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PubMed1988

Deinstitutionalization at the crossroads.

Much has gone wrong with deinstitutionalization. To get back on course, the author says, we should acknowledge that while deinstitutionalization was a positive step, it has gone too far--that some of the long-term mentally ill now in the community need highly structured residential care. The long-term mentally ill should be made the highest priority in public mental health, and a comprehensive system of care that recognizes their heterogeneity needs to be established. Vigorous rehabilitation efforts aimed at helping them attain higher levels of functioning should be continued, but mental health professionals should also give high priority to those who function less well and recognize the gratification that can be derived from working with them. The more favorable long-term outcome of schizophrenia should not be confused with the lesser improvements that can be made over the short or intermediate term. Professionals need to come to grips with the bureaucracy, politics, and inefficiency of our largest cities and should also actively advocate for involuntary treatment when it is clinically indicated.

Chronic Disease↗
PubMed1997

Deinstitutionalization of the elderly in Finland, 1981-91.

The success of Finnish deinstitutionalization policy among the elderly in 1981-1991 was evaluated in terms of institutionalization rates and case-mix. Censuses of institutionalized people in all public and private residential homes and health centre hospitals (or nursing homes) were performed in 1981, 1986 and 1991. Data on demographic factors, diagnoses and dependency level were gathered. Censuses from the closest years of psychiatric patients were also used to obtain a comprehensive view of institutionalization. The eligibility criteria for the study were (1) age 65 years or more (2) currently in long-term care. In both men and women the overall relative reduction was 33%, and largest in psychiatric care, at over 67%. In residential home care the relative reduction was about 40%. In health centre hospitals a slight increase was seen, about 10%. Length of stay shortened in residential homes but increased in health centre wards. Dependency level increased among the elderly people in long-term institutional care during ten years. In conclusion, the deinstitutionalization rate was substantial among the elderly in Finland. However, because of rapid demographic change the absolute number of elderly in long-term care remained almost constant. The case-mix has become more demanding and the proportion of elderly in constant need of extensive help has risen.

Activities of Daily Living↗
PubMed1997

Longitudinal study of deinstitutionalization and the exercise of choice.

Day-to-day choices available to former institution residents with severe/profound developmental disabilities (movers) were assessed before and after deinstitutionalization and compared with peers who remained in the same institutions (stayers). Data were gathered annually for both groups for 3 years after baseline. Personal characteristics of the two groups did not differ significantly at baseline, except that stayers exhibited more challenging behavior. This was controlled by using baseline challenging behavior as a covariate in group comparisons. Overall, movers exercised significantly more choice, although groups did not differ at baseline. Effects of deinstitutionalization did not differ with level of disability. However, the absolute level of choice available to both movers and stayers was very low.

Adult↗
PubMed1984

The young adult chronic psychiatric patient in an era of deinstitutionalization.

Assessments of the consequences of deinstitutionalization tend to focus primarily on observable changes in psychiatric services. Equally critical, and less often noted, are changes in the target population of deinstitutionalization that have accrued as the result of new service initiatives and changing loci of care. Young adult chronic psychiatric patients, a newly emerging service entity, throw into bold relief the problems associated with delivering care to a changing patient population.

Adolescent↗
PubMed1991

Deinstitutionalization and mental health.

Better understanding of the problems related to deinstitutionalization is essential for all those involved with community care. Finding ways to address the issues raised by deinstitutionalization is the key to using all community resources-including home care-in building a better system of mental health care.

Community Mental Health Centers↗
PubMed2000

[Many faces of deinstitutionalization--sociological interpretation].

The article summarizes in an international perspective what kind of results psychiatric deinstitutionalization has brought so far: a profound change of size and functions of the psychiatric hospital; better services for people with less severe problems; and the failing of community services to compensate for some of the functions of the former asylums, resulting in trans-institutionalization and/or neglect for many chronic patients. Three different sociological versions to explain the background and typical outcomes of psychiatric deinstitutionalization have been brought forward so far: political economy, professional dominance and post-structuralism. They are confronted with an approach using the concept of medicalisation which offers a more comprehensive understanding of the process.

Community Mental Health Services↗
PubMed2000

[Limits of deinstitutionalization?--perspective of the specialty clinic].

Deinstitutionalization is a complex process that in the past was often misunderstood solely as a run down or even closure of psychiatric hospitals. Although chronically mentally ill patients were prevented from long term hospitalisation some fundamental mistakes were repeated often: patients were simply discharged without any preparations and outpatient care was badly organised. In some cases this led to therapeutic neglect, social disintegration, homelessness, incarceration or other forms of dramatic loss of quality of life. These findings are internationally confirmed although there are remarkable differences between various health care systems. Especially when primarily determined by purely economic interests deinstitutionalization constitutes a severe danger for the whole psychiatric system of care and in particular for chronic patients. Intensive research is required to avoid severe disadvantages for the further development of psychiatry.

Community Mental Health Services↗
PubMed1990

Follow-up study of family attitudes toward deinstitutionalization: three to seven years later.

The attitudes of 32 families who had their relative with mental retardation deinstitutionalized and living in the community for 3 to 7 years were examined. Preplacement data on these families indicated a high level of satisfaction with institutional services and strong opposition to community placement. Postplacement data revealed a significant change toward more positive family attitudes toward deinstitutionalization. However, families were still concerned about high staff turnover rates, inadequate community services, and future relocations.

Adult↗
PubMed1989

The differential impact of deinstitutionalization on white and nonwhite defendants found incompetent to stand trial.

Previous studies have reported that state mental hospital deinstitutionalization has resulted in the processing of the mentally ill through the criminal justice system. Using pre- and postdeinstitutionalization samples of defendants found incompetent to stand trial (IST) selected from three states, this study examines changes in the mental health and arrest histories of white and nonwhite ISTs. These data reveal a significant increase in the number of nonwhite ISTs. Also, after deinstitutionalization, nonwhite ISTs had significantly more prior arrests and hospitalizations than white ISTs. There were, however, no differences in the offenses for which whites and nonwhites were arrested.

Commitment of Persons with Psychiatric Disorders↗
PubMed1987

[Deinstitutionalization in Québec.].

In this article, the author raises questions about the results and consequences of deinstitutionalization in Quebec. First presented is an analysis of the phenomenon that focusses on the prevention of admissions as well as the return and the maintenance of an individual in the community. TTie analysis leads to an assesment of the phenomenon's impact on the principal actors. There are two sides to the coin; the author examines the achievements and the weaknesses that subsist In Quebec, as elsewhere, certain problems are associated to deinstitutionalization; the author offers explanations to these problems.

English Abstract↗
PubMed1988

[The deinstitutionalization process in the USA (2nd part).].

In this second article, the author analyses the impact of American deinstitutionalization on patients, their families, the communities and the health care system (medical clinics, general hospitals, community mental health centres and residential concerns). Following his analysis, the author develops the various hypotheses produced to solve the problems created by deinstitutionalization. These hypotheses follow the dominant political theme of the 80s in the area of health and social services : the integration of services.

English Abstract↗
PubMed1980

Social implications of deinstitutionalization.

Attacks on custodialism offered the hope of more humane treatment approaches. Mental health planners thought that the costs of state hospital care could be reduced by discharging patients into the community. For state governments, this involved a shift of costs and responsibility to the federal government. This shift was accompanied by an increase in cost-effective planning at both state and federal levels. Cost-effective planning uses corporate-style standardization techniques to provide precise, measured types of treatment to certain categories of patients. Such planning is primarily oriented to balanced ledgers of the government budget, rather than meeting specific human needs. The shift in costs also increases profits in the private sector. This is most noticeable in the nursing and boarding home industry where entrepreneurs derive large returns from a newly custodialism mainly funded by government reimbursements. The institutional overuse of psychiatric drugs is continued in community programs. Cost-effective approaches also involve firing mental health staff and increasing the workload of those remaining. Community mental health centers and state hospital deinstitutionalization programs have largely failed to meet most of their promises such as noninstitutional treatment, more humane care, prevention, and rehabilitation. These failures have produced the beginning of a delegitimation of the new mental health approaches. This delegitimation is also used as part of more general attacks on social services so prevalent in this period of economic crisis. This reinforces the reliance on cost-effective plans which do not benefit clients. It also poses the danger of increasing the number of persons classified as psychological misfit among the marginal underclass. Even though this is an unintended effect, it can then be used to deflect onto these victims popular resentment against big business and the government. Further, the growth of such a misfit group, along with other types of social decay, may prompt an increase in the already growing forms of social control psychotechnology such as psychosurgery.

Community Mental Health Services↗
PubMed1985

Treatment patterns of young chronic schizophrenic patients in the era of deinstitutionalization.

A retrospective longitudinal treatment utilization study of 56 young chronic schizophrenic patients who began their treatment careers during the deinstitutionalization era was carried out covering all psychiatric services provided to each patient since first treatment. The group was primarily male and was characterized by histories of drug abuse and violence. Treatment utilization was heavy, discontinuous, and episodic with these patterns intensified for patients with histories of drug abuse. The majority of the group became "long-stay" hospital residents. The clinical and mental health policy implications of these findings are discussed and further research is suggested.

Adult↗
PubMedDate not supplied

A special population. The elderly deinstitutionalized chronically mentally ill patient.

Deinstitutionalization began with some noble sentiments: to treat and care for the mentally ill in settings that were closer to their homes, families, and neighborhoods; to treat people in more therapeutic and less restrictive settings; and to provide the array of services and settings in the community rather than in far distant institutions. However, few of these intentions have been realized. It is up to us to point out the discrimination, the inequity, indeed the insanity of our current practices and non-system.

Aged↗
PubMed1999

The family experience of deinstitutionalization: insights from the closing of Central State Hospital.

Since the early 1970s, policy makers and researchers have expressed concern about the potential negative consequences of deinstitutionalization on families. This article summarizes results of a survey of family and lay caregivers of patients discharged from Central State Hospital, which closed in June 1994. The survey was designed to assess the impact of the closing on family members, including their attitudes, caregiving responsibilities, and involvement in the treatment of the patients. Results indicate that family members have mixed feelings about the closure. Family caregivers also reported that they have not been asked to take on significant amounts of the caregiving responsibilities since the clients were moved from the hospital. Family members described a significant reduction in the frequency of contact they had with their loved ones and with professional caregivers since the closure. Implications for behavioral health policy makers considering or planning closing or downsizing long-term care facilities are discussed.

Adult↗
PubMed1982

Deinstitutionalization: a microcosmic perspective.

Changes have taken place in caring for chronic patients due to deinstitutionalization, and these changes have affected the services rendered by the community mental health centers. Statistical data on dehospitalized patients treated in a community mental health center located in the South Central Bronx are examined to determine trends in service utilization by these patients. Demographic characteristics of this population are also examined. Issues surrounding treatment and rehabilitation of chronic mentally ill patients are critically explored and recommendations for changes in the care of the chronically mentally ill patient are offered.

Adult↗
PubMed1987

Deinstitutionalization: a new scenario.

Deinstitutionalization appears to be an issue that is still pretty much up in the air. The public, courts, and state hospital administrators agree that large state, warehouse-like facilities are inadequate. The appropriate mental health delivery system for each state and the communities within each state need careful planning and implementation to be successful. Mental health populations in state facilities have dropped over fifty percent since 1955. The future planning of mental health delivery systems can be improved by training administrators to work with the public and the courts to provide services appropriate to each community or state.

Community Mental Health Services↗