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Results for “Deinstitutionalization”

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At least 19 recordsLinked to original sources

PubMed1998

[Deinstitutionalization in psychiatry: revising our principles of community psychiatry or failure of deinstitutionalization!].

OBJECTIVE: To update community psychiatry principles within the context of increased outpatient services. METHOD: Analysis of the evolution of some community models in Italy, France, Holland, and the United States. RESULTS: Deinstitutionalization was aimed to protect patients from the harmful effects of mental hospitals but failed to result in social integration for many of them. Success and failure of community practice shed a new light on the diversity and constancy of patients' needs. CONCLUSIONS: Quality-of-life improvement and services integration should be guided by planning and selection of the required services.

Community Mental Health Services↗

PubMed2006

The impact of deinstitutionalization of psychiatric hospitals on psychological distress of the community in Canada.

OBJECTIVE: There has been a plethora of studies that evaluate the impact of deinstitutionalization of psychiatric services, but they have not examined whether this policy has had an impact on the broader community. The present study addresses this gap by evaluating the impact of the deinstitutionalization of psychiatric hospitals on the mental health of the general population in Canada. METHOD: This research builds on an empirical analysis of 40 years of the process of deinstitutionalization of psychiatric services in Canada (Sealy and Whitehead 2004). An experimental design is simulated through the use of a derived construct, earlier vs. later deinstitutionalization, in order to test whether the policy of deinstitutionalization has achieved the goal of decreasing levels of psychological distress for people in the community. This study attempts to rectify some of the methodological limitations of past evaluations by standardizing the rates of deinstitutionalization among the provinces and taking into consideration the impact of the interaction among levels of perceived social support and the various social correlates of psychological distress. Cross sectional data from the 1994/95 (n = 16,989) and the 1998/99 waves of the National Population Health Survey (n = 14,682) are used to measure levels of psychological distress. RESULTS: Provinces that implemented this policy earlier have levels of psychological distress that are significantly lower than the provinces that implemented deinstitutionalization later. All high risk groups (people with lower levels of income and education, younger people, people living in urban areas) have significantly lower levels of psychological distress in 1998/99 (as compared to 1994/95) with the exception of single parents in the provinces that implemented deinstitutionalization earlier. CONCLUSION: Based on the NPHS, the earlier implementation of deinstitutionalization is associated with lower levels of psychological distress of the community as compared to the provinces that implemented deinstitutionalization later.

Adolescent↗

PubMed2001

Self-injurious behaviour before and after deinstitutionalization.

The deinstitutionalization movement is presently spreading in Europe. Studies evaluating the effects of deinstitutionalization on behaviour disturbances among people with intellectual disability (ID) have been inconclusive. The present paper focuses on people without self-injurious behaviour (SIB) who developed SIB after deinstitutionalization. The present authors studied individual and environmental characteristics before and after deinstitutionalization to look for factors associated with the development of SIB which could also be possible intervention points for preventive action. All those individuals in an institution for people with ID who did not have SIB before deinstitutionalization were included in the present study. The individuals who developed SIB after deinstitutionalization (n = 15) formed the study group (group A) and those who did not (n = 53) comprised the control group (group B). The population was examined both before and after deinstitutionalization. As far as possible, the same methods were used at both occasions. The covariates were both individual (e.g. mental health, behaviour disturbances and behaviour deficits) and environmental (e.g. caretaker education, caretaker:patient ratio, housing and leisure activities). Psychiatric disorders were identified in 1987 and 1995 with the Psychopathology Instrument for Mentally Retarded Adults, which was filled in by the caretakers. In 1987, the people in group A who acquired SIB had lower developmental quotients, used wheelchairs more often and had trouble with moving around without help. They also had a greater frequency of epileptic seizures, and hearing and communication impairment. In 1995, there were only minor environmental differences between groups A and B. There were significantly more individuals involved in the rotation period and more unskilled caretakers working with the people in group A than group B. The present authors found no differences between the two groups on variables such as global mental health and behaviour disturbances, or in the use of neuroleptics before or after deinstitutionalization. Groups A and B did not show differences in behaviour disturbances or psychiatric disorders in 1987. In both 1987 and 1995, there were no differences between groups A and B on variables such as accommodation, caretaker:patient ratio, the number of caretakers involved in direct care, the caretakers' education, or the time spent in structured activities before and after deinstitutionalization. The individual characteristics indicating that a person may acquire SIB are behaviour deficits which are suggestive of central nervous system dysfunction or damage, even if the results are inconclusive. The development of SIB may also be facilitated by communication deficits or by reinforcement of a incidentally occurring SIB if the staff includes many unskilled caretakers in the rotation period.

Adolescent↗

PubMed2002

Predictors for attacks on people after deinstitutionalization.

BACKGROUND: The deinstitutionalization movement is presently spreading in Europe, but studies evaluating the effects of deinstitutionalization on behaviour disturbances among people with intellectual disability (ID) are inconclusive. The prevalence of aggressive behaviour among people with ID is high in both institutions and in community. Aggression and attacks on people are a significant problem for people with ID in both institutions and society. In the present paper, the authors focus on individuals who started attacking people after deinstitutionalization. METHOD: The authors studied individual and environmental characteristics before and after deinstitutionalization to look for individual and environmental predictors for the development of aggression with the hope that some could be possible intervention points for preventive action. In an institution for people with ID, all who did not attack people before deinstitutionalization were included. The individuals who started attacking others after deinstitutionalization (n = 22) were the study group (group A) and those who did not (n = 42) comprised the control group (group B). The population was examined before and after deinstitutionalization. As far as possible the same methods were used at both occasions. The covariates included individual ones, such as mental health, behaviour disturbances and behaviour deficits, and environmental ones, such as caretaker education, caretaker:patient ratio, housing and leisure activities. Psychiatric disorders were identified in 1987 and 1995 with the Psychopathology Instrument for Mentally Retarded Adults (PIMRA), which was filled in by the caretakers. RESULTS: Group A showed significantly more self-injurious behaviour (SIB) than group B in 1987. The sum of behaviour disturbances shown in the past year, attacks on property, SIB and other disruptive behaviours were also significantly higher in group A than in group B. The soundness scores on the PIMRA for the people in group A were lower than for the people in group B. Group A contained significantly fewer people without behavioural problems in the past year. The authors could not find any differences on other individual characteristics such as aetiologies of ID and behaviour deficits in 1987. The caretakers' evaluations of the clients need for help, based on behaviour disturbances and mental health problems, were significantly higher in group A. The people in this study differed in age, gender and degree of ID from those in most other studies on ID and challenging behaviour. CONCLUSION: The individual predictors for starting to attack others after deinstitutionalization were SIB, a slight load of other behaviour problems and a low soundness score on the PIMRA. The only environmental predictor was the caretakers' evaluation of the subjects' need for help caused by behaviour problems and mental illness. The authors could not identify possible preventive intervention points, neither individual or environmental, and therefore, further studies are needed.

Adolescent↗

PubMed2000

Organizational analysis of deinstitutionalization in a psychiatric hospital.

BACKGROUND: Few studies have been conducted of the organizational aspects that impact on the course of psychiatric deinstitutionalization. METHOD: A case study was undertaken of 10 years of deinstitutionalization in a Montreal psychiatric hospital. RESULTS: Deinstitutionalization has forged ahead in the hospital over the past few years, although the course it has taken is not the one initially plotted by its promoters. Care management of deinstitutionalized patients remains under the control of the psychiatric hospital and its physicians. However, the patients' well-being has remained a focus of concern and does not seem to have been detrimentally affected by this development. CONCLUSION: Deinstitutionalization is both a solution to the criticisms levelled at the hospital-psychiatric approach of managing persons with severe and persistent mental disorders and an extremely useful tool in the power struggle among the various stakeholders in mental health services reform. Deinstitutionalization has become unavoidable.

Case Management↗

PubMed1982

Behavioral evaluation of a state program of deinstitutionalization of the developmentally disabled.

The purpose of this study was to evaluate one phase of a statewide program of deinstitutionalizing developmentally disabled individuals. Forty adults who had spent a minimum of six months in community placements were evaluated with respect to changes in behavior associated with movement out of state institutions and into community settings such as group homes and day activity centers. Pre- and post-deinstitutionalization measures were taken with the Behavior Development Survey. Post-deinstitutionalization measures on Cataldo and Risley's Resident Activity Manifest were compared to the same measures obtained on 159 developmentally disabled individuals scheduled for deinstitutionalization. A consistent pattern of positive changes on both instruments favored deinstitutionalization, but changes could not be unequivocally attributed to movement out of the institutions per se.

Adult↗

PubMed2003

Psychotropic drug use among people with intellectual disability before and after deinstitutionalization.

BACKGROUND: The use of psychotropic medication among people with intellectual disability (ID) is widespread, and they are one of the most medicated groups in society. A substantial number of individuals with ID receive psychotropic medications that may be inappropriate for their diagnosis. One of the main reasons for the use of psychotropic medication is challenging behaviours. Almost all prevalence studies show higher prevalence rates of psychotropic medication in institutions compared with community living. Studies on deinstitutionalization and the use of psychotropic medication are few and inconclusive. METHOD: The present study is a prospective cohort study without control group. It examines the use of psychotropic medication among 109 subjects aged between 16 and 65 years before (1987) and after (1995) deinstitutionalization. Psychotropic drug dosages were transformed to percentage of defined daily dosage. RESULTS: We found no major changes in the use of neuroleptics after deinstitutionalization neither in frequency nor in dosages, and the trend seemed indiscriminate in relation to diagnosis. The people with schizophrenia or an anxiety disorder did not receive proper drug treatment, nor did they before deinstitutionalization. CONCLUSIONS: The main predictor variable for neuroleptic dosage both before and after deinstitutionalization was challenging behaviour. The reason for this may be the difficulties in determining the extent to which presenting behaviours are the result of a psychiatric disorder or a behaviour disorder, the lack of knowledge among the caretakers and the ensuing referral practice, the lack of knowledge among the general practitioners, and the lack of access to specialized health services.

Adolescent↗

PubMedDate not supplied

Australia's National Mental Health Strategy and deinstitutionalization: some empirical results.

OBJECTIVE: To determine the role of the National Mental Health Strategy in the deinstitutionalization of patients in psychiatric hospitals in Queensland. METHOD: Regression analysis (using the maximum likelihood method) has been applied to relevant time-series datasets on public psychiatric institutions in Queensland. In particular, data on both patients and admissions per 10 000 population are analysed in detail from 1953-54 to the present, although data are presented from 1883-84. RESULTS: These Queensland data indicate that deinstitutionalization was a continuing process from the 1950s to the present. However, it is clear that the experience varied from period to period. For example, the fastest change (in both patients and admissions) took place in the period 1953-54 to 1973-74, followed by the period 1974-75 to 1984-85. CONCLUSIONS: In large part, the two policies associated with deinstitutionalization, namely a discharge policy ('opening the back door') and an admission policy ('closing the front door') had been implemented before the advent of the National Mental Health Strategy in January 1993. Deinstitutionalization was most rapid in the 30-year period to the early 1980s: the process continued in the 1990s, but at a much slower rate. Deinstitutionalization was, in large part, over before the Strategy was developed and implemented.

Australia↗

PubMed1986

Deinstitutionalization, another way: the Italian mental health reform.

The article describes the Italian experience of deinstitutionalization in psychiatry, a reform which has attracted international recognition as being the only instance of an industrial society eliminating detention in a mental hospital from its range of mental health agencies and services. The first part of the article highlights the differences between the Italian experience and psychiatric reforms in Europe and the US, where deinstitutionalization has been reduced to dehospitalization. The problems and failings of these reforms are examined. The second part describes the operation, very different in content and method from the above quoted experiences, of the Italian form of deinstitutionalization. Starting from a critique of the rationalistic problem-solution "paradign" in psychiatry, it has developed as a complex social process which: a) involves all its subjects as active participants, b) transforms the power relationship existing between the patient (and citizen) and the institution, c) creates mental health services which completely replace detention in mental hospitals by deconstructing them and reconverting the material and human resources found in them. An example of this reconversion is given in the way in which mental health services have been organized in Trieste. The fourth part examines the reform law arising from the deinstitutionalization process and the characteristics of its implementation, in order to show how this process continues through implementation. In the light of these considerations, deinstitutionalization is no longer perceived as an aspect of the "welfare crisis", but rather as a significant pointer to new-post-welfare social policies.

Deinstitutionalization↗

PubMed2001

Some perspectives on deinstitutionalization.

The authors discuss what can be learned from our experience with deinstitutionalization. The deinstitutionalization of mentally ill persons has three components: the release of these individuals from hospitals into the community, their diversion from hospital admission, and the development of alternative community services. The greatest problems have been in creating adequate and accessible community resources. Where community services have been available and comprehensive, most persons with severe mental illness have significantly benefited. On the other hand, there have been unintended consequences of deinstitutionalization-a new generation of uninstitutionalized persons who have severe mental illness, who are homeless, or who have been criminalized and who present significant challenges to service systems. Among the lessons learned from deinstitutionalization are that successful deinstitutionalization involves more than simply changing the locus of care; that service planning must be tailored to the needs of each individual; that hospital care must be available for those who need it; that services must be culturally relevant; that severely mentally ill persons must be involved in their service planning; that service systems must not be restricted by preconceived ideology; and that continuity of care must be achieved.

Criminal Law↗

PubMed2000

Cost-effectiveness analysis of psychiatric deinstitutionalization.

BACKGROUND: The cost-effectiveness of the eventual deinstitutionalization of patients with severe and persistent mental disorders who are currently hospitalized in long-term care remains a controversial matter. METHODS: A retrospective cohort of 96 pairs of psychiatric hospital patients with 1 member deinstitutionalized between 1989 and 1998 was followed up for nearly 10 years. All use of medical and social services was documented. Patients were evaluated at the start and end of the study on various clinical and social dimensions, as well as on quality of life. RESULTS: On several dimensions, deinstitutionalized patients scored more positively than did those patients still hospitalized. The lower daily cost of living accommodations for deinstitutionalized patients easily offsets the cost of services required for treatment in the community. CONCLUSION: Deinstitutionalization, as implemented in the hospital studied, remains for many patients a less costly option than continued hospitalization and is likely to improve their mental state and well-being.

Adult↗

PubMed1999

Deinstitutionalization of psychiatric patients in central Europe.

The central European countries Germany, Switzerland, Austria, and Luxemburg are confronted with a variety of individual problems concerning health care. After an analysis of problems which are shared by all the countries, these individual aspects are analyzed. In Germany there has been a rapid structural change of psychiatric care in the last 30 years. Although there was a broad movement to deinstitutionalize patients with chronic psychiatric disorders who need long-term care, there are still too many psychiatric beds in large psychiatric hospitals and still missing psychiatric departments in general hospitals in some areas. In Austria the process of deinstitutionalization has been delayed but a general survey of the health care system by the government led to an acceleration of this process in recent years. Due to historical reasons, the mental health care system in Switzerland is not easily comparable with the ones in the other two countries. Deinstitutionalization mainly means reduction of beds in the existing psychiatric hospitals rather than a structural change with a conversion to psychiatric departments in general hospitals. Luxemborg is a good example of the fact that economical factors are not the only aspects influencing development in psychiatric care. Psychiatric care is not community based, centralized, separated from medical care, and the supply system concerning complementary outpatients institutions is underrepresented. Thus, in all the countries the process of deinstitutionalization has still not come to a satisfying level. This is not only due to the economically difficult situation in the recent past. A change can only be expected when the opinions about modern principles of psychiatric care receive more weight in general society and with their political representatives.

Chronic Disease↗

PubMed1999

Psychiatric health needs and services before and after complete deinstitutionalization of people with intellectual disability.

Before total deinstitutionalization in Norway, many believed that the ordinary health care system could give people with intellectual disability the same or even better health care than that which they received in institutions. It was said that institutions created psychiatric problems, and that these would diminish or even disappear with the closing of these establishments. The present study is a prospective cohort study without a control group. It examines the frequency of mental health problems and the psychiatric health services which 109 subjects aged between 16 and 65 years received before (1987) and after (1995) deinstitutionalization. Mental health problems were defined as behavioural disturbances, and psychiatric disorders and symptoms. Psychiatric disorders were identified with the Psychopathology Instruments for Mentally Retarded Adults (PIMRA), which were filled in by the carers. Behaviour disturbances were identified as having occurred or not during the previous year. Psychiatric problems remained frequent, and there was a significant increase in behavioural problems in spite of total deinstitutionalization and improved physical living conditions. Access to qualified help, such as psychologists and psychiatrists, had been substantially reduced. Most mental health problems among people with intellectual disability are not solved by reorganization or deinstitutionalization, and such measures are no substitution for professional assistance.

Adolescent↗

PubMed2004

[Assessing deinstitutionalization of the nursing home area of a large state mental hospital from the point of view of patients and staff].

OBJECTIVE: Within the deinstitutionalization process of a large psychiatric hospital, the development of two cohorts of patients with chronic schizophrenia is compared over a two-year period: patients living in the hospital's nursing-home area (n = 50) vs. patients already released to two social therapeutic hostels (n = 51). Results of the cohort study were compared with assessments of nurses working in the nursing home (n = 55), focusing on their subjective views of the deinstitutionalization process and its impact on their working conditions. METHODS: Patients are assessed through yearly home-visits in their place of residence. The instruments used measure several outcome parameters: psychopathology, social disabilities, subjective quality of life, and normative needs for care. Concurrent staff assessments were conducted using standardized survey instruments focusing on current working conditions and quality of teamwork. Nineteen nurses participated in qualitative interviews evaluating the deinstitutionalization process. RESULTS: For all measures, patients living in the nursing home show significantly worse outcomes. Furthermore, during the study period 34 % experienced a change in their living situation with which they were dissatisfied. Needs for care and the number of areas of "unmet" need increased significantly for this subgroup. Patients living in social therapeutic hostels demonstrate stable levels of psychopathological symptoms, social disabilities, and needs for care. Assessments indicating a deterioration in patients' subjective quality of life focus mainly on areas important for social contacts. Regarding "personal concerns" and "insecurity at work", ratings from nursing home staff were significantly worse than those of a reference group from several other health care institutions (n = 224). Staff showed a tendency to give higher ratings for their opportunities to participate in decisions, in contrast with the low ratings for chances to improve their knowledge in the workplace, a result which may indicate a lack of prospects. In general, staff faces the conundrum of being asked to adopt a new mental health care paradigm while organisational structures are being eliminated and insecurity about career opportunities is increasing. CONCLUSION: To adequately manage deinstitutionalization of care, all participating parties must be involved in the process as early as possible to clarify expectations and to demonstrate commitment to future opportunities in the new system.

Chronic Disease↗

PubMed1999

Deinstitutionalization and schizophrenia in Finland II: discharged patients and their psychosocial functioning.

Three representative cohorts of schizophrenia patients deinstitutionalized from psychiatric hospitals in 1982, 1986, and 1990 were followed up for 3 years in Finland. Patients of the last cohort were older, more disturbed, and had been ill for a longer time than those discharged at the beginning of the 1980s. Despite this, the mortality of patients deinstitutionalized in 1990 did not increase, and their psychosocial functioning seemed to become even better during the 3-year follow-up period compared with those deinstitutionalized during the previous decade. Patients who had been discharged in 1990 were more often living alone than those discharged in the 1980s. Homelessness was rare throughout the study period. In general, patients were more satisfied with their life situation at follow-up compared with that on discharge. Furthermore, most patients were satisfied with their treatment situation. Altogether, the psychiatric care system seemed to be able to meet schizophrenia patients' need for care fairly well during the rapid deinstitutionalization process in Finland. More attention, however, should be paid to the loneliness and social withdrawal of discharged patients as well as to other disabilities in their social functioning.

Activities of Daily Living↗

PubMed1984

Deinstitutionalization and the homeless mentally ill.

Although homelessness among the chronically mentally ill is closely linked with deinstitutionalization, it is not the result of deinstitutionalization per se but of the way deinstitutionalization has been carried out. The lack of planning for structured living arrangements and for adequate treatment and rehabilitative services in the community has led to many unforeseen consequences such as homelessness, the tendency for many chronic patients to become drifters, and the shunting of many of the mentally ill into the criminal justice system. It has become clear after two decades of deinstitutionalization that what is needed is a vast expansion of community housing and other services and a whole revamping of the mental health system to meet the needs of the chronically mentally ill for support and stability. In addition, mental health professionals must accept the full extent of the dependency needs of many chronic patients.

Adolescent↗

PubMed1987

Beyond deinstitutionalization: a new ideology for the postinstitutional era.

The emergence of the young adult chronic patient, and the attendant perception that deinstitutionalization has failed, may be viewed as the inevitable result of the success of deinstitutionalization. Deinstitutionalization gave freedom to the mentally ill, but in doing so it left patients free to struggle on their own. The deinstitutionalization ideology failed to predict the difficult clinical reality that most patients do not readily choose the identity of chronic mental patient and are reluctant to make use of available treatment programs. The author presents the key principles of a new postinstitutional ideology that focuses on helping patients attain the best possible adaptation to their illness regardless of the setting in which they are treated. He hopes the ideology will infuse new hope and clinical expertise into work with people with chronic mental illness.

Chronic Disease↗

PubMedDate not supplied

Deinstitutionalization at the beginning of the new millennium.

Deinstitutionalization, which began in the mid-1950s, has had dramatic effects. It has decreased the number of occupied state hospital beds from 339 to 29 per 100,000 population. The plight of the new generation of chronically and severely mentally ill persons has posed the most serious problem: these individuals no longer receive life-long hospital admission and thus permanent asylum from the demands of the world. A comprehensive, integrated, and adequately funded system of care for this population needs to be established in the community. Where such systems exist, they can lead to higher levels of functioning and a better quality of life. Unfortunately, treatment, housing, and rehabilitation resources are presently insufficient to serve the substantial population of mentally ill in the community. Moreover, some patients who have been deinstitutionalized cannot be effectively treated without highly structured 24-hour care. The way deinstitutionalization has been implemented has probably contributed to the large numbers of severely mentally ill persons on the streets and in jails. Although deinstitutionalization can result in a much richer life experience in the community, much more needs to be done to make that occur.

Chronic Disease↗