Deinstitutionalization: A new scenario

Deinstitutionalization appears to be an issue that is still pretty much up in the air. The public, courts, and state hospital administrators agree that large state, warehouse-like facilities are inadequate. The appropriate mental health delivery system for each state and the communities within each state need careful planning and implementation to be successful. Mental health populations in state facilities have dropped over fifty percent since 1955. The future planning of mental health delivery systems can be improved by training administrators to work with the public and the courts to provide services appropriate to each community or state.     

Deinstitutionalization:

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Community Care and Deinstitutionalization:

No abstract available for this article.     

Deinstitutionalization and public policy

Deinstitutionalization, originally hailed as a major advance in public policy towards mental illness, has recently become increasingly controversial. This paper reviews the implementation of this policy in the United States, providing a critical examination of some of the central issues and problems that are the focus of current debates. It concludes with a pessimistic assessment of the likelihood of substantial improvements occurring in the lot of the chronic mental patient in the contemporary United States.     

A Systems Design Developmental Model for Programs of Deinstitutionalization

Devising plans to maintain individuals with a chronic mental disability in the community following a long-term hospitalization is a highly complex problem. One of the significant aspects of this problem is the availability of adequate living arrangements that promote individual growth and development, provide arrangements that promote individual growth and development, provide professional support and care, and elicit the concern of members in the community who will provide these living arrangements. Alternate living arrangements require social experimentation in efforts to ascerain and appraise which one(s) are most appropriate for any given community. This paper devises a method of sequential development of alternatives in which each arrangement is appraised as it emerges in the community in relation to cost, knowledge acquired and utilized, technology advanced, and other resources required. It was assumed that each living arrangement produces different results in development. It further assumes that each living arrangement learns in development to the best interest of the chronic mentally disabled. The result of this innovative systems design is that professionals can make decisions on placement based on knowledge, information, technology, and cost as it emerges in juxtaposition to the results such programs are having on those in need.     

Mental Health Care in the Aftermath of Deinstitutionalization: A Retrospective and Prospective View

This paper offers a panoramic assessment of the significant changes experienced by psychiatric care in Western Europe and North America in the course of the last decades of deinstitutionalization and reform. Drawing on different comparative studies and an own review of relevant data and reports, the main transformations in the mental health field are analyzed around seven major topics: the expanding scope of psychiatry; the decline and metamorphosis of the asylum; the introduction of alternative and diversified forms of care; the new challenges posed by chronic mental illness; the emergence of modern psychopharmacology; the deployment of subspecialization; and the new forms of coercion implemented with community mental health practices. Following a renewed diagnosis on the essential features of the reformed mental health systems based on the pattern of social inclusion inherent to the new devices and philosophies of care, some major challenges for the future such as the overburdening of services or the overt exclusion of a significant part of potential users are also identified and briefly discussed.     

Multipurpose Senior Service Program Deinstitutionalization Screen

The Multipurpose Senior Services Program Deinstitutionalization Screening Instrument has been designed to identify easily and quickly those patients in nursing homes who are likely to be returned to the community through case-management efforts. The six-item screen and tables allow the interviewer to determine the probability of a patient being successfully discharged from a nursing home.     

Deinstitutionalization, another way: The Italian mental health reform

The article describes the Italian experience of deinstitutionalizationin psychiatry, a reform which has attracted international recognitionas being the only instance of an industrial society eliminatingdetention in a mental hospital from its range of mental healthagencies and services. The first part of the article highlights the differences betweenthe Italian experience and psychiatric reforms in Europe andthe 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 contentand method from the above quoted experiences, of the Italianform of deinstitutionalization. Starting from a critique ofthe rationalistic problem-solution "paradigm" in psychiatry,it has developed as a complex social process which: a)involvesall its subjects as active participants, b) transforms the powerrelationship existing between the patient (and citizen) andthe institution, c) creates mental health services which completelyreplace detention in mental hospitals by deconstructing themand reconverting the material and human resources found in them. An example of this reconversion is given in the way in whichmental health services have been organized in Trieste. The fourth part examines the reform law arising from the deinstitutionalizationprocess and the characteristics of its implementation, in orderto show how this process continues through implementation. In the light of these considerations, deinstitutionalizationis no longer perceived as an aspect of the "welfare crisis",but rather as a significant pointer to new post-welfare socialpolicies.     

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 and the 'long-term mentally ill': a Swedish case study

We discuss deinstitutionalization and the question of how ‘long-termmentally ill’ persons adjust to life outside institutions.An interview survey was conducted in 1990 with 61 persons whohad been discharged to the community from a mental hospitalin the County of Värmland, Sweden during the 1980s afterat least five years inpatient care. The question of accommodationwas solved for all the interviewees prior to discharge and allnow live in modern apartments. Each discharge was preceded byan individual plan. The majority of the 61 ex-patients stillhad contact with psychiatry in some form but only 19 had beentreated in inpatient psychiatric care since they were discharged.While the ex-patients' material standard of living was satisfactory,the situation with respect to the occupation and fellowshipwas not. The need for intermediate forms of individually adaptedoccupation and supportive housing conditions is discussed.     

Bulimia: A historical perspective

The present paper reviews some of the historical references to the concept of bulimia found in the medical literature of the last 300 years. Bulimia is an eating disorder that is widely believed to be of very recent, historical origin. The current diagnostic category of bulimia may be denoted as “new”, largely because of increased prevalence, and changes that have occurred in symptoms seen as constituting the syndrome. However, available references show clearly that various conceptualizations of bulimia extend back several hundred years. Also, treatment approaches that are consistent with presumed etiology have been offered by several early writers. While bulimia has recently been viewed as an emergent variant of anorexia nervosa, historical evidence suggests that earlier conceptualizations of the term describe a symptom as well as a discrete syndrome. Despite the fact that the diagnosis and use of the concept of bulimia has been variable historically, its dramatic fundamental feature has remained consistent.     

Parasuicide: A Singapore perspective

Objectives. This study was undertaken to determine whether there were ethnic and social variations in parasuicide in the population of Singapore.

Methods. All hospital records of parasuicide from a teaching hospital between 1991 and 1995 were reviewed. Demographic data, reasons precipitating the suicide attempt and the psychiatric diagnoses were recorded. Altogether 814 patients were identified.

Results There was a general upward trend of cases admitted from 1991 to 1995. Young females appear to be the most vulnerable accounting for 60.5% of the study population. The Indian community has significantly higher risk of parasuicide compared to the Chinese and Malays. Overdose of medication was the most common method with paracetamol being implicated in 48.1% of all overdoses.

Conclusion Differences in parasuicide rates amongst the three ethnic communities can be attributed to various socio‐cultural factors. The phenomenon of parasuicide is of increasing importance as it particularly involves adolescents and young adults. Suicide prevention will continue to present a challenge for mental health professionals in the foreseeable future     

Deinstitutionalization of mental hospitals and rates of psychiatric disability: An international study

This study tests several hypotheses regarding the impact of deinstitutionalization of inpatient care on levels of psychiatric disability. It employs a secondary analysis of existing datasets from the World Health Organization's mental health program, the Global Burden of Disease study, as well as supplemental datasets on the national environments examined. The primary model accounts for 87.1% of the variation in global disability levels, but only a quarter or 28.3% of the recent changes in these levels between 1990 and 2015. One of the most important predictors of declines in mental disability is the proportion of a nation's health budget that is invested in mental health services.     

Multicultural education: A black perspective

Much of the behaviour of children within any preschool programme is directed and influenced by their teachers. Studies have indicated that if integrated programming for preschoolers is to be successful then the behaviours and attitudes of the teachers are crucial. In this study student teachers enrolled in a training programme were involved in programme development and implementation. The adult interactions with special needs and nonspecial needs preschoolers enrolled in two programmes were observed. Video tapes of each child were made at four different free play periods in each of two twelve week programme sessions. Questioning was by far the most frequent type of adult‐child interaction. Special needs children were asked many more questions than their nonspecial needs peers. In particular, the most questions asked were closed ones, requiring a yes/no or one word response. Questioning appeared to be used as a way to elicit speech from special needs children. Adults provided more explanations to nonspecial needs children, they responded to the children more frequently and engaged in more conversational interaction and maintenance functions. With special needs children, adults directed and ordered them. Training programmes could help adults to overcome acting in a stereotyped way toward special needs children.