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 667 records · Page 37Linked to original sources
PubMed1986

The chronic mental patient and community psychiatry: a system in trouble.

In Canada, as elsewhere, there has been a shift away from institutional care toward community care for chronic mental patients. This transition has not occurred without some difficulties arising. In this paper, various major issues pertaining to the care of chronic mental patients in the Canadian health care system are discussed, including problems associated with deinstitutionalization; the defining characteristics and epidemiology of chronic mental illness in Canada; and the debate over the optimal setting in which to provide housing and treatment for chronic mental patients.

Canada↗
PubMed1986

Care and treatment of the mentally ill in the United States: historical developments and reforms.

Three major cycles of reform in public mental health care in the United States--the moral treatment, mental hygiene, and community mental health movements--are described as a basis for assessing the shifting boundaries between the mental health, social welfare, and criminal justice systems. Historical forces that led to the transinstitutionalization of the mentally ill from almshouses to the state mental hospitals in the nineteenth and twentieth centuries have now been reversed in the aftermath of recent deinstitutionalization policies. Evidence is suggestive that the mentally ill are also being caught up in the criminal justice system, a circumstance reminiscent of pre-asylum conditions in the early nineteenth century. These trends shape the current mental health service delivery system and the agenda for policy-relevant research on issues involving the legal and mental health fields.

Community Mental Health Centers↗
PubMed1985

Job satisfaction, prestige, and the aftercare clinician.

Few would disagree that programs designed to assist deinstitutionalized mental-health patients have been seen as the step-children of community mental health. Many community mental-health programs were built quickly to rise to the challenge of the flood emerging from the hospitals. Unfortunately, this resulted in programs being poorly defined and reactive rather than responsive in nature. One of the issues that emerges as crucial is the status afforded to the aftercare clinician by other mental-health professionals. Personal experiences shared by community mental-health personnel suggest that clinicians who work with aftercare patients or who work in aftercare settings are attributed less prestige than their outpatient counterparts. The authors review the pertinent literature and reveal the results of a survey suggesting that aftercare clinicians view themselves as expert, but the rest of the system does not, leading to the inconsistent status profile. The problem then emerges that the aftercare clinician must "market" his or her expertise and specialized skills so that other clinicians recognize the unique therapeutic contribution of aftercare. The authors offer recommendations.

Aftercare↗
PubMedDate not supplied

Mental health services reform in Japan.

Economic and social pressures are driving Japan to reform its mental health services. Traditionally, psychiatric services in Japan have been custodial. Reimbursement has been principally fee-for-service, with incentives that encourage hospital-based care. Reform measures are beginning to promote the concept of "normalization," in which the mentally ill are seen to be disabled, like persons with physical disabilities. New practices including deinstitutionalization, differentiation of services, revisions in payment, and quality assessment are being introduced. This article provides an overview of the current status of Japanese mental health services, summarizes policy dilemmas, and identifies priority areas for intervention.

Adolescent↗
PubMed2000

[Reform of psychiatry in Spain].

Since the 1980's psychiatric care in Spain changed considerably (Reforma psiquiátrica española). In the course of this reform, many positive results were achieved. An extensive community network of mental health centres was build up which resulted in the majority of psychiatric patients being integrated in the Spanish general health care system and making a better organized mental health care structure possible. New legislation also improved the care and civil rights of patients. An analysis of the experiences of the Spanish psychiatric reform shows that the tendency to retain the old mental hospitals, alongside the other institutions still exists. The process of deinstitutionalization and the original aims of the psychiatric reform cannot only be satisfied by the closure of large psychiatric hospitals as during the reform new aspects and problems as well the great complexity of the task have become apparent. This article together with the details of the Spanish sources gives the German public a good overview of the developments in Spanish psychiatry.

Community Mental Health Services↗
PubMedDate not supplied

Providing general dentistry for people with disabilities: a demographic review.

In the mid-1990s, approximately 54 million American people had some level of disability, including 26 million who had a severe disability. In addition, more than three-quarters of individuals with mental retardation/developmental disabilities were deinstitutionalized during the past 30 years and now reside in our communities, relying upon community practitioners for needed services. This review is provided to make dental practitioners aware of the magnitude and dimensions of the situations in which persons with special needs require their services.

Adolescent↗
PubMed2001

Community-based dental services for patients with special needs.

Deinstitutionalization of individuals with mental retardation and developmental disabilities has increased the demand for dental services for these patients by community practitioners. There are numerous difficulties associated with the delivery of care to this population with special needs. Nevertheless, a county-by-county review for New York State indicates that in most instances, if all dentists are willing to help, there would be a relatively small number of these patients per dental practitioner.

Child↗
PubMed2001

The criminalization of adults with mental illness (Part 1).

In Part 1 of "The Criminalization of Adults with Mental Illness," we have identified the major factors contributing to the criminalization of the mentally ill as being deinstitutionalization (and the related underfunded, under-coordinated recommendations of the Joint Commission on Mental Illness in 1961), the sometimes overly restrictive legal protections, and states' implementation of usually underfunded Medicaid managed care programs. Subsequent papers will describe and discuss Tennessee statistics relative to criminalization of the mentally ill (Part 2) and will introduce methods for preventing criminalization of mentally ill adults and the maintenance of mentally ill individuals who have committed minor crimes in their respective communities.

Adult↗
PubMed2002

The changing role of the social worker in the mental health system.

The purpose of this paper is to discuss the role of the social work profession in the mental health service arena. It analyzes the changing mental health environment and the challenges facing social work. It stresses that the profession must adapt to the dramatic changes that have been taking place since the advent of deinstitutionalization and the need for community care for mentally ill persons. Historical analysis of the social work profession shows that its involvement in the mental health field has started during the early stages of the development of the profession. Psychiatric social work has been considered a prestigious area of practice within the profession. Historically, social workers in the mental health field rarely challenged the dominance of the psychiatric profession. This position seems to have restrained social work from providing its full potential contribution to this field of practice and to the population it served. Assessment of the continuing problems and current issues of the mental health system shows the potential central role of social work in this area. However, changes must take place in the practice of social workers in the mental health service system, as well as in the education and training of social workers. The paper discusses factors that facilitate or hinder the profession from appropriately adapting to the current service needs of the mentally ill persons, their families and communities, providing quality mental health and social services to this population and society as well.

Case Management↗
PubMedDate not supplied

[The applications to chronicity in mental health of the International Classification of Impairments, Disabilities and Handicaps].

The present work focuses on the difficulties to accomplish an adequate valuation of needs in "chronic" psychical patients. First, a reference is made to the characteristics of the so-called "new chronics", mostly cared outside the hospital, after the process of deinstitutionalization carried out during the last years. Then, an analysis of the International Classification of Deficiencies, Discapacities and Invalidities published by the World Health Organization in 1980, (as annex of the International Classification of Diseases) is carried out. This work studies basically the description of its classification contents and a valuation of its effectiveness as and instrument to be used in the planning and evaluation works and in the care of patients with mental "chronic" diseases.

Chronic Disease↗
PubMed2003

System flexibility in the rehabilitation process of mentally disabled persons in a hostel that bridges between the hospital and the community.

BACKGROUND: Deinstitutionalization and community mental health services have become the focus of mental health care in the United States, Italy and England, and now in Israel. METHODS: Tirat Carmel MHC developed an intervention model of organizational change implemented in a rehabilitation hostel. It is an interim service based on graduated transition from maintenance care to a transitional Half-way House, followed by a Transitional Living Skills Center oriented for independent community living. RESULTS: Of 205 rehabilitees who resided in the hostel since the beginning of the project, 138 were discharged to community residential settings: 67 patients were discharged to reinforced community hostels; 27 to sheltered housing and 23 to independent residential quarters; 7 patients were discharged to comprehensive hostels, 3 to old-age homes and 11 returned home to their families. In terms of employment, 79 were placed in sheltered employment facilities, 24 work in the open market and 3 returned to school; 22 work in therapeutic occupational settings and 10 patients discharged to comprehensive hostels and old-age homes are engaged in sheltered employment programs in those settings. CONCLUSION: The system flexibility model and the rehabilitation processes anchored in normalization supported the relocation of hospitalized psychiatric patients to community-based settings and enabled the rehabilitees to cope with readjustment to community life.

Community Mental Health Services↗
PubMedDate not supplied

Slipping through the cracks. Dental care for older persons with intellectual disabilities.

An increasing population of men and women with intellectual disabilities and other developmental disabilities is reaching older ages. As our country continues the process of deinstitutionalization, these individuals will require treatment in communities. Dental practitioners increasingly will be involved in the needs of this population, many of whom are members of families being treated in private dental practices. A review of these developments and the particular dental needs of these patients is considered.

Aged↗
PubMed1991

[Gerontopsychiatric patients in psychiatric facilities].

The population of Vienna is relatively old. The structure of care and support for aged patients is described. The relative share of aged patients in all admissions to the large mental hospital is smaller than their share in total population. Reduction in the number of in-patients also included the group of patients over 65 years. The task force "Ubergangspflege" (i.e.: transitional nursing) prepares and supports the deinstitutionalization of recently admitted and of long-stay patients. Utilization of a regionalized out-patients psychiatric department shows differences between the age group 60-80 years and the group over 80 years.

Aged↗
PubMed1990

[Dental health among homebound mental (psychiatric) patients].

The purpose of the present study was to describe the dental health behavior, oral health and dental treatment needs in a group of chronic, homebound mental patients. 84 patients were interviewed with regard to oral hygiene and utilization of dental services, by means of a standardized questionnaire. Furthermore, 56 patients were examined clinically. About 20% did not brush their teeth regularly. A similar group had not payed regular dental visits for the last 3 years although they were not edentulous. The dental examinations showed an average DMFS of 84.6. One out of four persons were edentulous and 45% of the dentate participants had periodontal pockets deeper than 5 mm. Restorative need was found for 71%, 12% were in need of fillings of more than 15 surfaces, whereas 45% were in need of scaling or advanced periodontal treatment. Finally, 15% exhibited need of their first removable denture. An index for the overall dental treatment need showed that 63% were in great need for dental treatment. The findings indicate significant dental needs in non-institutionalized persons with mental disease. A hospital based dental team combined with mobile primary dental health care are proposed as a possible solution to the dental health problems of deinstitutionalized psychiatry.

DMF Index↗
PubMed1990

From theory to practice in the care and education of mentally retarded individuals.

Issues related to the care and education of mentally retarded individuals were examined from a historical perspective. Historical analysis shows that institutions and special education services spring from common, although not identical, societal and philosophical forces. The adequacy and implications of the normalization concept were discussed in relation to both deinstitutionalization and mainstreaming, with the conclusion that mental retardation workers must pay more attention to bettering the lives of retarded individuals and less to the "social address" at which interventions take place. Suggestions for the future care and education of retarded individuals were provided, and the proper role of science in the mental retardation field was discussed.

Combined Modality Therapy↗
PubMed1990

Explaining trends in use of VA inpatient psychiatric services.

We examined the expansion of Veterans Administration (now Department of Veterans Affairs--VA) inpatient psychiatric services from 1963 to 1984. Aggregate national trends in VA inpatient episodes between 1963 and 1984 document not only increased use of inpatient services but also "decentralization," or a shift to providing psychiatric services in general VA medical centers. The national trends show a dramatic increase in admissions to psychiatric bed sections over the period 1963-1978, with admissions staying at this high level from 1976-1981 and dropping only slightly in the 1980s. Admission trends were disaggregated into first admissions and readmissions to psychiatric and general hospitals in a single VA medical district for the period 1972-1981. First admissions declined over the study period for both hospital types; readmissions increased initially, but declined somewhat at the end of the period. The admission trends and patterns in source of first admissions suggest that the growth of VA services reflects psychiatric "decentralization," as well as deinstitutionalization within VA.

Deinstitutionalization↗
PubMed1989

The corrections department: the forgotten branch of the mental health system.

The Hawaii Department of Corrections (DOC), like other corrections systems throughout the nation, struggles with problems arising from incarcerating mentally ill prisoners and detainees. The incarcerated population of mentally ill persons burgeoned as mental hospital inmates were "deinstitutionalized" during the 1960s and 1970s. However, correctional facilities, particularly jails, became alternative institutions for mentally ill persons when communities were unprepared to provide required services. Correctional facilities were equally unprepared to manage seriously disabled mentally ill (SDMI) inmates, but the facilities provided a dumping ground for a community's undesirables. Out of sight, out of mind!

Deinstitutionalization↗
PubMed1985

[Cooperation barriers in psychiatric and psychosocial after care: organizational and sociologic aspects].

Community based out-care systems for the long term patient has been a concern ever since deinstitutionalization and rehabilitation became a task in the 60's. Much of our efforts failed. Here we try to make the point of organizational factors and their impact on motivation and cooperative incentives both for the staff in the wards, and in the community based clinics. Exchange theory is offered as a base to outline better planning.

Aftercare↗