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PubMed1990

[Deinstitutionalization, the patients, the families and women: interests to reconcile].

Deinstitutionalization is very demanding for families. Forced to fill in the gaps of the system, their role is one of creating a therapeutic environment while receiving little support from government service organizations. Cohabitation often leads to difficult relations between a patient and his or her family. In such a context, a large proportion of families experience problems in their attempt to fill their parental role. Women are more affected by this situation seeing they provide a large part of the emotional support to chronically ill mental patients and maintain the contact with service organizations. Also, they must confront professionals who often judge them as overprotective or responsible if the patient is their own child. The authors definitely agree that collective responsibility must complement family responsibility to ensure the respect of patients', families', and women's rights.

Deinstitutionalization↗
PubMed1990

Changes in adaptive behavior of older adults with mental retardation following deinstitutionalization.

Changes in adaptive functioning of 32 older adults with mental retardation following deinstitutionalization were assessed. The Adaptive Behavior Scale was administered at two times (separated by 1.5 years) for these adults, who were transferred from a state-operated institution to an ICF-MR facility. An overall increase in both adaptive and maladaptive behavior was found. In addition, female residents and those with moderate/mild levels of retardation had higher levels of adaptive functioning than did males and those with severe levels of retardation. These findings extend previous research by focusing on the older segment of the mentally retarded population.

Adaptation, Psychological↗
PubMed1979

Deinstitutionalization in two cultures.

American and British reformers may act as if reducing the number of beds alone reduces human distress or the incidence and prevalence of psychiatric illness. Deinstitutionalization requires a recognition of changed relationships between patients and staff, and between patients and families. Our two cultures have responded differently to questions of where, by whom, and how to treat their mental patients.

Community Mental Health Services↗
PubMed1985

Evaluating the impact of deinstitutionalization on the lives of mentally retarded people.

The evaluation of the impact of deinstitutionalization should be based upon a thorough analysis of the sociocultural values inherent in the movement and should reflect the nature of the relationship between evaluation research and social policy formation. This review of current evaluation practice indicates a general failure to provide information relevant to the agendas of policy makers and service consumers due to the investigation of a restricted range of outcomes, inattention to the ecological context of behavior, and a range of methodological weaknesses. Promising directions in measuring quality of life and pertinent environmental variables were discussed.

Activities of Daily Living↗
PubMed1984

Medical care of the deinstitutionalized mentally retarded.

Community-based group homes for the deinstitutionalized mentally retarded are becoming more common. Individuals in this setting have unique acute and chronic medical conditions. Long-term use of medications, exposure to hepatitis B, problems with sexuality and special contraception needs are commonly encountered. The physician who provides care for patients in this setting can serve as a central referral source and coordinator of medical services, as well as an educator to staff and family.

Anticonvulsants↗
PubMed1983

A proposal for the deinstitutionalization of patients.

Outpatient treatment of cancer patients, often medically and psychologically sound, results in great savings for insurers but increased out-of-pocket expenses to patients. If insurers were to reimburse for nonmedical out-of-pocket costs as well as medical, this disincentive to deinstitutionalization would be removed.

Ambulatory Care↗
PubMed1983

Effects of deinstitutionalization on adaptive behavior of mentally retarded adults.

Twenty mentally retarded clients were moved from a large developmental center to three small community residences. Their functional abilities were measured at 0, 4, 8, and 12 months. Consistent improvement was found for language development, domestic activity, responsibility, and social interaction. Findings from this and other "deinstitutionalization" studies were synthesized. Results suggested that the improvement in functioning represents a manifestation of behavior already in the clients' repertoire rather than new learning. The need for systematic programming to promote learning, both in the community and institution, was emphasized.

Adolescent↗
PubMed1982

A matched comparison of the developmental growth of institutionalized and deinstitutionalized mentally retarded clients.

Seventy mentally retarded clients previously residing in a large state institution were matched with 70 clients who remained at the same institution. Clients were matched by sex, level of retardation, years institutionalized, self-care skills, age, and IQ. Developmental growth, operationally defined as adaptive behavior change using a research version of the AAMD Adaptive Behavior Scale, was measured for all clients at Time 1 and Time 2. Demographic and environmental factors that could be associated with adaptive behavior growth were explored. Only the deinstitutionalized clients displayed significant growth. They increased in adaptive behavior and showed no significant change in maladaptive behavior.

Adult↗
PubMed1980

Educating deinstitutionalized patients about fiscal realities.

Because of a previous misinterpretation of Social Security regulations, deinstitutionalized clients in a mental health clinic's rehabilitation center were faced with a decrease in Supplemental Security Income benefits, which meant that the adult home in which they lived did not receive full room-and-board fees. The home threatened to remove clients from the center. In the process of resolving the dilemma, the mental health clinic and the state hospital established a training program to enable clients to make their own financial decisions; it covered such topics as fees at the home and the center and what clients should expect from those facilities, the effect of sheltered workshop earnings on other benefits, and other options for housing and employment. The group leaders encountered problems in trying to get accurage information about benefits and restrictions and with the sometimes conflicting goals of the group home as a business interest. However, clients' interest in and comprehension of the material was high, and by the end of the course they were manifesting more independent behavior.

Deinstitutionalization↗
PubMed1994

[Deinstitutionalization of psychiatric care: the post-war process in developed countries].

The authors pay their attention to the transformation of the psychiatric care which has formed in many industrial countries after the second world war. It concerns namely the deinstitutionalization process together with a development of the community psychiatric care, or the reduction process of the psychiatric bed number simultaneously with a spread of the community mental health facilities. The authors follow these changes namely in Great Britain, USA and Italy. They also discuss some theoretical problems (functions of the community psychiatry, model programs) and compare the positive and negative influences of the changes mentioned above on the society.

Community Mental Health Services↗
PubMed1996

[Clinical characteristics of long-term hospitalized patients. Part I of the Berlin Deinstitutionalization Study].

The Berlin Deinstitutionalization Study investigates effects of the planned reduction of psychiatric hospital beds in Berlin prospectively. In the beginning cross-sectional survey all adult psychiatric patients from two and a half districts, who had been hospitalized for more than 6 months, were examined. The total sample was 422 patients. Treatment situation and needs for nursing care are reported. The primary diagnosis according to ICD-10 was organic disorder (incl. Korsakov's syndrome) in 70 patients and mental retardation in 61. Psychopathology and social disabilities were examined in 237 of the remaining 291 patients. On average, psychopathology and disabilities were moderate. A cluster analysis classified three groups. When patients should be discharged, special protective measures might be necessary only for the two smaller groups (together 31%).

Adolescent↗
PubMed1982

Beyond deinstitutionalization: a commitment law in evolution.

In 1973 Washington State changed its civil commitment law to more rigorously control the number of involuntary commitments in a move consistent with the national trend toward deinstitutionalization of the mentally ill and the development of community treatment alternatives. In 1979, after six years of working within narrowly drawn criteria for commitment, the state strengthened its civil commitment authority through revisions that included expanding the definition of "gravely disabled", adding destruction of property to the "likelihood of serious harm" clause, making the provisions for revoking conditional releases more stringent, and allowing spouses of mentally ill individuals to testify against them during commitment proceedings. Early figures show that involuntary commitments, while trying to cope with federal cutbacks and diminishing resources.

Commitment of Persons with Psychiatric Disorders↗
PubMed2000

Deinstitutionalization, social rejection, and the self-esteem of former mental patients.

Modified labeling theorists have long argued that the stigma of mental illness has important consequences for the lives of people with mental illness. We propose that social rejection is an enduring force in the lives of people with mental illness and that these experiences are central to understanding the poor self-concepts described by many former psychiatric patients. We explore changes in a cohort of recently deinstitutionalized mental patients' (N = 88) self-esteem and experiences with social rejection using data from a three wave panel survey conducted while institutionalized and over a two-year period following the patients' discharge from a long-term state hospital. Our results indicate that social rejection is a persistent source of social stress for the discharged patients. Moreover, these experiences increase feelings of self-deprecation that, in turn, weaken their sense of mastery. Where the patients' received their follow-up care--whether in a community setting or in another state hospital--had little impact on their self-related feelings or on their experiences of social rejection. Our results provide further support for modified labeling theory and underscore the need to consider the dynamic relationship between stigmatizing experiences and self-related changes.

Female↗
PubMed1986

[Deinstitutionalization : community-orientated services and training of workersts.].

The "deinstitutionalization" of services and their community uses imply important modifications in our professional practices. The citizen, the parent and the community resources become necessary partners in the care of the person maladjusted to his family and community environment. This change means that our social values have to undergo important modifications so that parents and citizens are recognized the abilities and resources to assist the actions of the professional services'networks. We have to study what professional abilities need to be developed in the different community environment to respect and give value to these new resources of the human and social ecology. A pedagogy of services has to be thought of in order to prepare both parent and citizen to be responsible for certain needs in the family and community. The training and the specialization of the personnel is in need of pedagogical strategies that will trancend the theoretical knowledge and will take account the environment's know how. In other words, strategies that will blend the theoretical knowledge with the Empirical one. Two training experiences are presented: one implies the initial training (Research project and in the house intervention) and the other is involved with the training of network's helpers (Community integrated services). Those experiences are two among others which illustrate the need to define the relationship between power and knowledge in order to help the growth of true institutional alternatives in education, psychiatry, social work. Finally, we should ask what type of society facilitates the collaboration between alternative professional resources and mutual aid?

English Abstract↗
PubMed1988

[The deinstitutionalization process in the United States (Part 1).].

In this first article, the author analyses the socio-e-conomico-political conditions that have led to the closing of 78.5 % of beds in American asylums in the last 30 years. The author goes on to show how the U.S. government used legislative and fiscal measures to accomplish its deinstitutionalization policy, a policy also influenced by court battles spearheaded by psychiatric patients and their supporters.

English Abstract↗