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PubMed1998

The therapeutic environment of psychiatric hospitals in Japan: a comparison of medical welfare facilities for senile dementia.

With the dual purpose of protecting the human rights of mentally disordered persons and promoting their social rehabilitation, the newly revised Mental Health Law was enacted in July 1987. It has brought significant change in that it has shifted Japanese mental health care from a hospital-based to a community-based system. Consequently, the therapeutic environment in the psychiatric hospitals has been changing from a closed to an open one. Recently, the amenity of hospital environments has been discussed. Furthermore, in the revision of medical fees of April 1994 the government established the long-term care ward system, which is a good indication of the changing nature of psychiatric institutions in Japan. I will report on the current therapeutic environment in Japanese psychiatric hospitals, and will also compare it with the care environment in facilities for healthcare services for the aged (and/or senile dementia) and special nursing homes for the aged.

Aged↗
PubMed1998

Community-based care for the mentally disordered in Kawasaki City: experiences from Kawasaki City Psychiatric Rehabilitation Center.

The basic aims of Kawasaki City Psychiatric Rehabilitation Center are: (i) taking some measures for the hospitalized patients unable to leave because of residential problems; (ii) providing a daily program for the discharged from psychiatric hospital; (iii) developing vocational rehabilitation for the mentally disordered; and (iv) developing a support network for the mentally disordered in the community. To fulfill these aims and to meet the various needs of our users, we have provided a very comprehensive program composed of a ward, outpatient section, day care groups, vocational service and half-way house. According to the program, various services such as medical treatment in a narrow sense, basic training of social skills and human relations, vocational training system that meets the various needs and work abilities of the users, and after care services that enable them to support themselves living in the community are available. These services give them great comfort to live in the community; however, they might serve to increase their dependency on the center. Our future task is to cooperate with various social resources such as workshops, group homes and places to stay and rest during the day, which are being developed in Kawasaki City. By supporting those facilities, we expect to refer our members to them and we put more weight on the indirect service than the direct one, which would hopefully enable us to cover and care for more people in need.

Community Mental Health Services↗
PubMed1998

Psychosocial rehabilitation models in the Asia-Pacific region.

Mental illnesses and mental health have, out of ignorance and fear, evoked a low priority in healthcare systems the world over. The concept that all mental illnesses were synonymous with madness has its origins in the beginnings of ignorance and fear. To a large extent, these have contributed to the marginalization of psychiatry and neglect of the mentally ill. The kings of old, seeing the ill-treatment of the mentally ill, built asylums for them, but again, the prejudice soon was overwhelming and care of the mentally ill was often given to those who were not the best administrators and carers. The long and controversial tradition of mental asylum care for the mentally ill was also brought about by the lack of specific treatments for mental illnesses. With the advent of chlorpromazine in the 1950s and other psychotropics afterwards, the need for incarceration in asylums became largely redundant. However, what also became obvious soon after was the fact that the psychotropics only helped to control symptoms and not to cure diseases of the mind. Although considerable research has gone into attempts at correcting supposed defects in neurotransmission, the cure of mental illness seems some way off. The need for rehabilitating or re-housing those with mental illnesses especially those needing long-term care and those whose cure seems difficult has been recognized for a long time. It was Phillipe Pinel who almost 200 years ago unchained the mental patients at an asylum in Paris and proposed work therapy and humane care. Psychosocial rehabilitation of the mentally ill is not, therefore, a new concept. The need for methods of changing the behavior, thinking and functioning of those with severe mental illnesses using psychological, social, occupational, behavioral and medical methods is called psychosocial rehabilitation. This method, although developed in stages over the past two centuries, has undergone changes and deterioration and development in different parts of the world with different priorities and emphasis.

Asia, Southeastern↗
PubMed2005

Public policy and mental illnesses: Jimmy Carter's Presidential Commission on Mental Health.

President Jimmy Carter's Presidential Commission on Mental Health was intended to recommend policies to overcome obvious deficiencies in the mental health system. Bureaucratic rivalries within and between governments; tensions and rivalries within the mental health professions; identity and interest group politics; the difficulties of distinguishing the respective etiological roles of such elements as poverty, racism, stigmatization, and unemployment; and an illusory faith in prevention all influenced the commission's deliberations and subsequent enactment of the short-lived Mental Health Systems Act. The commission's work led to the formulation of the influential National Plan for the Chronically Mentally Ill, but a system of care and treatment for persons with serious mental illnesses was never created.

Deinstitutionalization↗
PubMed1982

Half-way services in the rehabilitation of chronic mental patients. A residential programme.

The importance of adequate community facilities in the rehabilitation of chronic mental patients is stressed. In view of the common reluctance of relatives to accept this type of patient back home again, a residential programme was designed to obviate this problem. The rehabilitation unit described, achieved reintegration into the community of 36.1% of the patients through the use of hotels and sheltered accommodation. In all, 58.4% of the patients were discharged. Finally, mention is made of the advantage of the system, especially its economy, availability, and helpful collaboration of landladies.

Adolescent↗
PubMed1985

Psychiatric hospitalization in Italy before and after 1978.

The available information system in Italy does not allow to adequately evaluate the change in patterns of hospitalization that have taken place after the 1978 Mental Health Act came into force. There are huge differences among Northern and Southern Italy and inside these areas. On average, the reduction of public psychiatric hospitals activity had begun around 70's. People living in these hospitals at the census day January 1st were about 75,000 in the first years of the 70's, were 58,000 in 1977 and further decreased to 38,000 in 1981 (67.6 per 100,000 total population). This decrease was not counterbalanced either by private psychiatric hospitals, or by the newly opened Psychiatric Departments in general hospitals. Scant or no information is available on intermediate facilities, and on follow-up of discharged inpatients.

Affective Disorders, Psychotic↗
PubMed1985

The end of the mental hospital. A review of the psychiatric experience in Trieste.

This paper describes the closing of the mental hospital in Trieste and the establishing of a comprehensive community mental health service, over a period of 13 years from 1971. In 1971 the hospital had 1058 patients. By 1975 there were 656 patients, 403 of whom were guests, in effect ordinary citizens who had nowhere else to live. The paper describes this dramatic and innovative transformation, the rearrangement of wards, the abolition of shock therapies, the establishment of many flats and group homes, the starting of a cleaning cooperative employing ex-patients to do the work they previously did as "ergotherapy", the first mass exodus of the patients into the city. The paper goes on to describe the opening of 7 mental health centres between 1975 and 1977 and the present existing network of services. At this time the hospital buildings were converted into a variety of uses for the benefit of the local people. It describes in greater detail the philosophy and practice of one of these centres at Barcola and how the dialectical relationship between staff and client works to create a flexible and responsive service. It ends by repeating the assertion that the closure of the mental hospital is a first necessary step towards an improved mental health service for everyone.

Commitment of Persons with Psychiatric Disorders↗
PubMed1985

Bringing into action the psychiatric reform in South-Verona. A five year experience.

The organization of psychiatric care in Verona prior to the new Italian Mental Health Act, and the organization of the new South-Verona Community Psychiatric Service (CPS) implemented in 1978 after the approval of the new law, are described. Case-register data for the period 1979-1983 are also reported. To compare in-patient care provided in South-Verona after the Reform with that of the previous year, data on hospital admissions during 1977 were collected retrospectively. From 1977 to 1983 compulsory admissions have decreased by 67%, the average number of occupied beds per day and the average length of in-patient stay have decreased by 34%, while the total rates of admission have increased by 4%. The long-stay in-patient rate, which was already considerably low in 1977 (48/100,000), is still decreasing slightly and no "new" long-stay patients have accumulated in psychiatric institutions during the past three years. In South-Verona most of the patients are treated outside the hospital and the same staff is responsible for in- as well as for out-patient care (which includes domiciliary visits and day care), to ensure therapeutic continuity. Although it lacks some complementary facilities the South-Verona CPS in its five years of experience has been able to bring into action the psychiatric reform as indicated by the new Law.

Ambulatory Care↗
PubMed1985

Register studies: data from four areas in Northern Italy.

Descriptive statistics derived from four psychiatric case-register areas are presented. Attrition numbers of long-stay inpatients and the accumulation of high-user patients in non-residential facilities are discussed, with the aim of providing tentative suggestions for a more rational planning of services. Similarities and differences among various areas of Northern Italy are also described.

Chronic Disease↗
PubMed1985

A model of a single comprehensive mental health service for a catchment area: a community alternative to hospitalization.

The possibility of overcoming the Psychiatric Hospital with a single Community Service consisting of a network of territorial activities for the total population of a defined area is described. An evaluation is made from 1971 to 1983. Handicapped children are treated essentially in the family and normal educational structures. Diagnostic prevalence of more serious cases, modes of treatment, scholastic facilities and rejection of special schools are described. Work methods and community facilities, mean-year incidence and one-year prevalence of patients aged 15 + are examined. The latter convalidates priority towards serious risk situations. Specific rehabilitation and work-reintegration are programmed for handicap and disability patients. Release of long-stay psychiatric patients continues through alternative programmes with housing facilities. By 1985 the Psychiatric Hospital should close down. The population is treated by the C.M.H.S. when hospitalized in the General Hospital where no psychiatric ward exists. Crisis intervention, alternative treatment and hospitalization statistics are described.

Adolescent↗
PubMed1985

Psychiatric practice in Umbria: research and transformation processes in the light of juridical-prescriptive events.

The present paper provides a synthetic account of the process of renewal and transformation of psychiatric care in Umbria, and, more specifically, in Perugia, in the last two decades. In the first part we attempt to show that the significance assigned to the normative aspect in the framework of psychiatric care in Italy has been excessive, particularly in the last few years. In the second, we try to give an account of the psychiatric work done in Umbria. We deal first with the period preceding the passing of Law no. 180 by the Italian Parliament; then we discuss the relationship between the new law and the processes in action; finally, we consider more recent problems concerning the attempts to promote a psychiatric counter-reformation and the theory and practice of our work.

Community Mental Health Services↗
PubMed1985

The impact of Psychiatric Reform on inpatient services in a metropolitan area of Southern Italy: the Naples case.

Six years after the Psychiatric Reform, phasing out of Mental Hospital and implementing a community based Mental Health System, i.e. the main goals of the Reform, are not yet performed in Southern big cities of Italian peninsula. In Naples metropolitan area this new Mental Health policy faces with a dramatic lack of community services. This paper summarizes data concerning the trends in psychiatric admissions to some inpatient public settings of Naples before and after the Reform, with the intent of pointing out the short-time outcomes of this law in a highly populated area. The Authors stress some positive results of the Reform in the study area, as well as the factors which have contributed to the inadequate application of the new law.

Commitment of Persons with Psychiatric Disorders↗