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PubMed2005

Off the map: a critical geography of intellectual disabilities.

A "critical geography of intellectual disabilities" is outlined. Drawing on personal experience and borrowing poetic inspiration, claims about the end of the institutional era for intellectual disabled people are disputed, and the continuing eugenic legacy, complete with its multiple stigmatizing effects, is emphasized. The extent of the social exclusion experienced by many people with intellectual disabilities in the wider community, linked to various poor quality of life indicators, is also given attention. Finally, speculations are raised about how to move beyond the "asylum" and the "ghetto", empowering intellectually disabled people in the process.

Deinstitutionalization↗
PubMed2005

The entangled geographies of social exclusion/inclusion for people with learning disabilities.

People with learning disabilities (PWLD) are one of the most marginalised groups in Western society. Social policies attempting to redress this situation focus on their 'reinclusion' into mainstream socio-spaces through engagement in 'normal' activities, primarily paid employment and independent living. Drawing on group interviews in Scotland, the paper develops a nuanced account of the lives of PWLD, exploring their experiences of exclusion and seeming 'inclusion', and also the alternative spaces and networks of inclusion developed by many PWLD. The paper argues that the situations and experiences of exclusion/inclusion are complex and 'entangled', shaped by the socio-spatial contexts within which PWLD live. The paper 'reimagines' social inclusion as a transformation of mainstream social spaces to incorporate PWLD, achieved through self-advocacy.

Deinstitutionalization↗
PubMed2005

Places of social poverty and service dependency of people with intellectual disabilities: a case study in Baltimore, Maryland.

In the United States, post-asylum geographies of people with intellectual disabilities implicate the condition of service dependency in their social impoverishment, here defined as "isolation from the community and lack of real friendships and relationships" (The importance of income. The Self-Determination National Program Office of the Institute on Disability, University of New Hampshire, Concord, 1998, p. 2). Social historical geographies of people with intellectual disabilities, both general and local to Baltimore, Maryland, contextualize how one voluntary service organization re/created service dependency and social poverty of people with intellectual disabilities through residential location decisions.

Baltimore↗
PubMed2006

Beyond "Landscapes of Despair": the need for new research on the urban environment, sprawl, and the community integration of persons with severe mental illness.

The purpose of this commentary is to discuss important trends in the housing of people with severe mental illness in the past 20 years that require the attention of mental health geographers and other experts on the effects of place on mental health. Issues that are worthy of consideration in new research include: assessing the impact of place effects on community integration, the impact of sprawl, and the emergence of the independent scatter-site housing model. Possible implications of these trends for the effects of place on people with severe mental illness are discussed.

Adult↗
PubMed2006

The review panel process: an algorithm for the conditional release of insanity acquittees.

The release of insanity acquittees requires making informed decisions regarding both the presence and severity of an individuals' mental illness and the dangerousness of these individuals. This study evaluated the usefulness of employing structured assessments of mental health and violence risk factors in the conditional release decision-making process. All persons found Not Guilty by Reason of Insanity at East Louisiana Mental Health System, Forensic Division who underwent a review panel between July 1, 1997 and July 1, 1999 were included in this study. The Classification and Regression Tree analysis was utilized to arrive at cutpoints that would optimize the predictive ability of the decision tree analysis. The results indicated that the Community Outpatient Treatment Readiness Profile score was the strongest predictor -- all patients receiving a score of 62 or greater on this scale were recommended to remain at the facility. When women were recommended for release, it was to civil facilities and with moderate levels of symptoms. For males with moderate symptoms, low PCL-R scores were associated with recommendations for release, whereas high scores were associated with recommendations for continued commitment. Our data suggests that algorithms may be useful to governing bodies when making release decisions.

Adult↗
PubMed2006

PLC or TLC: is outpatient commitment the/an answer?

The lively debate over mandated community treatment in general and outpatient commitment laws (OPC) in particular has raised many issues. At its core, the debate is over how and to what extent laws should be formulated to persuade, leverage or coerce (PLC) persons with severe mental illness living in the community to comply with medications that mental health professionals believe they need. The alternative to PLC is what we call TLC (tender loving care): a strategy of using benefits - improved patient-centered treatment, entitlements and service delivery, including assertive outreach - rather than penalties or conditions on access to services, to induce compliance. We examine three aspects of the debate: (1) the empirical case for the need for OPC court orders to maintain revolving-door severely mentally ill persons in the community; (2) the normative argument over whether such orders constitute coercion, and, if so, whether that coercion is justifiable; and (3) the incentives such orders create to leverage community providers to augment resources and tailor treatment and services to entice patients to become willing participants in the management of their disorders.

Ambulatory Care↗
PubMed2006

Involuntary outpatient treatment as "desintitutionalized coercion": the net-widening concerns.

In American jurisprudence, two justifications have traditionally been put forth to support the government's social control of persons with mental illness: police power and parens patriae. As public mental hospitals became less available as loci in which to exercise these functions, governments sought alternative means to achieve the same ends. One prominent but quite controversial means is involuntary outpatient treatment (IOT). While the concerns about IOT have been myriad, one often alluded to but never documented is that of "net-widening." That is, once IOT became available, it would be applied to an ever greater number of individuals, progressively expanding the margins of the designated population to whom it is applied, despite the formal standard for its application remaining constant. We tested the net-widening belief in a naturalistic experiment in Massachusetts. We found that net-widening did not occur, despite an environment strongly conducive to that expansion. At this time, whatever the arguments against IOT might be, net-widening should not be one of them.

Ambulatory Care↗
PubMed2006

Attitudes towards disability in an undergraduate nursing curriculum: the effects of a curriculum change.

Through improved technology and treatment and ongoing de-institutionalisation, nurses will encounter growing numbers of people with disabilities in the New Zealand community and hospitals. Quality of nursing care is influenced by attitude and this study was to evaluate the effect of a curriculum change on the attitudes of two different streams of student nurses towards people with disabilities. During the year 2002 a focused disability unit was introduced to the revised undergraduate nursing curriculum of a major educational institution in New Zealand. The opportunity arose to consider student nurses' attitudes toward disabled people, comparing two streams of students undertaking two different curricula. A convenience sample of students completed the attitudes toward disabled persons questionnaire form B (Yuker, H.E., Block, J.R., Younng, J.H., 1970. The Measurement of Attitudes Toward Disabled Persons. INA Mend Institute, New York), prior to and on completion of their relevant disability unit. No statistically significant difference in scores was demonstrated. A number of possible reasons for this are suggested.

Adolescent↗
PubMedDate not supplied

A cost-benefit analysis of community and institutional placements for persons with mental retardation in Oklahoma.

Matched samples of 174 pairs of persons with mental retardation who live in either community settings or congregate care settings were compared on both cost and outcome dimensions. It was learned that costs were significantly lower in community programs. Greater levels of service and integration were evident in the community programs, but institutional programs offered vocational opportunities for more individuals. Although we were able to predict with accuracy who lived in community and institutional settings, we were unable to predict costs.

Adult↗
PubMed2000

Positive behavioral support of adults with developmental disabilities: assessment of long-term adjustment and habilitation following restrictive treatment histories.

The long-term maintenance of behavioral treatment effects is an important measure of clinical significance but is not reported with regularity in the published literature. The present report concerned therapeutic maintenance by evaluating five adults with developmental disabilities who had been exposed to multiple, restrictive procedures (food deprivation, mechanical restraint, electric shock) in a prior residential treatment facility and were transitioned to a new habilitation setting where these procedures were terminated in favor of alternative methods of behavior support. As revealed through a 24-month follow-up period, all of the participants were able to maintain clinically acceptable levels of challenging behaviors following the removal of the restrictive treatment procedures. Quality of life measures also revealed that the participants experienced greater independence, reduced supervision, and increased diversity in their living and work environments. These findings add to the limited studies on extended maintenance outcomes from behavioral intervention for serious clinical disorders in adults with developmental disabilities by demonstrating that positive adjustment can be sustained in the long-term without the continuation of restrictive treatment procedures.

Activities of Daily Living↗
PubMed1986

Discharge planning for the mentally disabled.

Discharge planning is an idiosyncratic process that depends on each patient's needs and situation. Consequently, each mental health professional plays various roles as the process evolves. The most fundamental and pervasive issue in planning for the discharge and placement of the mentally ill patient is balancing the client's need for stability and security against the need for independence and unrestricted functioning. Although the needs and resources relevant to each individual situation must be analyzed, everyone requires some degree of continuity in his or her relationships and in such fundamental aspects of his or her life such as living arrangements and financial security, in order to function well. Stability and consistency are vital for the mentally disabled person, whose very illness is often characterized by severe difficulties with trusting, forming lasting relationships, and an inability to cope with frustrations and problems. Conversely, stability and consistency can translate into overdependence on others or a restricted view of the world that may contribute to overdependence. The discharge planner must maintain a reasonable degree of stability and consistency without totally extinguishing the spark that encourages the degree of risk taking necessary for a normal existence. The discharge planner will also be forced to deal with other issues such as public reactions to the mentally ill and fiscal constraints. The mentally ill have no real constituency to advocate for them; therefore, the services provided for them are often easy targets of a budget crunch. In addition, residences for the mentally ill are difficult to establish because of public attitudes and fears; often communities resist having one developed in their midst. Consequently, many residences are located in impoverished areas where clients are subjected to innumerable obstacles in attempting to live normal, productive lives. The discharge planner also may struggle with the discouragement of repeatedly placing the same patients. Many patients can manage community life for a limited time only before they decompensate and require read-mission, which starts the discharge planning process all over again. Other patients may learn to manipulate the system by getting readmitted when they want respite from the responsibilities of everyday life in the community. Community placement philosophy dictates that, assuming some measure of psychiatric stability, any time spent in the community as opposed to the hospital is advantageous to the patient. Thus readmission rates are not accurate indicators of success or failure in community placement.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗