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PubMed1979

"What's new about independent living?".

The major purpose of this article is to examine important differences between independent living and traditional rehabilitation models of service provision, including comprehensive medical rehabilitation programs, state vocational rehabilitation agencies, and group homes designed to deinstitutionalize developmentally disabled individuals. The article is introduced by an overview of types of independent living programs in this country and their evolution. Goals, methods of service delivery, and program management techniques in independent living programs are contrasted with those of traditional models. Finally, trends that may develop as independent living becomes a standardized service entitlement are addressed, and the potential usefulness of some independent living concepts and methods in traditional rehabilitation programs are suggested.

Delivery of Health Care↗

PubMed1984

[Epidemiology and space of the therapeutic project].

The author suggests an analysis of the evolution of psychiatry referring to space concepts, according to three stages. In the first one, the topographical space is represented by the asylum and the nosography, which both bound a closed field. The second stage represents the dynamical space of therapeutic institution which refers to the psycho-analytical and sociological concepts. The third stage opens a space of meaning; it refers to the concept of sector, to the process of deinstitutionalization and to the epidemiological field; it tries to surround some projects linked with the notions of mental health and prevention.

Community Psychiatry↗

PubMed1984

Maladaptive behavior of mentally retarded individuals in residential facilities.

Results of a national interview study of 2,271 mentally retarded residents in 236 public and community residential facilities were reported. Maladaptive behavior was more prevalent among residents of public residential facilities, particularly among new admissions and readmissions, but the frequency at which residents performed various types of maladaptive behavior and the responses elicited from direct-care staff members were similar in public and community facilities. Implications for the deinstitutionalization process were discussed.

Dangerous Behavior↗

PubMedDate not supplied

Dilemmas in planning for the protection of children and youths in residential facilities.

Protection of children and youths after placement must be given increased emphasis because deinstitutionalized care is itself not harm-free and also because the needs of many children for care, control, and treatment are likely to be met in residential facilities for the foreseeable future. However, the diverse and often incompatible views of advocates and providers of child care about the issues affecting the protection of residents in institutions loom as obstacles to planning for the protection of children and youths after placement. Both of the extreme views of institutional abuse and neglect issues deny the need for child protection after placement. The first holds that since the child or youth is being protected and/or treated, no ongoing child protection is necessary. The other view holds that any child protection effort short of closing residential facilities is futile and therefore without merit. Underreporting of abuse or neglect is widespread; accountability of facilities for the protection of residents is, as a result, unevenly established. These conditions are attributable in part to the inadequate statutory base for protecting children in institutions. At the same time, because of the lack of a planned approach to protection within facilities, and between facilities and child protection agencies, residential facilities are likely to suffer negative public exposure when moderate or serious incidents of maltreatment become public. The absence of procedures for facilities themselves to recognize abuse and neglect invites exposure of incidents by staff and residents. The ad hoc manner in which incidents are managed by external agencies often inflicts unwarranted costs on the reputations of residential facilities that in many cases may have only one or two serious incidents a year. Finally, the use of "last resort" placements may be putting some children and youths into situations of unacceptable risk. Despite the existence of differing views in the residential care field, we have identified areas of agreement between the child protection agencies and residential facilities upon which public policy might build. The problem may not be so much that these attitudes exist, as that the states have not responded in a planned and credible way to the problem of institutional abuse and neglect. Nevertheless, development of a planned and credible approach must deal with these areas of difference if protection of children after placement is to be improved.

Adolescent↗

PubMed1983

Recent developments in the care, treatment, and rehabilitation of the chronic mentally ill in Norway.

As in most other Western nations, the ideology shaping mental health care in Norway has shifted since World War II from a traditional institutional approach to a community-based concept of treatment for the chronic patient. And as in many other countries, communities have been poorly equipped to deal with the influx of deinstitutionalized patients. Few appropriate community alternatives have been developed to care for hospitalized patients, many of whom must remain institutionalized. The author reports on a 1979 census of Norway's mental patients which showed that about half of the mental hospital patients could be expected to remain in the hospital because adequate community facilities did not exist. However, the author says, there is a new interest in Norway in reducing the number of hospital beds and transferring more patients to community programs; one large mental hospital has recently been closed. Legislation focusing on patients' rights and new research on "quality of life" of patients are also pushing mental health care into the community, he says.

Chronic Disease↗

PubMed1981

Intellectually limited parents.

Studies of the child-rearing competency of mentally retarded parents are few and based primarily on deinstitutionalized populations; results have been equivocal. A checklist devised to assess intellectual limitation in parents led to the identification of 45 families with an intellectually limited parent in the course of evaluations of 370 children in a pediatric development clinic. It became evident that the presence of a benefactor was crucial in enabling limited parents to meet community expectations. Identification of parental limitations is seen as a prerequisite to essential modifications in service delivery to both parents and children.

Adult↗

PubMed1995

[The deconstructions of schizophrenia (I)].

Standing in the midst of this great historical change, as sometimes it is called the switch to the "post-modern", we are now confronted with the demand of paradigm change in every field of scientific knowledge. So it is the case with psychiatry. Just about 100 years ago, the trend of "social defense" (society's need to be protected from harm) was going on covering the whole civilized countries. It brought about a situation that could be generalized as "institutionalism" which made mental hospitals huge and custodial, resulting in the prevalence of nihilism with regard to treatment. It was just at this time that Dementia praecox, the preconcept of Schizophrenia, was formed by Kraepelin, E. (1896) as a mental disease resulting in peculiar dementia. After some period, Dementia praecox was transformed into Schizophrenia (Gruppe der Schizophrenien) by Bleuler, E. (1908) with a new methodology: to grasp the disease from the symptomatic viewpoint. Jaspers, K. (1912) as well as Schneider, K. (1938) followed him in the way that was psychopathologically more strict; the latter reached the formulation of the . Despite this eventful metamorphosis of the concept of Schizophrenia, its fundamental traits have remained unchanged until the late 1960's. They could be summarized as follows: 1) What patients mention is incomprehensible; 2) The prognosis leads to peculiar dementia; 3) The real cause of the disease is the brain disorder. These three are the reflection of the custodialism, curative nihilism and materialism through the institutionalized mental hospitals in those days. Now, since the 1970's, the situation has been completely changed, or at least, faced with inevitable changes. The tide of "deinstitutionalization" is covering all over the civilized countries, demanding the normalization of mentally disordered persons. Thus, deprived of its motherland (i.e. institutionalism), the concept of Schizophrenia has got into confusion or even crisis. And in order to relieve this confusion, severe attempts are internationally being made to identify the diagnostic criteria of Schizophrenia by means of what they call "operational diagnosis". I believe, however, that what is truely necessary is not such a compromising modification, but a more radical change that is: the DECONSTRUCTION OF SCHIZOPHRENIA.

Community Psychiatry↗

PubMed1994

CMHS data highlights on: availability of psychiatric beds, United States: selected years, 1970-1990.

Despite the decrease from 474,190 to 250,541 between 1970 and 1990 in the overall number of non-Federal psychiatric beds (excluding "scatter" beds in non-Federal general hospitals), the trend was by no means constant over time. Between 1970 and 1982, a period of rapid deinstitutionalization of State mental hospitals, the number of beds in all organizations combined dropped precipitously from 474,190 to 222,666, led by State mental hospitals which decreased from 413,066 to 140,140 beds. This was the height of the community mental health center movement and the prevailing view of mental health administrators was that persons with mental illness could be cared for better in the community, rather than at State mental hospitals, far from their homes. Thus, some hospitals closed altogether, and many others closed wards and units as part of the downsizing process. Contrary to a decrease in the number of beds in State mental hospitals during the 1970-82 period, the number of beds in other organization types, in particular private psychiatric hospitals and separate psychiatric services of non-Federal general hospitals, remained relatively constant. The net result was a substantial decrease in the overall number of non-Federal psychiatric beds. In the 1982-90 period, a different phenomenon occurred. The number of beds in State mental hospitals was continuing to decline, but at a slower rate from 140,140 to 98,789, while the number of beds in other types of mental health organizations, particularly private psychiatric hospitals and separate psychiatric inpatient services of non-Federal general hospitals, expanded somewhat.(ABSTRACT TRUNCATED AT 250 WORDS)

Hospital Bed Capacity↗

PubMed1993

Competency, civil commitment, and the dangerousness of the mentally ill.

The purpose of this study was to assess if a relationship exists between the nature of an individuals criminal charges and the finding of fitness among defendants evaluated at the Forensic Psychiatry Clinic servicing Manhattan. We examined the records of 354 defendants referred to the Forensic Clinic from the New York Criminal and Supreme Courts for a competency to stand trial evaluation. We reviewed their charges in light of the finding of competency. Incompetent defendants were most often accused of misdemeanors rather than felonies and of non-violent rather than violent crimes. Perhaps individuals who are thought to be psychiatrically disturbed get detained by the police on trivial charges so as to get them off the streets. Deinstitutionalization and civil commitment laws are considered as contributing factors and their impact is discussed.

Adult↗

PubMed1996

Dementia and Down syndrome.

Through deinstitutionalization, more adults with mental retardation are living in the community under the care of family physicians. Patients with Down syndrome are at high risk for early Alzheimer's disease. This case report describes a 43-year-old woman with Down syndrome whose progressive functional decline over 3 years was attributed to dementia of the Alzheimer type.

Adult↗

PubMed1996

Comparative mortality of people with mental retardation in institutions and the community.

The role of institutions has come into question in recent decades, and the size of the institutionalized population has been drastically reduced. Risk-adjusted mortality rates in institutions and the community in California from 1980 through 1992 were compared, with the aim of improving our understanding of the capacity of the community health system to support deinstitutionalization. Risk-adjusted odds on mortality were estimated to be 72% higher in the community than in institutions. Some problems with health care delivery in the community were reviewed; these may help account for the difference. Consumers and guardians should weight these considerations when making choices between institutional versus community-based care.

Activities of Daily Living↗

PubMed1977

Behavioral effects of interinstitutional relocation of mentally retarded residents.

Deinstitutionalization requires relocation of mentally residents. An exploratory investigation was conducted of the impact of interinstitutional relocation. The subjects were residents transferred from a large institution to a smaller facility and a matched comparison group from the latter facility. The 92 male and female subjects ranged from 10 to 42 years of age. The Adaptive Behavior Scale was administered prior to relocation, immediately following relocation, and 6 to 8 weeks following relocation. Higher functioning residents showed a pattern of lowered functioning and withdrawal following relocation. Relative to the comparison group, they were more withdrawn and suffered setbacks in language development. In contrast, lower functioning residents generally increased activity levels of both adaptive and acting-out behavior. The necessity for risk/benefit analysis preceding decisions to relocate residents was discussed.

Adaptation, Psychological↗

PubMedDate not supplied

Predicting future long-term-care needs in a community.

Under current financial restraints, planning for the future long-term-care needs of older Canadians is coming under increasing scrutiny. Even though health care is moving to a community-based system (i.e., deinstitutionalization), this is not necessarily the most cost-effective strategy for severely disabled older adults. Three models are used in the present paper to estimate the number of severely disabled (two or more ADL disabilities abilities) older adults expected in the next 5 to 10 years in a small community in Northern Ontario. While mortality and disability rates are the main predictors, it was also necessary to consider additional factors particular to the community in question. It is suggested that for long-term-care planning to be effective and economically sound, similar strategies will be needed throughout Canada.

Activities of Daily Living↗

PubMedDate not supplied

The impact of organizational downsizing on the job satisfaction of nurses.

Professional nurses across Canada are being affected by health reform initiatives designed to deinstitutionalize the health care system. This panel study examined the impact this restructuring has had on nurses' overall job satisfaction as well as their satisfaction with various aspects of their job and work environment. The participants consisted of 345 nurses employed in 3 community hospitals in southwestern Ontario. Hospital downsizing had relatively little effect on overall job satisfaction, satisfaction with kind of work, amount of work, and physical work conditions. However, compared to before the downsizing, nurses reported a significant deterioration in satisfaction with their career future, hospital identification, supervision, and co-workers following the implementation of restructuring initiatives. We discuss the organizational and management implications of these findings and suggest ways that hospital administrators can minimize the negative effects of downsizing on nursing professionals.

Adult↗

PubMed1996

[Training needs for educators and nurses using the individualized services plan in mental health].

With the help of the method elaborated by Herskowitz (1977), this study examines the training needs of 42 workers (19 educators and 23 nurses) using when needed, the individualized services plan in a context of external services (deinstitutionalization) in mental health and internal services (hospital). A modified version of a questionnaire developed by Hurteau (1988) adapted to the context of mental health, identifies the training needs of workers using the individualized services plan under five specific dimensions and three types of knowledge. In the light of results obtained, certain training needs appear as top priority, especially conducting meetings and methods of elaboration of individualized services plan. Moreover, workers would like to obtain training on community-oriented services offered to people with needs in mental health.

Community Mental Health Services↗

PubMed1997

Impact of social changes on female mentally disordered offenders from 1980 to 1994 in Japan.

Social change, particularly in mental health policy, may affect the distribution of crime and the legal process. This article presents trends in female crimes during a 15-year period (1980 to 1994) and examines the characteristics of the 1980 and the 1994 group of female mentally disordered offenders (MDOs) in Japan. Data were obtained from the prosecutor's files on a total of 2,094 MDOs who were not prosecuted, or whose criminal responsibility was judged as diminished, or who were exempted due to mental disorders in 1980 and 1994 throughout Japan. Female MDOs accounted for 270 (12.9%) of these cases. A comparison was made between the 1980 group (140 women) and the 1994 group (130 women) in regard to demographic status, criminal variables, psychiatric variables, and legal dispositions. Findings revealed a parallel relationship between female criminals and female MDOs. In both the female criminals and female MDOs, the trend was toward a decrease in homicides and an increase in larceny and drug-related crimes. The 1994 group was more likely to have an even distribution across age groups, have more employment and more job change experience, live more independently, and to have committed more nonviolent crimes, and have more prior crime records than the 1980 group. There was no significant difference in their homicide victims or in the index diagnoses between the two groups. Compared with the 1980 group, the 1994 group was significantly older (40 years versus 36 years on average), had received more outpatient and community mental health services, had been charged more often with larceny, had higher criminal recidivism rates, and had experienced a more simplified legal process as well. The effect of deinstitutionalization is also discussed.

Adult↗

PubMed1998

[Forensic psychiatric examinations of the mentally retarded].

3,343 forensic psychiatric examinations were recorded in Norway from 1980 to 1996. 294 patients were diagnosed as mentally retarded. The annual number of mentally retarded persons increased during the observation period, but the relative percentage remained stable. The majority of the retarded persons being discussed had been charged with sexual felony, and some with arson. About half had previous convictions. Few had problems with alcohol or other intoxicants. Every fourth retarded person examined was considered not only to be mentally retarded, but also to suffer from other psychiatric disorders. We discuss to what extent deinstitutionalization of retarded persons and the accompanying social isolation they experience could contribute to the increase in maladaption and criminal behaviour. It is stressed that many of the sexual felonies may be explained by the fact that the mentally retarded are mentally immature.

Female↗

PubMed1983

Mentally ill women in a county jail.

We studied 101 inmates of a county jail for women who were randomly selected from those referred for psychiatric evaluation. Eighty-six percent had a history of psychiatric hospitalization; 94% had prior arrest records, 50% of these for felonies. More than half met the criteria for involuntary hospitalization. When arrested more than 40% were transients, and only 7% were employed. Seventy percent had histories of serious physical violence, more than 40% had engaged in prostitution, and 84% of those with children had demonstrated an inability to take care of them. Far fewer mentally ill women than men were incarcerated in county jail. As in our study of male inmates, there appeared to have been some "criminalization" of the mentally ill. There is a need for more mandatory aftercare and ongoing involuntary treatment for this population.

Adult↗