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PubMed2004

Deinstitutionalization for older adults with severe mental retardation: results from Australia.

A deinstitutionalization research project in which residents from the largest institution in Queensland, Australia, were relocated after a government decision to close the center was described. Outcomes of relocation into community living for adults with severe mental retardation, many of whom were older (over 40 years) and had been institutionalized for much of their lives, was addressed within the Australian context. Results from the relocation and outcomes for people aged 20 to 39 years (n = 37), 40 to 59 years (n = 39), and over 60 years (n = 24) were described. Group results focused on adaptive and maladaptive behavior, choice-making, and objective life quality were discussed together with the implications for service provision.

Adaptation, Psychological↗
PubMed1998

[The deinstitutionalization process].

This study develops some considerations about the deinstitutionalization process considering the conception and stigma of madness, and the difficulties to reverse it in society as it was constructed through history. Authors analyse the consolidation of the necessary infrastructure to this process, making direct relations with all social subjects and policy determination.

Attitude to Health↗
PubMed1986

Planning for community physician services prior to deinstitutionalization of mentally retarded persons.

This study assessed the need for physician services among a group of institutionalized mentally retarded individuals in anticipation of their transfer to community residential facilities and subsequent management of their care by community-based physicians. The clients' personal physicians in the institution identified every chronic condition which required physician services, and recommended the kind of physician and frequency of visits for the management of each condition. Key informants reviewed these estimates and determined if there were sufficient physicians in their communities to provide this care. Thirty-two per cent of the conditions but only 8 per cent of the clients could be managed by a primary care physician. The most frequently required specialties were neurology, orthopedics, and ophthalmology. While primary care services and many of the necessary specialty services were available in the community to meet the needs of these individuals, several specialties essential to the medical care of this group were not available. These included orthopedics for the multiply-handicapped, neurology including behavioral neurology, and psychiatry. Deinstitutionalization policies which rely solely upon community physician services will lead to inadequate medical care in the community for some mentally retarded individuals. In these situations, alternative approaches to care must be developed.

Adolescent↗
PubMed1989

Deinstitutionalization: a public policy perspective.

1. Deinstitutionalization was initiated in an era of social reform to protect the rights of the mentally ill; however, a strong research base was absent and led to major flaws in the policy's implementation. 2. The chronically mentally ill are frequently poor advocates for themselves and, without even the most simple needs fulfilled, end up homeless. 3. The homeless mentally ill require comprehensive support systems with assured continuity of care. An emerging concept to deal with this issue is that of case management. 4. The mental health professional can strive to influence future public policy as patient advocate and nonpartisan educator.

Community Mental Health Services↗
PubMed1999

[Discharge in inpatient care. Results of a survey. Postscript to part III of the Berlin Deinstitutionalization Study].

PURPOSE: 42 percent long-term patients from the Berlin Deinstitutionalization Study sample have been discharged to full-time institutional settings. METHODS: The questionnaires of a mail-survey covered features of 58 different non-hospital full-time institutional settings and care for a group of 125 long-term mental patients. RESULTS: The return rate was more than 70 percent. For 78 percent of the discharged former long-term inpatients the political goal of complete psychiatric care in the patient's home area has been reached, but only 20 percent live in smaller institutions of up to 40 places. CONCLUSIONS: The significance of other data of the survey does not exceed that of stock-taking and certain indications because of the selective data and the limitations of the method. There is an urgent need for further research in examining the quality of non-hospital institutional care for psychiatric long-term patients.

Adult↗
PubMed1980

The regulation of family involvement in deinstitutionalization.

Conflicting legal, administrative, and professional policies surround family involvement in the deinstitutionalization process. This article addresses these discrepancies and makes recommendations for developing effective and consistent channels of policy among social workers and other helping professionals.

Deinstitutionalization↗
PubMed1986

Intervention in the psychiatric hospital in the era of deinstitutionalization.

This article, written following a survey of staff in a psychiatric hospital, analyzes how the trend toward deinstitutionalization has influenced institutional practice. Interviews reveal that intervenors support the objective of social reintegration, even if they find it a source of contradictions. In their daily activities, the staff are concerned mainly with improving their patients' quality of life, but this concern is also accompanied by the apprehension of encouraging dependency on the institution. Thus intervenors experience difficulty in focusing their practice on a system of representation capable of reconciling the ideal of rehabilitation with the characteristics of their clientele. Recognizing the paradoxes associated with work in the institutional setting does, however, make it possible to start a process of clarification that is likely to support intervenors and improve the quality of their relationship with chronic psychiatric patients.

Activities of Daily Living↗
PubMed1988

The paradox of psychiatric deinstitutionalization: historical perspective and policy implications.

Deinstitutionalization has, in effect, resulted in the creation of new forms of asylum for the mentally ill. Rather than being generated in a planful, humanitarian manner, the reduction in the census of state hospitals has been governed by federal health and welfare programs not designed for the mentally ill. By relying upon Medicaid and SSI, states were able to shift their financial burden for the mentally ill to the federal government. Reliance upon Medicaid has resulted in nursing homes playing a major role in psychiatric care. SSI stipends are not adequate to cover rising housing costs--even in low-income areas. As a result, large numbers of the mentally ill are among the populations of homeless persons in the United States.

Deinstitutionalization↗
PubMed1999

Deinstitutionalization and community based psychiatry--some aspects from literature.

The dramatic changes in the transformation of psychiatry can be summarized in a few words; deinstitutionalization, community psychiatry, team-work, sectorization, continuity of care and comprehensiveness. A model for planning, implementation and evaluation of community health facilities is presented. Risks and benefits with the community approach is discussed as well as the economy. Saving from the closing down of the mental hospital should be adequate to fund community services for the long stay population. But other wise community mental health oriented services should not be considered a way of saving money.

Community Mental Health Services↗
PubMed2000

[Where are the limits? From institution to deinstitutionalization exemplified in Saarland].

In 1998, the 1876 founded "preussische Provinzialirrenanstalt", a large asylum in Merzig (Germany), was closed down. Instead several psychiatric departments were founded in the rural county ("Bundesland"). On the asylum's former area in Merzig a new and modern general hospital including a psychiatric department was established. The present article will show up the former psychiatric hospital's genuine working fields, treating violent, self-harming and mental ill people needing help. It will describe in a differentiating way how the new services for the different groups of mental ill persons run: Decentralized general psychiatric care in defined regional areas (without forensic patients), central treatment for the forensic patients, regional care for people with mental retardation. In completion of this network there exist regional solutions for the themes "living in a own home", "Working and occupation" and "day-structuring". In conclusion, deinstitutionalization will not have any limits, despite of a few exceptions, if the limits of institutional thinking can be overcome.

Community Mental Health Services↗
PubMed2000

[Perspectives of psychiatric care in Leipzig--deinstitutionalization from the viewpoint of neurologist/psychiatrist in private practice and the work of consortium of community psychiatric services].

Two perspectives of mental health care in Leipzig are outlined. Critical aspects of deinstitutionalization are discussed from the point of view of an office-based Nervenarzt (neurologist and psychiatrist). The limitations of office-based practice in providing care for the severely mentally ill (SMI) are described, i.e. lack of a multidisciplinary community mental health team, community psychiatric nursing and social work back-up in particular. Residential service and nursing homes are often under-staffed and ill-prepared for caring for people with SMI. A second view-point describes the Verbund Gemeindenahe Psychiatrie, a community psychiatric service for the just under 500,000 population of Leipzig in seven community mental health centers each combining day hospital, out-patient clinics and multidisciplinary community psychiatric care. This service is unique in Saxony and well accepted by service users and professionals.

Community Mental Health Services↗
PubMedDate not supplied

Deinstitutionalization of children with mental retardation: what of dental services?

During the past thirty years there has been marked deinstitutionalization from large state facilities for youngsters and adults with mental retardation and developmental disabilities. In the past, dental (and general medical) services were provided in the institutions by an in-house staff. Increased numbers of former residents now live in small community units. These local residents must now rely on community dental practitioners for needed preventive and restorative services. The current status of these services (or lack there of) is reviewed, together with relevant concerns.

Adult↗
PubMed1979

Deciphering deinstitutionalization: complexities in policy and program analysis.

Deinstitutionalization as a public policy promised to be a major departure from previous psychiatric practice. Decrying traditional "medical paradigms" and the custodial "warehousing" of mental patients, policy makers advanced a "bold new approach" for care in the community. Progressive humanitarian reform could go hand in hand with fiscal conservatism. Community Mental Health Centers were to be the heart of a new national effort. But the rhetoric of reform failed to coalesce the activities among competing federal and state interests and systems. Intended beneficiaries may have become unfortunate victims.

Community Mental Health Services↗
PubMed1979

In defense of deinstitutionalization.

Political and economic decisions contributing to deinstitutionalization had widespread support from psychiatrists, social reformers, and civil libertarians. The fortuitous advent of Medicaid and SSI abetted movement out of institutions, but these federal programs impede efforts to reform remaining state hospitals--yet progress has been achieved.

Cost-Benefit Analysis↗
PubMedDate not supplied

[The creation of a new pathology in Paris. The case of deinstitutionalized patients].

The development of attitudes towards the mentally ill, the progress of psychotherapeutic care and medicines, allowed the looking after of psychotic patients outside of the hospital institution, while keeping their social links with their personal environment. The setting up of alternative structures in the context of the communitary psychiatry was supposed to enable the reinsertion of the stabilized psychotic patients. In Paris, the lack of such structures, and the difficult socio-economic context condemn these patients to drifting aimlessly, locked out of any institution, which worsen their pathological state. These "deinstitutionalized" patients cause a serious problem for the Health system.

Community Mental Health Services↗
PubMed1992

Psychosocial problems of deinstitutionalized VA psychiatric patients in Puerto Rico.

As a result of public law 99-166 the Department of Veterans Affairs Medical Center in San Juan (DVAMC), Puerto Rico engaged in a planned de-institutionalization of psychiatric veteran patients who had been treated in two contracted psychiatric hospitals in the community. This research seeks to determine whether they were receiving treatment after the deinstitutionalization effort was completed, the types of psychosocial problems they were facing and the resources utilized to cope with them. The authors found that the veterans were receiving treatment for their psychosocial problems, they relied to a great extent on DVAMC for services and that the psychosocial problems of those veterans over age 55 were less and differed from those under age 55.

Activities of Daily Living↗
PubMed2004

Relationships between the deinstitutionalization of healthcare for patients with mental disorder, substance abuse, and isolated death.

Isolated death (ID) (i.e., dying alone without anyone noticing for several days) has been suggested to be related to social isolation, mental disorder, and alcohol and/or drug abuse. A major transfer of patients with a mental disorder and/or alcohol and/or drug abuse from institutionalized care to treatment as outpatients has been enacted in Sweden during the past decade. On the basis of the assumption that such deinstitutionalization is likely to result in increased social isolation, our working hypothesis was that the incidence of ID among patients belonging to these categories has increased in Sweden. The present study involved all deaths subjected to a medicolegal examination in Stockholm County (with a population of approximately 1.9 million people) during the period 1992-2000. The pattern of ID (defined as cases involving a postmortem delay between death and discovery of at least 1 week), as well as the incidence of fatalities subjected to medicolegal examination with a record of mental disorder and/or alcohol and/or drug abuse was evaluated. Throughout this period, the proportion of the deceased with a record of a mental disorder was high among all the cases examined and higher still among the cases of ID, especially among those younger than 65 years of age. There was a rather limited increase in the incidence of ID and a much more pronounced increase in the number of former psychiatric patients whose deaths were subjected to medicolegal examination, but did not satisfy the criteria for ID. A record of alcohol and/or drug abuse was more common than a diagnosis of mental disorder among both the males and females who died at an age of less than 65, with a clear difference between the cases of ID and non-ID in the case of men. There was no significant increase in incidence over the course of this study. Thus, this study reveals a slight increase in the number of IDs and a more pronounced increase in the number of medicolegal examination of non-IDs of individuals with a record of a mental disorder.

Age Distribution↗
PubMed1991

The closure of a major psychiatric hospital. Characterization of the long-term population over one year at an early stage of deinstitutionalization.

A political decision to decentralize psychiatric care in a county in Sweden was arrived at in October 1984. This will lead to the closure of the only large psychiatric hospital in the area, which will be replaced by three smaller units. The long-term care in the hospital will cease completely and be replaced by district-based psychiatric services. All patients in the hospital's long-term unit were studied over one year at an early stage of deinstitutionalization. The results showed that 12% of patients were discharged during that year, mostly to other institutions, only 2 patients to their homes. Twenty-five per cent died, and one-year mortality was 40% for patients with severely impaired ADL functioning. The demented patients deteriorated significantly in ADL functioning.

Adult↗