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 1,225 records · Page 68Linked to original sources
PubMed2000

The impact of a state hospital closure on local jails: the Kansas experience.

In 1990, Kansas's Mental Health Reform legislation began transferring fiscal support for the delivery of mental health services away from state institutions and into the local community, culminating in the closure of one state hospital facility in 1997. Kansas jails were studied to determine the resulting impact of that hospital closure on the State's jail systems, including whether an increase in incarceration rates of persons with severe and persistent mental illnesses followed the closure of the hospital. Though a relationship between the hospital closure and incarceration rates cannot be substantiated, the results do provide a rare birds-eye view of the extent of and problems associated with the incarceration of persons with mental illness in a predominantly rural state.

Community Mental Health Services↗
PubMed2001

The last mental hospital.

The public mental hospital system was created in part because many mentally ill people were being held in prisons and jails. Support for those hospitals waned over time, however, and by the time they had degenerated into "snake pits" a consensus was reached to close them down. Unfortunately, they were not replaced with adequate community mental health resources, so as the hospitals have emptied, the prisons and jails have filled, partly with the mentally ill. That is the destructive reason for the growth of prison psychiatry in this country: the prison has become the last mental hospital. The constructive one has been a new emphasis on bringing psychiatric treatment to a previously neglected population: people who have committed serious violence, whether because of Axis I mental illnesses or Axis II character disorders. Unfortunately, four inter-related, mutually reinforcing nationwide trends threaten to reinforce that destructive development and vitiate the constructive one.

Deinstitutionalization↗
PubMed2001

State mental hospitals in Washington State in an era of policy change.

This paper examines changes in use of state mental hospitals in Washington State from July 1, 1990, to July 1, 1997. It focuses on the phenomenon of ongoing use of state mental hospital by patients over a period of years. Two panels of state mental hospital users were identified: one preceded and one followed implementation of state mental hospital downsizing policies. Though the number of adults per year using the state mental hospital decreased following policy implementation, there was a significant increase in the overall rate of ongoing use. A logistic regression for ongoing use with multiple individual and regional predictor variables is described.

Adult↗
PubMed2002

Psychosocial rehabilitation in a public psychiatric hospital.

Patients with chronic mental illnesses have complex treatment needs that often pose significant challenges to mental health professionals. This paper describes the implementation of a psychosocial rehabilitation program to meet the treatment needs of patients in a public psychiatric hospital providing long-term care. A core group of professional staff adopted psychosocial rehabilitation principles in order to transform a custodial model of care to a highly interactive educational and skills building program. A model of service delivery was established to address patients' skill deficits and barriers to returning to the community. This article describes the major steps and challenges faced in overcoming obstacles and implementing a psychosocial philosophy of treatment in an inpatient setting. It suggests that it is possible for the public hospital to reinvent itself into an environment that can stimulate recovery and hope.

Deinstitutionalization↗
PubMed2001

The incarceration of individuals with severe mental disorders.

This study examines the extent to which severely mentally disabled (SMD) patients in one county mental health system were incarcerated in the local jail and examines characteristics of a sample (N = 30) of such individuals. We found that in the study year, 7.9% of known SMD patients had at least one incarceration in the county jail. Diagnoses were predominantly in the schizophrenia spectrum with 70% also actively abusing substances at the time of incarceration. The majority of crimes were non-violent and substance abuse related. Half of the sample was judged to be candidates for diversion programs. Our findings are consistent with recent literature confirming that substance abusing SMD individuals are at high risk of incarceration and could benefit from integrated mental health and substance abuse treatment.

Adult↗
PubMed2001

Chronicity reconsidered: improving person-environment fit through a consumer-run service.

In the past, the term "chronic" referred to people who had serious mental illness and who typically received long-term care in a state mental hospital. Although this term recently has fallen out of favor, we resurrect the term here, not to revive a demeaning euphemism, but rather to redefine it as the result of a poor person-environment fit between the complex and challenging needs of those with serious psychiatric disorders and a community-based service system that often is ill-equipped to treat them. Previous research indicates that recurrent acute hospitalizations and an inability to establish or maintain tenure in the community may be due to a disconnection from community-based services and supports, social isolation, and demoralization. One promising approach to addressing these issues is that of peer support. To illustrate the potential utility of peer support in improving person-environment fit and decreasing the chronicity of the subsample of people who continue to have difficulty in establishing viable footholds in the community, we describe a peer support-based program, the Welcome Basket, developed, staffed, and managed entirely by mental health consumers. Preliminary analyses that evaluate Welcome Basket's effectiveness are included, and we discuss the implications of these data for future research and program development in this area.

Adult↗
PubMed1999

Assessing community attitude towards home-based care for people with AIDS (PWAs) in Kenya.

This paper presents data on an assessment of community attitudes toward HIV/AIDS and home based care. The findings indicate that due to inadequate information about the disease and care expectations, people were ambivalent toward the sick and in some instances out-right rejection prevailed. This formed the basis for their preference for institutional based care as opposed to home based care. This was further compounded by the economic status of the household/family. Sheer poverty militates against providing adequate home care in as much as families may be willing to do so. It also confirms that one may perhaps be too taken in by the romanticized idea of unswerving community support. This may further relegate the burden to the primary unit, the family and especially the women who ultimately carry the load with limited resources. This emphasizes the need to initially share the issue with the community in order to work out the mechanisms that will lessen the burden of, and facilitate home care. Training in the care of AIDS patients is crucial yet lacking at the family and community level. Whereas care, counseling and social support are particularly important prerequisites for home-based care, these were conspicuously lacking. Very few caregivers had appropriate training and were worried about their lack of knowledge and yet they had to care for patients. It was evident that they lacked a framework that would provide the capacity to facilitate home care. Such a framework would bridge the gap between the noble concept of home-based care and the realities of home based care.

Acquired Immunodeficiency Syndrome↗
PubMed1998

The TAPS Project 41: homes for life? Residential stability five years after hospital discharge. Team for the Assessment of Psychiatric Services.

This paper describes pathways followed by 567 long-stay patients who were resettled into the community, as part of a program to close two psychiatric hospitals in London and replace them with community-based services. Sixty-one percent of the former patients remained in their original placement--mostly group homes--over the five-year follow-up. Transition from one house to another mostly took a direct course, with only 27 patients changing houses by way of long intermediate hospitalisation. Change of residence was at the same level of support, with only a slight trend towards less supervised facilities. Ten patients could not be traced and have possibly become homeless. Only 3 patients were in prison during the five-year follow-up. More than a third of the sample were readmitted at least once during that period. It is concluded that community residences established under the resettlement program served as relatively stable homes for the majority of patients.

Adult↗
PubMed2000

Community mental health services and the prevalence of severe mental illness in local jails: are they related?

The excessive prevalence of severe mental illness noted in correctional settings has sometimes been attributed to the inadequacy of community based mental health services. This study examines the prevalence of severe mental illness in two jails situated within catchment areas featuring markedly different levels of community mental health services. We use these settings to test the hypothesis that greater levels of services in a community are associated with lower prevalence of severe mental illness in the community's jail. An epidemiologic approach, using standardized field instruments, was used to estimate the prevalence of major mental illness in detainees arriving at the two sites over a 6-month period. The hypothesis that greater levels of mental health resources in a community would be associated with lower prevalence of mental illness in the community's jail was not supported. These findings suggest that community-based mental health services by themselves do not affect the prevalence of mental illness in jail.

Adult↗
PubMed1998

The rights of state hospital patients: from state hospitals to their alternatives.

During the 1980s and 1990s the locus of psychiatric treatment in many states shifted from state hospitals to the psychiatric units of general hospitals. The extent to which the rights guaranteed to psychiatric inpatients by state mental health agencies will survive this "privatization" process is unclear. The authors explore this issue by providing a "status report" of patient rights, identified through a national survey. They discuss the problems of preserving these rights as an ever greater proportion of care is provided in general hospitals under the mechanism of managed care.

Deinstitutionalization↗
PubMed1998

Characteristics of violent versus nonviolent patients with schizophrenia.

Recent research has demonstrated an associative link between some forms of mental illness and violence. While much of this violence is committed by persons with schizophrenia, the characteristics of violent versus nonviolent schizophrenic patients has received limited attention. Two studies with small sample sizes compared these groups on psychological dimensions in acute care settings, but there appears to be no study of continuing care inpatients. This study compared a statewide sample of violent and nonviolent inpatients with schizophrenia on several domains of social interpersonal behavior. In a between-group analysis, violent patients showed evidence of serious dysfunction in community self-care and community adjustment, whereas the nonviolent were more impaired in the areas of depression, restlessness, and internal confusion. A within-group analysis of patients with interpersonal violence and those with noninterpersonal violence yielded similar findings of serious community dysfunction versus internal confusion. The implications are discussed.

Adult↗
PubMed1997

The prevalence of mental illness among inmates in a rural state.

A limited number of recent empirical studies suggest that inmates suffer from high rates of serious mental illness. Different explanations are offered depending on the type of institution: jail or prison. The literature is based largely on urban samples and does not offer comparisons of rates across types of institution within a single study. The present study examined a random sample of 213 jail and prison inmates in a rural state using the Diagnostic Interview Schedule (III-R). Among jail inmates there was little evidence of high rates of serious mental illness, suggesting the criminalization of mental illness may not be as evident in rural settings as urban areas. Among prison inmates, however, high rates of mental disorders were found, supporting previous findings in urban and rural jurisdictions. Implications of the findings are discussed in the context of a consolidated correctional system.

Adult↗
PubMed1997

Clinical and human resource planning for the downsizing of psychiatric hospitals: the British Columbia experience.

Riverview Hospital, B.C.'s only and Canada's largest remaining provincial psychiatric hospital began a formal planned "downsizing" process in 1992. This initiative was an important element in the Province's strategic plan to shift to a more community-focused mental health system and to bring tertiary psychiatric services "closer to home" by redeveloping Riverview Hospital on three sites. The paper summarizes the literature pertaining to the "downsizing" of psychiatric hospital services in relation both to clinical and human resource planning. It describes the mental health system in B.C. and the service system context in which this exercise is occurring. It is based on the first three years of experience in identifying the major challenges and the strategies developed to meet these challenges. It draws some conclusions about the effectiveness of these strategies and it speculates about the likely future challenges as the "downsizing" process continues.

British Columbia↗
PubMed2003

Four decades of community mental health: a symphony in four movements.

The authors present a detailed chronological discussion of the evolution of community mental health care in the United States with emphasis on the period of the 40 years since the passage of the Community Mental Health Centers Construction Act of October 31, 1963.

Community Mental Health Centers↗
PubMed2004

Mentally ill persons in the criminal justice system: some perspectives.

There is an increasing number of severely mentally ill persons in the criminal justice system. This article first discusses the criminalization of persons with severe mental illness and its causes, the role of the police and mental health, and the treatment of mentally ill offenders and its difficulties. The authors then offer recommendations to reduce criminalization by increased coordination between police and mental health professionals, to increase mental health training for police officers, to enhance mental health services after arrest, and to develop more and better community treatment of mentally ill offenders. The necessary components of such treatment are having a treatment philosophy of both theory and practice; having clear goals of treatment; establishing a close liaison between treatment staff and the justice system; understanding the need for structure; having a focus on managing violence; and appreciating the crucial role of case management, appropriate living arrangements, and the role of family members.

Community Mental Health Services↗
PubMed2001

Visual impairment in adult people with moderate, severe, and profound intellectual disability.

PURPOSE: To assess visual impairment in adults with intellectual disability after de-institutionalisation. PATIENTS: The county has a population of 385 483 persons of 18 years and older; 961 were moderately, severely or profoundly intellectually impaired (ID), 837 of them (87 %) participated in the investigation. METHODS: Visual acuity, VA: Østerberg picture charts and reduced copies for near vision could be used in 71% of the patients. Teller preferential looking procedure was applied to people who were unable to cooperate with the picture charts. When examined with picture wall chart VA 0.3-> or =0.10) was found in 10.8%, severe low vision in 1.2% (VA <0.10-> or =0.05), and blindness (VA<0.05) in 3.8%. Poor near vision (<0.3) was present in 19%. Those assessed with Teller acuity cards had poorer vision than the others. It is possible that the low values of assessment with Teller cards represent a combination of gnostic and resolution deficiencies, which means that the results of grating VA and recognition VA are non-comparable. Ophthalmic disorders: The most widespread medical condition was cerebral visual impairment, the most frequent eye disorders were optic atrophy, high myopia, cataract, and keratoconus. Refraction: Refraction was assessed in 710 persons (85%), the most prevalent cause of visual impairment was uncorrected ametropia. Hypermetropia of >+1.50 was found in 151 of 710 subjects (21%), and spectacles were used by 106 (15%); myopia <-1.0 was present in 213 individuals (30%), 95 persons (13%) had lenses <-1.0. CONCLUSION: Resettled adult people with intellectual disability have a high prevalence of treatable visual impairment. A structured scheme of referral to optometric and ophthalmological care is essential if these people are to be given the care to which they are entitled.

Adult↗