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PubMed1990

Reframe your outlook on recidivism.

1. Deinstitutionalization has placed many chronically mentally ill people in communities that are not prepared to care for them. A lack of fit between clients and the programs provided often results in repeated visits to psychiatric emergency services. 2. Repeated visits to a community program can be viewed positively: community services carry less stigma than hospital admissions, they are less expensive, and they are directly linked with the community. 3. By encouraging a return to a community program before decompensation necessitates a hospital admission, it becomes possible to focus on how a client can cope with, rather than simply react to, the illness.

Adaptation, Psychological↗
PubMed1991

Conceptualizing psychosocial nursing in the jail setting.

1. The deinstitutionalization movement led to the release of thousands of mentally ill patients, many of whom were incarcerated as a way of dealing with their disturbed behavior. More restrictive civil commitment laws have also contributed to the number of mentally ill who are incarcerated. 2. Health care and security can be perceived as competing interests in the correctional institution. These competing interests may also be perceived as sources of conflict because each interest aims towards divergent goals that interfere with the other. 3. A problem central to the inadequate services for the mentally ill offender is that few people are aware of the poor conditions for this population. Correctional and mental health organizations must educate the public about the plight of the mentally ill offender.

Attitude of Health Personnel↗
PubMed1994

Educating the paraprofessional staff on the psychiatric unit. A neglected topic.

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.

Adaptation, Psychological↗
PubMed1995

Serving time: psychiatric mental health nursing in corrections.

1. The opposing philosophies of custody and caring result in direct implications for nurses working in the correctional environment. Nurses constantly "walk in line" between the requirement of security, health care, and client advocacy. 2. Deinstitutionalization, increased rates of incarceration for interpersonal violence, and substance abuse related crimes have resulted in a rapidly expanding prison population. Of all offenders, 10% to 15% have a major mental illness, leading to many treatment challenges for the nurse. 3. Therapy issues with this population are complicated. Correctional nurses must have a good understanding of the therapeutic nurse-client relationship, with particular attention to therapeutic impasses, transference, and countertransference. 4. Historically, role development for nurses working in corrections has been particularly difficult. Correctional nurses must grapple with issues surrounding professional identity, professional isolation, and territoriality.

Criminal Law↗
PubMed1997

Walking a mile in their shoes... Symbolic interactionism for families living with severe mental illness.

1. With deinstitutionalization and changes in legal rights of patients, care of patients with severe mental illness has shifted from a hospital-based to a community-centered system. 2. Families often serve as an extension of the mental health system, providing important case management functions such as assessment, monitoring, crisis management, and advocacy. 3. Symbolic interactionism provides a framework for understanding the role of meaning in individual and family responses to the disruption of life that results from severe mental illness.

Adaptation, Psychological↗
PubMed1986

Therapeutic modality comparisons in day treatment.

The deinstitutionalization of patients with chronic mental illness and shorter hospitalizations of individuals recently diagnosed as mentally ill has resulted in the establishment of an enlarged network of community mental health services. Diminished federal financial support calls for greater efficiency and accountability in the delivery of community-based mental health services. The purpose of this study was to determine whether differences in treatment approach relate to differences in outcome measures of symptom reduction, community tenure, and relapse. In a study of two day treatment centers, one offering twice as much activity therapy as verbal therapy, and the other offering twice as much verbal therapy as activity therapy, it was found that clients receiving primarily activity therapy achieved four times more symptom reduction, equivalent community tenure, and a three and a half times greater relapse rate than clients receiving primarily verbal therapy.

Adolescent↗
PubMed1987

Occupational therapy in mental health: crisis or opportunity?

For at least a decade, concern has been expressed about the status of occupational therapy in mental health. Increases in the number of new jobs and clinicians have not kept pace with growth in other practice areas. Although growing criticism of the practice of deinstitutionalization and an increased focus on cost-effectiveness have recently become major public policy trends in mental health practice, the psychological and nursing professions have responded creatively in order to expand their influence and practice. This paper relates changes in the delivery of mental health services to the systematic study of policy development and careful planning needed to help occupational therapy accomplish the same goals.

Humans↗
PubMedDate not supplied

The process and outcomes of a multimethod needs assessment at a homeless shelter.

Many factors contribute to homelessness, including extreme poverty, extended periods of unemployment, shortages of low-income housing, deinstitutionalization, and substance abuse. As a result, the needs of people who are homeless are broad and complex. This needs assessment used literature reviews, review of local documents and reports, participant observation, locus groups, and reflective journals to guide the development of an occupational performance skills program at one homeless shelter in south Florida. Through these methods, the role of occupational therapy was extended beyond direct service to include program and resource development, staff education, advocacy, and staff-resident mediation. The findings of the needs assessment and the actions taken as a result of this work point to the huge potential for occupational therapists and students to work together with staff and residents of homeless shelters.

Florida↗
PubMed2005

[The fate of patients with very severe and chronic mental disorders when there is no psychiatric hospital: a case study].

The Eastern Townships (Estrie) is an area of Québec which has never had a psychiatric hospital and is thus an extreme example of deinstitutionalization. How can people with the most severe mental illnesses be cared for? Does this system have harmful consequences? The authors present a case study with both qualitative and quantitative data to elucidate their questions. They found 36 patients with very severe mental illness (prevalence 12,4/100 000). This region does not send its most severely ill patients outside and generally succeeds in providing them with care and services in a network of small and medium size residential facilities. On the other hand, the authors have also been able to identify a certain drift of patients towards the correctional system ; cases with double or triple diagnosis do not easily have access to care ; through lack of an alternative, patients with potentially chronic violence often are stuck in a hospital in short stay beds (prevalence 1,6/100 000). It thus appears possible to eliminate the use of a psychiatric hospital for patients with very severe mental disorders as long as they are provided with supervised and long term care facilities (need : 10-20 places/100 000).

Adolescent↗
PubMed1998

A US experience: consumer responsive quality of life measurement.

OBJECTIVE: In the United States, interest in quality of life and social disabilities associated with mental illness intensified in the wake of the deinstitutionalization of the late '60s and '70s. Although mental health professionals in the United States have begun to recognize the importance of quality of life considerations to patient management and treatment outcomes, review of the literature shows there is minimal research in mental health on this important topic. As a result, little theoretical or methodological progress has been made. Quality of life has not been clearly conceptualized or defined and there are no agreed-upon standards or criteria for measurement. This presentation will: (a) review important conceptual issues in quality of life research, (b) discuss the benefits of and obstacles to incorporating consumer values in judgments of quality of life, and (c) present data from the Wisconsin Quality of Life Index (W-QLI; Becker et al., 1993) to illustrate the usefulness of a consumer responsive model of quality of life and the importance of incorporating consumer values in the assessment of quality of life of persons with schizophrenia. METHODS: The W-QLI was administered to a convenience sample of psychiatric outpatients with a DSM-IV diagnosis of schizophrenia. The W-QLI is a self-administered individually preference-weighted index that measures nine separate domains encompassing quality of life. The W-QLI scoring method results in separate scores for each domain and allows for the relationships among separate domains to be studied. The nine separate domains include: (a) satisfaction level for different objective quality of life indicators, (b) occupational activities, (c) psychological well-being, (d) physical health, (e) social relations, (f) economics, (g) activities of daily living, (h) symptoms, and (i) goal attainment. RESULTS: Study findings are consistent with previous theory and empirical research which supports the independence of component quality of life domains. Results show that while consumers' and clinicians' judgments of outcome correlated, there were important differences. Clinicians systematically rated function higher and social relations lower than did consumers, and there were significant differences in consumer and provider goals for improvement with treatment. Overall ratings of quality of life and function are only weakly correlated with psychopathology. The findings support the importance and feasibility of incorporating consumer values and judgments of quality of life in outcome measurement.

Adult↗
PubMed1990

Medication refusal: suggestions for intervention.

The civil rights and deinstitutionalization movements of the 1960s gave rise to legal and ethical challenges to the physician's authority to prescribe psychoactive medication to patients who refuse such medication. While no definitive legal ruling has been rendered in this area--and may never be rendered--a review of the important cases to date identifies consistent themes of patient competency, the possibility of physical threat, risks versus benefits, due process, and patient advocacy, all of which form the framework for intervening with patients who choose to refuse medication while preserving their right to do so.

Adult↗
PubMed1997

Long-term care in Canada.

Problems associated with long-term care in Canada include the growing number of elderly citizens, inconsistencies in social policy and legislative initiatives among provinces, effective quality assurance, and cost containment. Deinstitutionalization and independent living have shifted the focus to community participation.

Aged↗
PubMed1980

Community support systems and urban mental health.

The many social systems of which individuals are members have an important role in promoting and restoring mental health. Pilot projects have shown that "natural" support systems in communities can collaborate with mental health professionals in programs designed to promote mental health in communities. Government plans for community support systems for deinstitutionalized psychiatric patients have been very inadequate and have largely ignored natural support systems. Planners and providers should take advantage of the considerable resources for support which already exist in urban communities.

Community Mental Health Services↗
PubMed1984

A taste of nutrition--a nutrition resource for leaders working with mentally handicapped adults.

The trend towards deinstitutionalization for mentally handicapped adults has precipitated a need to provide these individuals with nutrition education and food preparation skills. Food, nutrition, and eating are important components of training programs for life skills, which lead to greater independence for the mentally handicapped. The types of nutrition information and learning activities needed for the mentally handicapped were determined through a literature review and a series of interviews with those working with this target group. The nutritional concerns of mentally handicapped adults include food selection to meet their nutritional needs, menu planning, food preparation, weight control, and nutrient-drug interactions. A Nutrition Resource Kit for Leaders Working with Mentally Handicapped Adults has been developed in The Regional Municipality of York in response to local demand for nutrition education programs and resources for mentally handicapped adults. The kit provides those working with mentally handicapped adults with background nutrition information, learning activities, resource materials, and references to additional resources. The topic areas covered include basic nutrition, nutritional concerns of mentally handicapped adults, nutrient-drug interactions, menu planning, shopping strategies, and food preparation. Dietitian-nutritionists can assist leaders who work with mentally handicapped adults by providing them with up-to-date nutrition information and motivating the to use available nutrition education resources.

Humans↗
PubMed1986

Law and psychiatry: Scandinavia in the 1980s.

The major policies and practices with regard to the civil and criminal commitment of the mentally ill in the Scandinavian countries during the 1970s and 1980s are described and discussed. Deinstitutionalization, community work, and outpatient treatment within geographically defined sectors have been introduced in all the Nordic countries. At the same time, criminally committed mental patients constitute an increasing proportion of the involuntarily hospitalized population. The special defense of insanity and tests such as McNaughtan are not used in the Scandinavian countries. The handling and disposition of severely mentally ill criminal defendants is closer to the notions of guilty but mentally ill in some U.S. jurisdictions, although in Scandinavia such persons are hospitalized and do not receive penal sentences. Even though forensic psychiatry has come under much criticism, there is still a need for psychiatric evaluations for courts and there is still a need for the provision of mental health treatment, rehabilitation, and follow-up for mentally disordered offenders.

Commitment of Persons with Psychiatric Disorders↗
PubMedDate not supplied

Social work in the health field.

Health care delivery systems are under careful and systematic scrutiny. Particular concerns are the availability and access of health care to those in the lower and middle income groups and the escalating costs of health care which until quite recently have exceeded annual inflationary rates of increase. Efforts in social work in the health field have reflected these developments. Programmatic trends in health and social work now emphasize ambulatory care and are reflected in the concept of primary care medicine. Deinstitutionalization as a preferred program for patients is under review with particular emphas -is on providing adequate supportive services to maintain patients in a home care environment. Social work is a major discipline contributing to these programs through appropriate interventive measures. Moreover, the role of the social worker, because of involvement with front line community activities, is particularly suited to make a substantial contribution to this trend.

Ambulatory Care↗
PubMed1980

Qualities of institutional care that affect outcome.

Much has been written about institutions and care of the elderly. This paper begins with a description of the elderly population and its use of institutional care. A brief history of two types of institutions which provide long-term care to the elderly-mental hospitals and nursing homes-is covered next, along with some of the problems these institutions face in terms of their patients becoming institutionalized and what has happened as a result of pressures to deinstitutionalize the mental hospital population. Ways of assessing quality of care are highlighted in regard to current needs and methods of dealing with these needs. Some of the studies which emphasize outcomes in relation to institutional structure and process are then reviewed. Finally, some conclusions are drawn which summarize major needs and deficiencies in this area of study.

Aged↗
PubMedDate not supplied

Children with mental retardation: stigma and stereotype images are hard to change.

Societal attitudes and perceptions of children with mental retardation have stigmatized and stereotyped generations of youngsters. Deinstitutionalization and mainstreaming most of these children in our schools and general communities require that we recognize and reevaluate many long-held beliefs and how they serve as obstacles to implementing and ensuring needed health and social services. The background and current status of these attitudes are reviewed in an effort to 1) increase practitioner understanding of the population of youngsters with mental retardation that increasingly will be seeking the services of community dentists and 2) encourage legislative efforts and grass-root initiatives (such as the Special Olympics) to change/improve attitudes relative to children with mental retardation.

Attitude of Health Personnel↗