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 1,135 records · Page 63Linked to original sources
PubMed1985

Mental health professionals' knowledge in the field of caring for chronic mental disorders.

A national sample of 246 Canadian mental health professionals was given a knowledge test concerning principles of care for chronic mental patients. Results showed that: (1) mental health professionals were moderately knowledgeable on this topic (mean score 66%), (2) errors made were more commonly in the direction of over-enthusiastic support for the community approach and (3) there were no differences in knowledge scores by a demographic or professional status variables included in this study.

Adult↗
PubMed1986

Cues of disability and treatment continuation of chronic schizophrenics.

Serious questions have arisen concerning the retention of the chronically ill in outpatient community mental health clinics (CMHC). This study tests a model based upon sociological theories of disability and the sick role to explain differential continuation in treatment among schizophrenics. We hypothesized that economic, social and medical cues facilitate a patient's self-definition of disability and contribute to continuation in treatment. Data were collected from the clinical charts of 879 chronic schizophrenic patients at five CMHC's. Hypotheses were tested using OLS multiple regression and logistic regression. Findings indicated level of functioning may be an important explanatory variable. Analysis strongly indicated the efficacy of the medical model in the area of treatment continuation.

Antipsychotic Agents↗
PubMed1986

The changing structure of Dutch mental health care.

Current mental health care policy in The Netherlands emphasizes a major shift from intramural to extramural care. A decline in psychiatric hospital admissions is to result from intensified psychiatric care offered by non-residential provider agencies, an increase in sheltered housing and day care capacity and an integral role in mental health care for the general practitioner. To allow for such a far reaching change, fortification of the greatly fragmented non-residential sector of Dutch mental health care was necessary (in 1982 more than 300 agencies in a country of 14.5 million inhabitants). Mergers have recently led to 60 Regional Institutes for Ambulatory Mental Health Care (RIAGG). This amalgamation within the non-residential sector is considered a major step towards the integration of the entire Dutch mental health care system. The article provides insight into the development of mental health care policy in The Netherlands and offers an analysis of the process of merger of non-residential services. As a necessary preface to this material a sketch of the historical and administrative context of Dutch health care is provided.

Ambulatory Care↗
PubMed1989

Mental health monopoly: corporate trends in mental health services.

Over the past 30 years, a number of important changes have occurred in the mental health system. This paper examines the origins and effects of these changes, utilizing a political-economic framework. Three main areas are emphasized: the increasing absorption of mental health care into the health care system in general; the ways in which care has been transferred away from traditional settings and responsibilities; and the movement of for-profit chains into mental health services. Particular focus is placed on the rationalizing and monopolizing tendencies increasingly evidenced in the mental health field.

Community Mental Health Services↗
PubMed1991

Community versus hospital care: the crisis in psychiatric provision.

The movement away from hospital-based schemes of care for those with a psychiatric disability in favour of community-based schemes of care constitutes a turning point in the history of psychiatric provision in most Western European societies. The origins and rationale of this movement have sometimes been explained by reference to extra-discursive (economic) interests, and sometimes by reference to a form of technological or scientific determinism in which the discovery of such things as the neuroleptic drugs during the 1950s is said to have played a major role. This paper argues that the impetus for community as against hospital-based care can only be understood in terms of a changing discourse of psychiatry and psychiatric nursing, and especially those forms of thought which have tended to place 'illness' in the wings and set its primary sights on behavioural and social 'deficits'. There is a sense, therefore, in which hospital-based practices of psychiatrists and nurses have constituted the source and origin of their own transformation--a transformation in which the rationale of the psychiatric hospital has been eroded. The arguments in this paper are substantiated by reference to a current study of the forms of knowledge and daily practice which are drawn upon by nurses and psychiatrists in the psychiatric wards of a large Northern Irish hospital.

Community Mental Health Services↗
PubMed1992

Social network transactions of psychiatric patients.

In this research we examine self-reported social network transactions of former psychiatric inpatients residing in different types of housing in the community. Unlike earlier research, we found considerable reciprocity in network transactions with family and friends. Only professionals provided more support than they received from patients. Providing emotional support to others was positively correlated with positive affect, community integration, and mastery. Respondents reported more supportive than unsupportive transactions with network members and more supportive transactions with friends than with family or professionals. Finally, residents of supportive apartments and group homes provided and received support more frequently than residents of board-and-care homes. We discuss the results in terms of their implications for policy and future research.

Adaptation, Psychological↗
PubMed1993

A typology of care episodes experienced by people with schizophrenia in an English town.

The paper presents an analysis of the psychiatric care histories of people diagnosed with schizophrenia which is set within the policy context of the deinstitutionalisation debate. The durations of successive terms of in-patient and community care were drawn from the records of the Salford Psychiatric Case Register and related to the age, gender and social isolation of each patient. Strong age-sex interactions are revealed by the tendencies for young male patients to exhibit rapid hospital readmission and discharge rates and elderly female patients to experience long terms of in-patient care. The role of social isolation in relation to these care durations turns out to be more restricted.

Adult↗
PubMed1995

An economic analysis of the resettlement of people with mild learning disabilities and challenging behaviour.

New models of care are needed following the closure of long-stay mental handicap hospitals. Based on an evaluation of a recently established assessment and treatment service in south-east England, this paper is concerned with the costs and likely benefits of different patterns of services for people with mild learning disabilities and severely challenging behaviour. Different models of provision are compared in terms of their costs and quality of life opportunities for clients. The assessment and treatment services provided a better understanding of the care needs, and achieved a reduction in challenging behaviours. It was therefore possible to give access to care settings closer to a normal life. For approximately 25% additional expenditure, 20 out of 34 clients who received the service moved to community placements, including three who had been referred following a breakdown in the community. If community care is to be implemented as a policy for clients with learning disabilities and serious challenging behaviours, it is necessary to recognise the financial implications. Better quality of life opportunities for this client group are associated with higher costs. When seen in the dynamic context of the costs and quality of life opportunities of the subsequent care, a high cost assessment and treatment service may be a good investment. On current evidence, the additional benefits of community homes, with a closer association with the local community, and greater freedom for clients is bought only at quite a high cost.

Adult↗
PubMed1995

The extent of support for ordinary living provided in staffed housing: the relationship between staffing levels, resident characteristics, staff: resident interactions and resident activity patterns.

Staffed housing has become an accepted alternative to institutional residential services for people with learning disabilities on the expectation that such provision will promote 'ordinary' patterns of living. Information on staffing levels and the behavioural characteristics of residents together with direct observational data on staff: resident interactions and resident engagement in activity were collected on 15 housing services in South Wales and analysed to explore the interrelationship between these key input and outcome variables. Staffing levels were found to be related to resident characteristics in general but not consistently so. The extent of staff: resident interaction per staff was related to resident characteristics, with staff in services for more able residents spending more time with them. The level of staff support given to residents with more substantial disabilities, slightly higher than that given to more able residents, reflected high staffing input. Resident engagement in activity was strongly related to ability. Participation in household activity was virtually non-existent among residents with the greatest disabilities. The results were compared to similar data from earlier studies on a range of residential services. The relative benefits of small, community-based housing services over institutional and larger community settings were confirmed by the Welsh data. However, comparison to other housing services, which had a particular emphasis on staff helping residents become involved in domestic activity, supports the conclusion that 'ordinary living' for people with severe or profound learning disabilities depends not only on the provision of ordinary environments but also on the orientation and working methods adopted.

Activities of Daily Living↗
PubMed1995

Empowerment and the psychiatric consumer/ex-patient movement in the United States: contradictions, crisis and change.

A political movement in the United States by consumers and ex-patients of psychiatry has challenged the assumptions and negative consequences of traditional mental health practice and its control by professionals. In recent years, the movement has succeeded in gaining support to produce alternative programs based on a philosophy of 'consumer empowerment' and run entirely by consumers and ex-patients. In this article, I present results from an ethnographic study of one such alternative and I attempt to explain the discrepancy between the center's philosophy of empowerment and its actual practices. Utilizing this data, the consumer literature, and interviews with consumer leaders nationwide, I explain this situation in terms of conceptual problems with the terms 'empowerment' and 'consumer empowerment', local structural conditions under which the center operated, and the larger situation of the psychiatric consumer/ex-patient movement in the United States today. The case study represents a crisis in the consumer movement today, in which rapid growth of alternatives has been accompanied by a social amnesia of the emancipatory vision that originally spawned the movement.

Adult↗
PubMed1989

Movement of developmentally disabled individuals among out-of-home residential facilities.

This paper reported on the movement of a large (N = 2271) probability sample of the nation's residents of public (PRF) and community (CRF) residential facilities for developmentally disabled children and adults. Estimates placed the national population at 217,410 in all facilities--73,709 in CRFs and 143,701 in PRFs--in the fall of 1978, when the sample was selected, although extrapolation from subsequent surveys suggest that the CRF numbers should be about 100,000. In the winter of 1979 direct care staff and administrators completed detailed information about each resident sampled, about themselves, and about their facilities. In 1980 they were asked if their residents had moved exactly one year later. Most residents (91%) had not moved; 1.3% had died; and about 8.5% had moved. Most moves featured greater integration into the community. Multivariate analyses indicated very little difference between moved and unmoved residents. Among moved subjects, three dimensions accounted for 62% of the common variance in placement status: (a) ability, (b) age, and (c) autonomy.

Adolescent↗
PubMedDate not supplied

Community integration of young adults with mental retardation: a multivariate analysis of adjustment.

The purpose of the present study was to determine whether differences in community adjustment existed for three groups of young adults with mental retardation using data organized on the basis of four empirically validated factors identified in prior research. A descriptive discriminant function analysis was used as a follow-up to a statistically significant multivariate analysis of variance F-ratio. Results obtained from the discriminant analysis indicated that five variables (number of limiting factors, earned income, number of support services, living arrangement, number of daytime activities) contributed substantively to separation of the three group centroids.

Activities of Daily Living↗
PubMedDate not supplied

Specialized group homes for persons with severe or profound mental retardation and serious problem behaviour in England.

Thirteen people with severe or profound mental retardation identified by their local service agencies as presenting the most serious problem behaviour were transferred from institutional care to specialized group homes. A multiple time-series design and direct observation were used to evaluate whether there was any change in their level of participation in meaningful activity; social interaction and problem behaviour were also observed. Participation increased significantly on transfer and included a wider range of activities. The majority of participants did not increase their major problem behaviour. The results support the view that individualised community-based placements can replace institutions for this group of clients.

Activities of Daily Living↗
PubMedDate not supplied

Who stays, who goes? Downsizing the institution in America's most rural state.

Between 1988 and 1993, Wyoming reduced the census of its only state institution for persons with mental retardation by more than 50%, with a significant percentage occurring as a result of a class action suit in 1990. This article demonstrates the similarities between the characteristics of the individuals who left the Training School and those who remain, as well as the differences in the characteristics of those leaving during three 2-year periods--prelawsuit, transition, and postlawsuit. Descriptive data were gathered in 1988 and 1993 using the Inventory for Client and Agency Planning. Individuals left the large, residential institutional settings for less restrictive, rural placements in the community. This study updates the literature and confirms that all of the residents of the state-operated institutions can be placed into community settings even in America's most rural state.

Activities of Daily Living↗
PubMed1996

TAPS project 28: does reprovision benefit elderly long-stay mental patients?

A survey of all inpatients aged 70 years or more was conducted in one of London's mental hospitals in 1989. Baseline measures of cognitive and behavioural disabilities were established for each of the 130 functionally-ill long-stay patients. Three years later 71 patients were still alive, being equally distributed between hospital and community facilities. The study examines the outcomes of patients who had left hospital in comparison with a similar group who remained there. The results indicate that behaviour of patients who were settled in the community was stable and even improved slightly over time, as opposed to those who remained in hospital, who became more disturbed. Direct examinations demonstrate that while those who remained in hospital markedly deteriorated in their cognitive function, patients who left hospital had also declined, but to a much lesser extent. When considering the overall outcomes, we come to recognise the potential for stabilization and even improvement in the condition of ageing schizophrenics being moved from hospital to the community.

Aged↗
PubMed2006

Public attitudes towards mental patients: a comparison between Novosibirsk, Bratislava and German cities.

PURPOSE: It is commonly assumed that reforms in the sector of psychiatric care have contributed to reducing the stigma attached to mental illness. In order to examine whether a relation between the psychiatric care set-up and stigmatisation of the patients exists we compared public attitudes towards mental patients in three countries at differing stages of progress in psychiatric reform. METHODS: Population surveys on public attitudes towards mental patients were conducted in Novosibirsk (Russia) and Bratislava (Slovakia). The data were compared with those from a population survey that had recently been carried out in Germany. In all three surveys the same sampling procedure and fully structured interview were used. Public attitude towards mental patients was elicited using a perceived devaluation-discrimination measure. RESULTS: Psychiatric patients face considerable rejection in all three locations in question. Overall, the degree of perceived devaluation and discrimination was similar in all countries with a significant, but marginal tendency towards stronger devaluation of mental patients in Germany. CONCLUSION: Our results do not support a strong relationship between psychiatric reform and mental illness stigma.

Adolescent↗
PubMed2005

Introduction to theme section on geographies of intellectual disability: 'outside the participatory mainstream'?

This paper introduces the following theme section on Geographies of Intellectual Disability. It outlines the historiography of geographical work on intellectual disability, noting in particular the contributions of Wolpert (Transactions of the Institute of British Geographers 5 (1980) 391) and Hall and Kearns (Health and Place 7 (2001) 237), before tracing claims made about both the 'institutional' and 'deinstitutional' eras in the changing geographies confronting and experienced by intellectually disabled people. This account, highlighting the tendency for such people to remain 'outside the participatory mainstream' in almost all circumstances, offers along the way an introduction to the four contributions that follow.

Deinstitutionalization↗