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At least 19 recordsLinked to original sources
PubMed1978

A conceptual approach to deinstitutionalization.

Many serious problems in deinstitutionalization result from conceptual oversights or confusion. Understanding deinstitutionalization as a process and a philosophy, as well as a fact, permits planning that will accommodate the variety of patient populations that are the products of the deinstitutionalization movement. The role and possible contributions of the state hospital in caring for chronic patients must be assessed objectively. Effective program planning for chronic patients during this period of deinstitutionalization depends on a careful and realistic definitiin of what individuals are to be treated in the community. Such planning must not only attempt to match patients and appropriate treatment settings but must aim at enhancing rehabilitation, where feasible, through a skills training approach.

Community Mental Health Services↗
PubMed1979

Linking deinstitutionalization of patients with hospital phase-down: the difference between success and failure.

Deinstitutionalization of patients is an inevitable forerunner of hospital phase-down or closure, but if the two processes are carried out at the same time, they will be counterproductive. An evaluation of the combined deinstitutionalization and phasing down of a state hospital in Pennsylvania indicated conflicts in the areas of case management, community and political support, and administrative flexibility. A substantial problem was that deinstitutionalization is time-consuming and must be flexible enough to allow for the development of essential community supports and for largely unpredictable reactions from patients, families, communities, and service providers. Conversely, hospital consolidation must be relatively quick and inflexible to permit the orderly redisposition of staff and patients, reduce unnecessary staff resistance and anxiety, and withstand changing political pressures.

Community Mental Health Services↗
PubMed1979

Deinstitutionalization in the absence of consensus.

The process of deinstitutionalization began almost unnoticed in 1955 as state hospital populations started to decline, and it proceeded without adequate planning and without development of a social consensus. The inevitable result was strong criticism, severe personal dislocations, and, with rare exceptions, programmatic chaos. The authors trace and describe the reasons for the growing polarization about deinstitutionalization among such groups as mental health professionals, public officials, families, advocacy groups, citizens, and unions. They also note that between 1950 and 1970 the total institutionalized population in the U.S. was not reduced but simply shifted. Deinstitutionalization should focus not on the location of care but on the broader problem of improving the lot of persons with chronic illness, regardless of its cause or time of onset, the authors suggest. They outline the basic elements of a service and financing system to meet both the daily-living and the specifically medical needs of the chronically ill.

Aftercare↗
PubMed1979

Deinstitutionalization: avoiding the disasters of the past.

The reasons for the problems created by deinstitutionalization have only recently become clear; they include a lack of consensus about the movement, no real testing of its philosophic bases, the lack of planning for alternative facilities and services (especially for a population with notable social and cognitive deficits), and the inadequacies of the mental health delivery system in general. Providing care for the chronically ill and preparing for future deinstitutionalization means that the issue must be reconceptualized not as one of where people should be housed but as the need to provide the full range of treatments and services that are available in a total institution. Attitudinal and institutional biases and discriminatory practices must be combated, planning for community facilities and services must be improved, and funding for both institutional and community services must be provided during the phasing down of institutional services. The author proposes a set of ten commandments or basic rules to guide future deinstitutionalization activities.

Community Mental Health Services↗
PubMed1992

Psychiatric deinstitutionalization and its cultural insensitivity: consequences and recommendations for the future.

Despite the plethora of models and strategies for addressing issues that surround the chronically mentally ill, there remains a paucity of literature that addresses the specific implications of deinstitutionalization on racial minorities. Racial minorities comprise a significant number of the homeless, jailed, and geriatric mentally ill. History and current reality suggest the reasons why some chronically mentally ill blacks and their families have feared the impact of deinstitutionalization. This article examines the Ohio State Department of Mental Health's response to these issues as a possible prototype for statewide coordination for deinstitutionalization.

Black or African American↗
PubMed1977

Deinstitutionalization of mental health services in rural areas.

While the deinstitutionalization movement in both urban and rural areas has been plagued by problems, the author feels that they are exaggerated in rural communities and are complicated by such factors as the essentially urban nature of the deinstitutionalization model, the unique demographic conditions of rural America, and the lack of anonymity in rural communities. However, rurality also has several advantages for the deinstitutionalization movement, including the existence of a strong sense of community, and the increased opportunity for the therapist to know personally the patient, his family, and his friends and thus to make more humane decisions concerning his treatment.

Community Mental Health Services↗
PubMed1979

Unexpected consequences of deinstitutionalization of the mentally disabled elderly.

An unexpected consequence of the rapid deinstitutionalization of state mental hospital patients has been a sharp rise in posttransfer mortality among the elderly. Considerable evidence suggests that outcome is mediated by two factors. Elderly patients with certain characteristics - especially physical frailty and severe cognitive impairement - comprise a high-risk subgroup for whom relocation is likely to be fatal. Among other elderly persons, environmental, personality and personality-environment congruence are associated with posttransfer prognosis. The studies reviewed indicate that the therapeutic value of deinstitutionalization for mentally disabled elderly persons is problematic.

Aged↗
PubMed1992

Deinstitutionalization at a large facility: a focus on treatment.

This paper describes deinstitutionalization efforts at a large facility. The implementation of a behavioral model and development of specific training curricula are described. Emphasis was placed on the design of individualized treatment services. The quality assurance mechanisms utilized included internal monitoring systems as well as evaluations conducted by external agencies. Client treatment programs were geared toward the acquisition of skills necessary for successful community integration. Finally, it is emphasized that clients in all facilities are entitled to effective and appropriate treatment based on their individual needs and not based on client building size.

Activities of Daily Living↗
PubMed1979

The effect of deinstitutionalization on the state hospital.

Recalling the important statement about the bankruptcy of the state hospital system and the need for a multitude of treatment settings made by Harry Solomon, M.D., in 1958, the authors acknowledge that the changes he prophesized have largely come about. Using the Massachusetts Mental Health Center as the model, they describe how an inpatient unit operates as part of a deinstitutionalized network of services for seriously ill patients. They discuss the five general types of patients admitted and the problems of providing adequate care to such a diverse population. Finally, they make a strong plea for the establishment of regional facilities to care for patients with unusual, complicated problems.

Boston↗
PubMed1979

The effect of deinstitutionalization on a general hospital's inpatient psychiatric service.

As a result of the deinstitutionalization movement, increasing numbers of former state hospital patients are being rehospitalized in general hospital psychiatric units. Because of this change in patient population, the general hospital has had to adjust its treatment strategy to emphasize meticulous review of previous psychiatric history, including medications; plans for meeting the patients' posthospital housing, vocational, and social needs; and development of plans with community care-givers for continuing care. General hospital staff members have to be educated to develop competence in working with the new patient population and a tolerance for chronicity; that can be done through several forums ranging from large staff meetings to individual supervision.

Adult↗
PubMed1979

From the hospital to the prison: a step forward in deinstitutionalization?

In Massachusetts there is a growing trend to transfer both direct and indirect mental health service delivery from civil mental hospitals to prison facilities. Three factors associated with deinstitutionalization and a community-based delivery system appear to have contributed to the trend. Those factors are the over-all compromising of programming caused by unitization of state hospitals and the requirement that a full range of psychiatric services be available in every community, the decrease in morale and training of state hospital employees not involved in community treatment, and the lack of outreach to patients in the community who are dangerous or difficult to deal with.

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↗
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↗