharged from a state hospital to community residences and 10 patients who remained in the hospital. Patients were evaluated at three time intervals on eight outcome indexes. Eight months after the patients left the hospital they reported significant positive changes in the quality of their lives. None of the patients were rehospitalized during the study period.

Attitude to Health↗