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PubMed2000

New Zealand children's health camps: therapeutic landscapes meet the contract state.

This paper surveys the history and current status of children's health camps in New Zealand, and places these sites within the theoretical context of therapeutic landscapes. The first health camp was established in 1919, and the seven current camps provide respite, education and health care for approximately 4000 children each year. We analyse the health-place relations inherent in the health camp concept and suggest that the 'therapeutic landscape' idea developed by Gesler provides a useful framework to explain the development of camps as sites for enhancing child and family welfare. Specifically, we contend that changing understandings of health and children have been closely linked with changing perceptions of what is therapeutic about the camps. Survey data demonstrate that contemporary restructuring of the welfare state has recast the role of health camps and placed them in a precarious position in terms of both financial viability and public acceptability. We conclude that the current status of health camps is ambiguous given the pressures of deinstitutionalisation philosophies and the regulatory environment of formal contracts between funders and providers.

Child↗
PubMed1989

Cost-containing medical technology.

The types of technologies most likely to contain healthcare costs are ones which (a) bring about a reduction in the volume of contact between the non-institutionalized populations and the medical profession, (b) permit the delivery of services and care in non-institutional settings, (c) enhance self-care or caregiving by the informal sector, and (d) shift the provision of services from the highly trained and costly fee-for-service professions and hospitals to those in the primary care subsector. To translate new technologies into cost savings or reduction in the rate of growth of healthcare expenditure, provincial governments must make some essential organizational changes and resource allocation decisions. As well, some form of technology assessment, if not essential, would be a very useful adjunct.

Ambulatory Care↗
PubMed1996

Foster parents' early adaptation to the placement of a child with developmental disabilities in their home.

Eight foster parents of children with developmental disabilities (DD) were interviewed about their early adaptation to placement of the child in their homes. Analysis using a grounded theory methodology showed important adaptations in the physiological, role function, interdependence, and self-concept modes of adaptation. Parents described less attention to their own physical health, dominance of the parenting role over all other roles, decreased social interactions, and a sense of personal satisfaction in response to placement of a child with DD in their homes. Implications for nursing practice are included.

Adaptation, Psychological↗
PubMed1997

Evolution of community mental health case management: considerations for clinical practice.

Case management has been the preferred method of helping persons with mental illness live in the community. This report examines the historical development of case management practice over the past 30 years. The analysis revealed that evolutionary growth in case management developed in response to expansion of community mental health services rather than consumer interests to improve their quality of life. Consequently, this reveals itself in the lack of outcome criteria needed to measure case management effectiveness. Currently, the concept of case management is undergoing a revolutionary paradigm shift that is "consumer-driven" and responds to consumer concerns. However, as mental health care costs rise within a rapidly growing community mental health care system, managed care is being implemented as a method to contain these rising costs. Because of major differences in philosophical underpinnings, developments in support of public mental health managed care may jeopardize the genesis of consumer-driven case management by supporting case management models that reflect managed care ideology.

Case Management↗
PubMedDate not supplied

Improve quality in nursing homes or institute community placement? Implementation of OBRA for individuals with mental retardation.

A matched sample longitudinal design was used to compare the outcomes for individuals with mental retardation who were either retained in nursing homes or transferred to community based living arrangements. Persons who moved from nursing homes to community residences experienced increased performance in adaptive behavior skills, whereas persons who remained in nursing homes regressed. Individual habilitation plans became nearly universal in both environments, but those plans prepared in the community were more focused on vocational type goals. Hours of service also increased in both environments, with the greatest increases being observed in habilitation training. Nursing services dropped to near-zero levels in community-based programs.

Activities of Daily Living↗
PubMed2001

Has the attempt to reduce psychiatric inpatient treatment been successful in Finland?

The deinstitutionalisation process in Finland's psychiatric healthcare did not start until the late 1980s. Our aim is to evaluate how the use of psychiatric inpatient treatment was associated with deinstitutionalisation given the changes in the modality of treatment ideology (years 1987--1991) as well as being due to economic pressures (years 1991--1995). Special emphasis is given on the inpatient treatment of schizophrenia and other psychotic disorders. Data was retrieved using the national hospital discharge register of all treatment periods in psychiatric hospitals and treatment periods due to psychiatric disorders in other hospitals. Three years (1987, 1991, and 1995) were compared. Four healthcare districts in northern Finland were studied. Resource use was measured by number of treatment periods and inpatient days in relation to population. Psychiatric inpatient treatment was reduced in 1987--1991, when resources in community care increased. During the period of economic pressures (1991--1995), when community care resources no longer increased, inpatient treatment started to rise again. Over the whole period, psychiatric treatment in primary care institutions increased. Reduction of psychiatric beds results in increasing inpatient treatment in non-specialist institutions, especially when community care fails to serve the patients. In the future it is important to evaluate whether the quality of care remains in the standard of specialised services when treatment shifts away from the specialist level.

Adult↗
PubMed2003

Four-year outcome in non-compliant schizophrenia patients treated with or without home-based ambulatory outpatient care.

Non-compliance in neuroleptic maintenance treatment is a major concern in schizophrenia. Home-based outpatient care has been shown both to improve medication compliance and reduce relapse frequency. We analysed the need for hospitalisation, levels of functioning and mortality rate during the de-institutionalisation process in 41 schizophrenia patients with repeated hospitalisations and prolonged history of non-compliance. Eighteen of the patients received ambulatory outpatient care (AOC) after discharge. This treatment procedure focuses on enduring neuroleptic maintenance treatment. One of the hospital nurses takes care of home visits every 2-4 weeks. In the 4-year follow-up, half of the patients in the AOC group did not need hospitalisation at all and the number of days of hospitalisation in the whole group diminished by almost four-fifths compared with the previous 4 years. In the non-AOC group, there was a more limited decrease in the number of days of hospitalisation during the corresponding follow-up period. The mortality rates showed a slight tendency towards a better outcome in the AOC group. There was no change in the levels of functioning in the AOC group. This treatment can be carried out with limited resources. It clearly reduces the need for hospitalisation in a subgroup of schizophrenia patients having problems with compliance and recurrent relapse. The effectiveness of AOC on the mortality rates of schizophrenia patients needs further examination.

Adult↗
PubMed2005

Mental health care in London.

AIM: To describe principles and characteristics of mental health care in London. METHOD: Based on existing data, service provision, number of professionals working in services, funding arrangements, pathways into care, user/carer involvement and specific issues are reported. RESULTS: London experiences high levels of need and use of mental health services compared to England as a whole. Inpatient and compulsory admissions are considerably higher than the national average. Despite having more psychiatric beds and mental health staff, London has higher bed occupancy rates and staffing shortages. At the same time there is a trend away from institutionalised care to care in the community. CONCLUSION: Mental health services in the UK are undergoing considerable reform. These changes will not remove the greater need for mental health services in the capital, but national policy and funding lends support to cross-agency and pan-London work to tackle some of the problems characteristic of mental health in London. Whilst various issues of mental health care in London overlap with those in other European capitals, there also are some specific problems and features.

Catchment Area, Health↗
PubMed1999

Changing patterns of mental health care in Greece (1984-1996).

Greece joined the European Community in 1981 and, three years later, the Commission of the European Communities provided financial and technical assistance under EEC Regulation 815/84 for the modernisation of the traditional psychiatric care system, with the emphasis on decentralisation of mental health services and the development of community-based services, as well as on deinstutionalization of long-stay patients and improvement of conditions in public mental hospitals. Over the last 11 years, the implementation of the EEC Reg. 815/84 programme contributed to a significant shift towards extramural care and rehabilitation. The role of the large mental hospitals has gradually been diminished and a large number of long-stay patients have been deinstitutionalised. It is commonly accepted that the EEC-funded psychiatric reform programme, despite inadequacies and constraints, had an impact on the changing mental health scene in Greece.

Adolescent↗
PubMed2000

From distributions of deviance to definitions of difference: past and future mental health geographies.

This paper reviews research in mental health geography that has examined landscapes of deinstitutionalisation, community care and everyday social life. It complements Philo's (1997, Across the water: reviewing geographical studies of asylums and other mental health facilities. Health and Place 3, 73-89) review of geographical studies concerned with asylums and other mental health facilities. Offering an interpretation of developments in this research sub-field, it charts a 'first wave' and a 'second wave' of inquiries, identifying shifts of substantive emphasis, theoretical approach and methodological practice. The gains and drawbacks of both 'waves' are discussed, with particular attention to absences both in what is researched and in the extent of political and policy engagement. The possible contours of a 'third wave' mental health geography, building on the strengths of earlier research but addressing new questions in new ways, are outlined in conclusion.

Community Mental Health Services↗
PubMed2000

Mental health care reforms in Britain and Italy since 1950: a cross-national comparative study.

This paper discusses a cross-national comparative study, which compares the implementation and geographical outcomes of mental health reforms in Britain and Italy since 1950. Working within a cross-national framework, the research adopts a sensitivity to the role of place by exploring the social and spatial restructuring of mental health care service provision in two localities - Sheffield and Verona. By focusing upon the local experiences of mental health care reform, the research strives to gain a clearer understanding of why local geographies of mental health care provision appear to vary across space, both within national boundaries and across them.

Cross-Cultural Comparison↗
PubMed2000

'Breaking out of the asylum': developments in the geography of mental ill-health--the influence of the informal sector.

This paper focuses on the changing role of the voluntary sector in the provision of care and support to community-based individuals with mental ill-health (MIH) in contemporary Scotland. In doing so, it reflects on the ways in which deinstitutionalisation is contributing to changing interrelationships between the formal and informal sector, the influence of the voluntary sector in the development of the locational geographies of individuals with MIH, and factors contributing to geographical variations in access and availability of voluntary sector supports. These developments are considered within the framework of the shadow state.

Community Mental Health Services↗
PubMed2000

Burger King, Dunkin Donuts and community mental health care.

This paper describes the patchwork of cottage industries and human warehousing composing Montréal's 'community mental health care' system. It examines the ways in which this system's clients assemble a collage of ad hoc facilities including homeless shelters, rooming houses, food banks and soup kitchens through which they pursue the fragmented task of daily survival. In their various forms of transit around the city, released psychiatric patients, who rotate in and out of the local psychiatric wards, construe the grammar of urban space. In examining their use of key city sites - malls, fast food outlets, churches and the streets - it becomes apparent that the 'mad' have a particular relationship to these places which they pass through and use on certain terms. Examining the nature of their journeys, the scenes on which they are set and the social relationships of space in play, it is evident that the 'mad' have a particular (dialogical) relationship to the city: a relationship which they share with other, multiply disenfranchised people. This raises significant social questions concerning the politics of city space, and the kinds of fragmented lives and forms of subjectivity that they produce.

Adolescent↗
PubMed2001

Making space for the 'intellectual' in geographies of disability.

There is a growing body of work on geographies of deinstitutionalisation and its consequences, but the weight of this scholarship has focussed on people with mental health problems and physically disabled people. With only few exceptions, the 'post asylum geographies' of intellectually disabled people remain neglected by geographers. We advocate a redressing of this imbalance. First, we assess reasons for the relative absence of 'intellectual' considerations in geographies of disability. We then consider ways in which the full spectrum of those with mental differences might be included in geographical research. We conclude that Wolpert's call 25 years ago to 'open closed spaces' is just as applicable to our efforts to conceptually link health, place, and disability, as it is to the material welfare of vulnerable groups in society.

Deinstitutionalization↗
PubMed1997

Managing risk in the city: the role of welfare professionals in managing risks arising from vulnerable individuals in cities.

Modern cities depend on individualism and the process of contracting. Contracts between individuals contribute to stability and order in cities. However, this is challenged by risks and uncertainties especially those relating to vulnerable individuals who are unable or unwilling to enter into contractual relations. This paper focuses on the role of caring professions and the impact of new strategies for managing risks related to vulnerable adults and children, especially the shift from managing risk in institutions to managing risk in the community. This paper is based on research funded through the ESRC Risk and Human Behaviour Programme.

Adult↗
PubMed1997

Across the water: reviewing geographical studies of asylums and other mental health facilities.

It is possible now to identify a small field of geographical studies exploring how space, place, environment and landscape are bound up in the worlds of people experiencing mental health problems. Some of these studies take seriously the institutions which have been provided to shelter, control, care for and even cure such people, and this interest has often touched upon the rise of the 'asylums' in Europe and North America (chiefly as an eighteenth- and nineteenth-century phenomenon). This paper surveys the geographical literature tackling asylums and other mental health facilities, and then offers an interpretation of the theoretical claims and substantive research undertaken in this respect by Michael Dear and various co-workers. Running through the paper is an argument about the need for studies of 'asylum geographies' to be attentive to what Gunnar Olsson terms 'ontological transformations' between thoughts and things.

Community Mental Health Centers↗