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 631 records · Page 35Linked to original sources
PubMed2003

Discharges of patients from public psychiatric hospitals in Italy between 1994 and 2000.

BACKGROUND: Psychiatric hospitals in Italy had to be closed under a law dated 1994. AIMS: To investigate the discharge of patients from public psychiatric hospitals. METHODS: A total of 4492 patients from 22 psychiatric hospitals were described at recruitment and followed during the period 1994-2000. Their characteristics were investigated as determinants of discharge to community residential facilities for psychiatric patients versus other settings. RESULTS: All 22 psychiatric hospitals closed between 1994 and 2000; 678 patients had died, and the remainder were discharged. Of these, 39% went to nursing homes, 29% to community residential facilities for psychiatric patients, 2% joined their family, less than 1% were settled in private independent accommodation, and 29% remained in the psychiatric hospital, although defined as discharged. Ten patients were recorded as missing when still in the psychiatric hospitals, none after discharge. Younger, more educated patients and patients from two of the four regions studied were more likely to be discharged to community residential facilities. CONCLUSIONS: The majority of patients were discharged to highly supervised settings. The potential risk of abandonment due to deinstitutionalization was not observed in this population. The wide use of highly supervised settings can be explained by the patients' old age, but different local policies may have affected the discharge process.

Adult↗
PubMed2001

Move of adults with mental retardation from institutions to community-based living: changes in the oral microbiological flora.

In the Western world, the policy of deinstitutionalization and integration of individuals with mental retardation is generally accepted. We tested the hypothesis that de-institutionalization may lead to changes of habits with a potential to influence oral health. When 57 adults with mental retardation moved from an institution to community-based living, their oral hygiene habits, gingival bleeding, and a three-day food record were registered one month before and 9 and 21 months after the move. Mutans streptococci and lactobacilli in saliva, P. intermedia/P. nigrescens, P. gingivalis, and A. actinomycetemcomitans in supragingival plaque, and C. albicans on mucous membranes were analyzed. After 21 months of community-based living, fewer persons showed high classes of mutans streptococci, growth of P. intermedia/P. nigrescens, and high frequency of sucrose intake, and more subjects showed growth of C. albicans. In a short perspective, the indicators of oral diseases suggest an unchanged or lower risk of oral diseases after the de-institutionalization of individuals with moderate or severe mental retardation.

Adult↗
PubMed2005

Environmental cognitive remediation in schizophrenia: ethical implications of "smart home" technology.

OBJECTIVE: In light of the advent of new technologies, we proposed to reexamine certain challenges posed by cognitive remediation and social reintegration (that is, deinstitutionalization) of patients with severe and persistent mental disorders. METHOD: We reviewed literature on cognition, remediation, smart homes, as well as on objects and utilities, using medical and computer science electronic library and Internet searches. RESULTS: These technologies provide solutions for disabled persons with respect to care delivery, workload reduction, and socialization. Examples include home support, video conferencing, remote monitoring of medical parameters through sensors, teledetection of critical situations (for example, a fall or malaise), measures of daily living activities, and help with tasks of daily living. One of the key concepts unifying all these technologies is the health-smart home. We present the notion of the health-smart home in general and then examine it more specifically in relation to schizophrenia. CONCLUSION: Management of people with schizophrenia with cognitive deficits who are being rehabilitated in the community can be improved with the use of technology; however, such technology has ethical ramifications.

Cognitive Behavioral Therapy↗
PubMed1986

[The psychiatric hospital: from yesterday to tomorrow].

A study carried out in a psychiatric hospital in the Montreal region reveals that in spite of deinstitutionalization, long-term stay remains an important factor in the use of beds. For some patients the hospital remains a permanent home, either from their first admission or from the time they are institutionalized after multiple admissions. For both in- and out-patients, return to the hospital and long-term care are almost inevitable. Generally speaking, the services of the hospital are used by the same long-term patients, and this to the extent that the hospital cannot provide services to other establishments or play its second-line role. This is frustrating for other institutions in the network, even though they accept the inevitability of the situation given the lack of adequate community resources for these patients. One of the primary functions of a psychiatric hospital also seems to be to fill in the gaps in the service network. In this regard, its expertise in the field of intervention in chronic psychiatric patients must not be overlooked. Given the current situation, the hospital's responsibility in regard to second-line services cannot be clarified until it has been determined just how much of the responsibility for care of psychiatric patients can be assumed by the community itself.

Adult↗
PubMed1989

Mental hospital depopulation in Canada: patient perspectives.

This paper reviews briefly the history of mental health depopulation in Canada over the past 30 years. The term "deinstitutionalization" is often used but is unsatisfactory. Using an exploratory, qualitative, methodological approach, data were collected on the problems encountered by a disproportionate, stratified random sample of 139 formerly institutionalized patients living in various geographical locales in Eastern Canada. Adopting a symbolic interactionist theoretical approach, this study, in an effort to fill a neglect in the literature, attempted to discover what the everyday world(s) of Canadian ex-mental patients was really like. Problems encountered related to stigma, poor housing, lack of back living skills, poverty, unemployment and aftercare. Quotations from patients are provided to illustrate such themes. The findings are discussed.

Activities of Daily Living↗
PubMed1990

Dorothea Dix and her two missions of mercy in Nova Scotia.

Dorothea Lynde Dix, 19th century defender of the rights of the mentally ill to hospital care, holds a significant place in the history of Nova Scotia. Her two major accomplishments in this province include laying the groundwork for its first psychiatric hospital and the outfitting of treacherous Sable Island with rescue equipment to aid ships stranded off its shore. The techniques that Miss Dix employed in these missions parallel those she successfully used in the establishment of psychiatric hospitals in a number of American states. It will be argued that her influence has been a positive one on the treatment of the mentally ill particularly in light of the failures of the deinstitutionalization movement.

Deinstitutionalization↗
PubMed1992

Planning mental health services: I. Background and key issues.

Planning mental health services is a complex task requiring an understanding of background developments and key issues related to mental health services. In Canada, the deinstitutionalization of patients attempted to shift the locus of care from provincial psychiatric hospitals to general hospital psychiatric units. This resulted in the isolation of provincial psychiatric hospitals, general hospital psychiatric units and community mental health programs, with little overall accountability for the services provided--three solitudes. To move toward the creation of responsible, integrated systems a number of issues must be addressed: target population(s); the roles of provincial psychiatric and general hospitals; community support services; continuity of care; co-morbidity; consumerism; and methods of integration. In the development of a comprehensive mental health plan, each issue should be recognized and decisions made which are in keeping with current knowledge. A companion report will survey Canadian initiatives in mental health planning and discuss approaches to many of the issues identified.

Activities of Daily Living↗
PubMed1992

Assessing the "criminalization" of the mentally ill in Canada.

This paper is an overview of the conceptual and methodological problems encountered trying to assess the hypothesis that the mentally ill, as a consequence of deinstitutionalization, are being "criminalized". Generalizations are difficult to make, in large part because most of the studies are American and do not fit well into the Canadian scene. Relevant Canadian findings are reviewed and compared to the US data. There is some evidence that Canadian patients may be diverted from the criminal justice system more often than in the US, where there are fewer resources. However, this conclusion must be tempered by the fact that Canadian surveys have found high rates of mental disorder among prison and jail inmates.

Canada↗
PubMed1989

The evaluation of mental health care systems.

While the demand for deinstitutionalization, strongly supported by the economic aspect of the issue, has resulted in a steep decline in the number of psychiatric beds in many Western countries, the evaluation of extramural psychiatric care has several difficulties, including that of proving effectiveness without experimental control of confounding influences. For a cohort of schizophrenic patients we investigated the impact of out-patient psychiatric treatment on length of stay in hospital and length of stay in the community. Out-patient care had a significant influence on readmission, but no effect on the length of in-patient treatment. While the average cost of community care was less than half that of traditional hospital care, in 6% of the patients this threshold value of continued in-patient care was exceeded. There also seems to be a non-monetary threshold, above which community care is no longer appropriate.

Cohort Studies↗
PubMed2002

Risk, response, and mental health policy: learning from the experience of the United Kingdom.

Policy makers in the United States and the United Kingdom recognize that mentally disordered offenders present special challenges to law enforcement, mental health, and social service systems, as well as the community. Although various policy initiatives have advanced over the past twenty years to improve the management of mentally disordered offenders, mental health policy has chronically failed in both countries. Because safety concerns have emerged as the mental health system has been "deinstitutionalized," debate is growing about whether the community-care approach works-for the community. This study argues that mental health policy fails because policy makers focus on the wrong risks and design policies that manage these risks in ways that increase the possibility of adverse clinical and economic outcomes. The argument made here uses the case of persons with severe mental illness in the United Kingdom as an example of the complex relationship between risk and policy making in democratic governance. Emphasis is on the nature of risk in mental health policy and how government responds to policy and political risks. Mental health policy in Britain is then analyzed in terms of its response to and management of risks. Mental health policy has historically mismanaged the risk issue in the United Kingdom and as such has set in motion the growing community-care backlash. The path to a better outcome lies in the responsible management of the right risks. Lessons from the United Kingdom experience can be usefully applied to mental health issues in many industrial democracies.

Attitude to Health↗
PubMed1997

Discharge planning and community housing in Ontario.

As hospital budgets in Ontario (and elsewhere) continue to shrink in the face of governmental fiscal pressure, bed closures lead to the discharge of increasingly vulnerable persons. Many of these persons have no family and no obvious place to go. Community supports to assist people outside the hospitals are not provided at a level commensurate with the need. The result is inadequate housing, social isolation, non-existent care and, in too many cases, reinstitutionalization and/or preventable deaths. This paper describes the process by which vulnerable adults wind up in unsuitable community settings, as a result of ill-conceived deinstitutionalization in the province of Ontario. It places a particular focus on the difficult role played by the discharge planner as conduit from hospital to community. The planner is often caught in the middle, facing hospital (and physician) directives to empty beds precipitously, alongside an acute shortage of suitable housing in the community. Departing patients are often sent to settings that lack any form of governmental inspection, regulation, licensure, or control: they are at the mercy of often indifferent and, at times, overtly rapacious landlords who may take the welfare cheque and give little in return. Selected case material, including one recent inquest, highlight the difficulties.

Adult↗
PubMed1996

The quality of life of persons with severe emotional disability: a review of empirical studies.

Following the deinstitutionalization of persons with serious mental illness from state hospitals, many persons with serious mental illness did not receive the care that they needed and encountered unexpected negative experiences. Among the negative experiences were frequent rehospitalizations, involvement in the criminal justice system, and homelessness. Seeing these negative outcomes, mental health professionals in the 1980s debated the quality of life of persons with severe and persistent mental illness and concluded that the main goal of treatment was to improve the quality of life of those afflicted. Thus, the quality of life became a critical variable in determining the effectiveness of mental health treatment. This paper reviews studies that used quality of life as an outcome measure in treatment services for persons with serious and persistent mental illness and the policy implications of these studies.

Affective Symptoms↗
PubMed2002

Community integration and statewide systems change: qualitative evaluation research in community life and disability.

As the disability field moves to the next generation of community life, this article describes the findings of a qualitative state policy research study on deinstitutionalization and community integration. New Hampshire was selected as a leading national example in the United States based, in part, upon the closure of its only public institution showing community leadership in the field of mental retardation and developmental disabilities. Drawing on the disciplines of politicial science, sociology, psychology and rehabilitation (Majchrzak, 1980), the research design uses a multi-case, multi-site study approach (Yin, 1989), and on-site, semi-structured interviewing of key informants using a research field guide (Taylor & Bogdan, 1984/1998). The qualitative research reflects an indepth version of state formative evaluation research studies on community integration (e.g, Taylor, Racino, & Rothenberg, 1988), and the use of coded data and multiple analytic techniques (e.g., Glaser & Strauss, 1967) congruent with the emerging support and empowerment paradigm (Racino, 1992). The article highlights four sets of research findings (i.e., state characteristics and community integration practices, thematic case studies of change, comparative roles in the change process, and a theoretical framework for understanding change) which form the basis for further statewide study of change toward community life in the United States.

Community Mental Health Services↗
PubMed1984

Blending administrative and community organization practice: the case of community residential facilities.

The authors discuss the management of community programs serving deinstitutionalized populations. They make a case for the concept of "community integration" (re-entry into society), arguing that translating the concept into meaningful practice requires clearer specification of the relevant client communities and calls for a blending of traditional administrative and community organizations skills, with resultant implications for social work education. Illustrations are drawn from the field of mental health and the needs of the chronically mentally ill.

Community Mental Health Services↗
PubMed2006

Longitudinal frequency and stability of family contact in institutional and community living.

We examined the frequency and stability of family contact with long-term institutional residents during a major deinstitutionalization project. Movers relocated to community accommodation between Assessments 1 (baseline) and 2. Stayers remained institutionalized. We investigated family contact longitudinally over four annual assessments. There was no significant between-group difference in frequency of family contact at baseline, but, subsequently, movers had more frequent family contact than did stayers. There was a significant decline over time in the proportion of stayers with family contact and a significant increase in movers with family contact, with a marked resumption of contact by movers during the first year of community living. Carefully supporting family (re)involvement during the relocation process may be associated with stable, long-term family contact.

Community Mental Health Centers↗
PubMed1998

Longitudinal study of institutional downsizing: effects on individuals who remain in the institution.

In a 4-year study we examined the longitudinal effects of deinstitutionalization programs on those who remain in institutions being downsized. Individual outcomes investigated were community access, social activities, community inclusion, family relationships, and choice. Effects of residential relocation on individual outcomes such as adaptive behavior were evaluated and total daily per-person expenditure on institutional services for participants was determined. Downsizing was associated with decreased community integration but no change in most other outcomes. Availability of therapy services fell over time, and individuals experienced many residential and day program moves within the institution. Per person expenditure on services increased substantially. Finally, no significant changes in adaptive behavior were associated with intrainstitutional moves.

Activities of Daily Living↗
PubMed1998

Mortality in persons with developmental disabilities after transfer into community care.

More than 2,000 persons with developmental disabilities have been transferred from California state institutions into community care in recent years. We investigated whether this has been accompanied by a change in mortality rates, using data on 1,878 clients moved since April 1993. Mortality rates were compared to those expected for comparable persons in institutions. Risk-adjusted mortality rates for movers exceeded institutional rates by 51%, p < .05. After removal of cancer deaths in both groups, this increased to 67%. The effect was largest shortly after the move and in the subjects who had moved most recently. The deinstitutionalization process in California appears to have resulted in a substantial increase in mortality, indicating the need to ensure continuous, consistent, and competent medical care and supervision in the community.

Activities of Daily Living↗
PubMedDate not supplied

Emerging trends in mental health policy and practice.

The continuing deinstitutionalization of patients in public mental hospitals and the growth of managed care are fundamentally altering mental health practice. Managed care provides opportunities for achieving parity of insurance coverage between mental and physical illness, but serious problems persist in integrating mental health, substance abuse, and general medical care and assuring an appropriate range of services and programs for persons with serious mental illness residing in community settings. Hospital and community care are poorly coordinated, and hospital care needs to be integrated into a more balanced system of services. Important new roles are emerging for purchasers, patient advocates, and mental health authorities.

Comprehensive Health Care↗