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PubMedDate not supplied

Where the action really is: Medicaid and the disabled.

Discussions of Medicaid tend to focus on low-income children and their mothers and the institutionalized elderly as the principal beneficiaries, but Medicaid spends more on the nonelderly disabled than on any other group. In the past two decades Medicaid has helped finance the deinstitutionalization of the mentally retarded and a growing proportion of the mentally ill, but implementation of the Olmstead decision has deflected advocates' attention from the more important issue of how managed care plans treat disabled Medicaid beneficiaries.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

[Nursing and caring for in the area of mental health].

This study describes the sociopolitical aspects that involved the psychiatric assistance reform, focusing the deinstitutionalization process and the importance of nursing beyond a component of the interdisciplinary team. It aims to analyze the process of nursing assistance to the mentally sick in services outside the hospital. It is a bibliographical review of national periodicals from 1999 to 2001. The authors discuss workers' engagement in the area of mental health, with the "deconstruction"/construction about care, making necessary a humanized approach by way of the interpersonal relationship of patients, nurses and the teams responsible for giving assistance to the mentally sick.

Community Mental Health Services↗

PubMed1980

Labeling theory and community care of the mentally ill in California: the relationship of social theory and ideology to public policy.

The practical merit of a labeling theory approach to mental illness is examined and assessed through an exploration of its application in terms of public policy, i.e., community mental health policy in the state of California since 1968. Primary focus is placed on the impact of the deinstitutionalization of mental health services in that state, and the release of former mental patients into the community. Similarities in the fundamental ideological underpinnings of labeling theory, an associated conspiratorial model of mental illness, and contemporary California mental health policy, are presented and examples of policy input by labeling theorists and researchers are detailed. The impact of the California policy on the mentally ill is generally negatively assessed in terms of three major criteria: (1) rehabilitation; (2) reintegration; and (3) quality and continuity of care. The "translation" of several theoretical misconceptions regarding mental illness, caused by putting labeling theory into official policy, is suggested to lie at the root of many of the policy's implementation problems. The uses of social science theory and research are discussed, and caution is advised in the translation and application of social scientific theory and research to public policy proposals and programs.

Attitude of Health Personnel↗

PubMed1989

Homelessness and mental illness: who resorts to state hospitals?

Mental illness among the homeless is a topic which has received much attention in the last few years. Most studies in this field have examined the incidence and prevalence of mental illness among the residents of temporary shelters, missions and SRO hotels. Using data from a broader policy study of community mental health, this study addresses the issue of mental illness and homelessness from a different direction. By examining the incidence and subjective meaning of homelessness among patients in state hospitals, this study attempts to understand the relationship between homelessness, illness and the admission process. It was found that a significant portion (18 percent) of hospitalized mental patients attributed their admission to problems in housing. This group uses the hospital as a resource in their lives, admitting themselves to the hospital to replace inadequate social networks. For such patients, a mental hospital admission reflects a rational decision, based on his/her understanding of the limited options for care in an age of deinstitutionalization.

Chicago↗

PubMed2000

From ex-patient alternatives to consumer options: consequences of consumerism for psychiatric consumers and the ex-patient movement.

The psychiatric consumer movement in the United States evolved out of the political activism of a small group of antipsychiatry "ex-patients" (former patients) early in the 1970s. The shift in the movement from radical opposition to the medical model to viewing the latter as a possible choice in treatment occurred gradually under a series of social and political changes (e.g., deinstitutionalization), responses to those changes (e.g., the Community Support Program of the National Institute of Mental Health), and the involvement of new actors on the scene (e.g., the National Alliance for the Mentally Ill, a family consumer movement). This article traces the evolution of the psychiatric consumer movement up to the early 1990s in the light of these larger social, political, and economic developments. The author then considers the consequences of that evolution for both consumers and the ex-patient movement in the context of the unique nature of consumerism in the United States and the more recent restructuring of mental health services under managed care.

Commitment of Persons with Psychiatric Disorders↗

PubMed1984

Economic crisis and health policy in the Netherlands.

Beginning with a brief historical overview of health policy in the Netherlands from 1945-1960 (a period of restoration of the capitalist economy after World War II) until 1960-1970 (a period of capitalist expansion), this paper discusses the health policy of the Dutch state under the present conditions of economic crisis. The main characteristics of this policy are growing state intervention, reorganization of the decision-making process, deinstitutionalization of health care, a laissez-faire policy with regard to services in the so-called first echelon of the health sector, reprivatization of health costs, and an ideological emphasis on individual responsibility for health and self-care. The paper concludes with a discussion of the various strategies proposed for the health sector by the Left and the connection between prevention and social struggle.

Costs and Cost Analysis↗

PubMed2005

The Sasagawa project: a model for deinstitutionalisation in Japan.

Japanese psychiatric services are still typically hospital-based. The Sasagawa Project is the first systematized deinstitutionalization project in Japan that aims to make the transition from hospital to residential living while ensuring both the quality and continuity of care for the patients. Seventy-eight (51 males) patients (mean age 54.6) with chronic schizophrenia, who were considered appropriate for discharge received continuous cognitive behavioural therapies based on the Optimal Treatment Project manualised protocol, both before and after the hospital closure. During the first 12 months after the deinstitutionalisation was initiated on April 1st, 2002, ten people had incidents that interrupted their stay in the residential Sasagawa Village. A common criticism of many treatment outcome trials is that evaluation is focused on changes in clinical severity. In the Sasagawa project the transition appeared to have been smooth and relatively few incidents occurred could be related to the transition to a less intensive residential care. This project might be a useful model for effecting and monitoring transition from hospital to community care in Japan and other countries where such changes have been proposed.

Activities of Daily Living↗

PubMed2006

Facilitating discharge in state psychiatric institutions: a group intervention strategy.

Despite more than 30 years of deinstitutionalization, a significant number of individuals continue to experience prolonged stays in state psychiatric hospitals. Many of these individuals appear to develop an ambivalence or resistance to discharge. This can itself contribute to further delay in discharge planning and implementation. We will describe a group intervention for persons with long stays labeled as "resistant." This effort was guided by the premise that each individual could benefit from personally exploring those aspects of his or her experience that may be contributing to continued hospitalization. The group utilized standard methods of rehabilitation and training with strong emphasis on validating individual needs and feelings, peer support and practical results. After 1 1/2 years of group intervention, 5 of the 7 group members had achieved discharge and initial community success.

Deinstitutionalization↗

PubMed2006

A six-month outcome of long-stay inpatients resettled in a hostel.

This prospective study evaluated a 6-month outcome of resettlement of long-term psychiatric inpatients to a hostel-based residence. Participants included 92 patients with DSM-IV chronic psychotic disorders, aged 18 to 65 years, hospitalized for 16.7 +/- 10.6 years. Evaluations performed at 2 weeks before their resettlement and following 6 months of hostel residence included the Positive and Negative Syndromes Scale, Montgomery and Asberg Depression Scale, Clinical Global Impression, Global Assessment of Functioning, Social Adaptive Functioning Evaluation and Social Behavior Schedule. The Nurses' Observation Scale for Inpatient Evaluation was completed regularly. Psychopathological symptoms declined and social interaction increased. Hostel-based deinstitutionalization programs are a promising alternative for long-term psychiatric inpatients.

Activities of Daily Living↗

PubMed1994

Studying mental illness: a student's perspective.

Upon deinstitutionalization, a mentally ill person's awareness of the stigma attached to his or her illness can negatively influence any effort to become a productive member of society. Support systems are vital in that they facilitate such efforts. The family is perhaps the most important support system because it provides emotional support, which is crucial because it promotes a sense of self-esteem and decreases depression, anxiety, sickness, and mortality. An awareness of stigma on the part of the family could undermine its role as a support system for a relative with mental illness.

Adult↗

PubMed1994

Nursing assistance for families of patients.

With deinstitutionalization, families have become the primary caregivers of persons with mental illness. Mental health professionals and family members must work together to prevent damage to our most valuable resource, the family. Nurses, who often provide the most continuous care for seriously mentally ill persons, are in a unique position to reach out to families and provide the help that they need as primary caregivers. Let us not fail our patients or their families.

Caregivers↗

PubMed2003

Cognitive-behavioral therapy. Treating individuals with dual diagnoses.

Because deinstitutionalization of individuals with mental retardation/developmental disability and mental illness has become the standard of practice, many practitioners are now faced with the challenge of serving the needs of this specialized population. The existence of mental illness in individuals with mental retardation has been well established in the literature, but there are relatively few studies involving therapeutic interventions in this client population. However, there is a theoretical framework that guides practice and measures the effectiveness of interventions with this specialized population. This article presents a case study exploring the application of cognitive-behavioral therapy to a client with mental retardation and mental illness. The theoretical framework, major concepts, and key assumptions of the theory will be reviewed, as well as treatment outcomes.

Adaptation, Psychological↗

PubMedDate not supplied

Getting it right: appropriate therapeutic recreation programs for community based consumers of mental health services.

Over the last two decades in Australia, the deinstitutionalization process, which began with the intent of moving consumers of mental health services from in-patient facilities and then seeking to integrate these same individuals into the community, has served to highlight a wide range of consumer needs that have remained largely unfulfilled throughout the process. One such need has been the provision of appropriate therapeutic recreation programs for the community based consumers of the various state co-ordinated mental health services. This paper argues a case for a change in the approach which professional staff provide and lead therapeutic recreation based programs to enable participants to be empowered, rather than disempowered, through their involvement. Further, this paper contends that there is a need for health care staff, more generally, to accept the concept of such programs for the community based consumers of various mental health services as a valued one.

Australia↗

PubMed2005

[Foster home caregivers' point of view on the transformation of mental health services in Québec].

This article presents the major findings from a study that examined foster home caregivers' views on the impact of the transformation of mental health services on caregivers and their work with persons with serious mental illness. In Québec foster homes, (or more commonly known as foster families), represent one of the oldest models of community based housing for persons with serious mental illness. In fact, the emergence of the first foster home dates back to the 1950ies. Over time, a large number of persons discharged from psychiatric hospitals during the process of deinstitutionalization were placed into these homes. Foster homes are private homes located in the community and operated by non professionals who can accommodate up to nine individuals. These residences provide a normal environment for its residents. Foster home caregivers must ensure a secure and safe environment as well as obtain certain services and encourage the social integration of the residents. Today foster homes are regulated by Bill 120 (Québec Government, 1995) and are designated as "family type resources" (RTF).

Adult↗

PubMed1990

Mental healthcare: expand with caution. There is more involved than financial incentives.

Increased needs, insurance coverage, and physical expansion are evidence of mental healthcare's growth. Greater societal acceptance, the demand for more local care with deinstitutionalization, and liberal reimbursement have expanded mental health services. However, reduced federal funding and competition demand specialization in such areas as geriatric services. Ambulatory services make mental healthcare more affordable and accessible. Providers must target populations who use such outpatient care and study local trends before planning these programs. Inpatient mental health services continue to expand, although at a slower rate. Thus organizations and professionals have begun selective contracting, and capitation reimbursement based on case management is developing. Providers considering expansion or initiation of mental health services confront competitive marketing and must recognize trends in outpatient, chronically ill patient, and after-care services. Strategic planning is essential to uncover opportunities and potential risks. Other issues to consider include the psychiatrist shortage, uncertain payment systems, and a possible reversal of growing mental health services and declining acute care needs.

Attitude to Health↗

PubMed1991

Community-based care: an alternative to institutionalization.

By focusing on the deinstitutionalization of the physically, mentally, and developmentally impaired, the public's attention is too frequently diverted away from the greater need for the development of community-based services.

Community Mental Health Services↗

PubMed1992

Principles for treating aggressive patients in a day hospital: balancing safety with patient autonomy.

Responding to an increase in the number of acutely and severely ill patients being treated in partial hospital programs, this paper addresses the treatment of aggressive patients in acute partial hospital settings. The authors review the limited conceptual literature published in this area and then suggest concrete strategies of intervention that fit the day-to-day life of a day hospital. They take as a guiding principle for these interventions an extension of the tenet of deinstitutionalization that patients be treated in the least restrictive manner possible and offer a variety of possible interventions for managing aggressive acts, ranging from least to most restrictive. Six issues which arise in applying less restrictive controls in the partial hospital treatment of aggressive patients are then identified, and illustrations of the principles employed in each of these areas are provided through reflection on two representative clinical vignettes. Taken together, these principles and interventions suggest ways for staff to intervene with aggressive patients, with each other, and with the significant others in patients' lives, in a manner which respects and fosters patients' autonomy and individual responsibility for their own behavior while maintaining a safe environment.

Adult↗

PubMed1983

Public policies and family outcomes: empirical evidence or ideology?

Research findings and other data dealing with government policies and programs such as Social Security, supplemental security income, welfare reform, deinstitutionalization, abortion, and compensatory preschool education show that these programs have promoted family well-being and not hindered family interests.

Aid to Families with Dependent Children↗