Deinstitutionalization and psychosocial rehabilitation

Abstract

IntroductionBarbacena is a Brazilian city with 140,000 inhabitants, which was known as the “city of madmen” because of the excessive number of patients in psychiatric hospitals. In 2000 it began a deinstitutionalization process, and the patients were transferred to assisted residential services.ObjectiveDescribe the process of deinstitutionalization and social rehabilitation of psychiatric patients.MethodologyThe following characteristics were studied: sex, age, medication use, psychiatric diagnosis and the development of social skills.ResultsIn each therapeutic residence (RT) lives eight patients, supervised by upper and mid-level professionals. Since the implementation of RTs about 400 patients leave the psychiatric hospitals. Most had mental retardation (51.0%), followed by schizophrenia (31.0%). More than half (58.5%) were men. The age ranged from 29 to 97 years, with a average of 64.8 ± 12.4. A decrease in the average dose of neuroleptics was seen after deinstitutionalization. Direct observation of patients in the RT, and the reporting of caregivers has shown that patients have developed wide range of social performance, such as dating, started at professional courses, attending exercise classes, travelling and learn how to use money.ConclusionIn despite of difficulties in the psychiatric reform process, the community-based treatment and psychosocial rehabilitation approach are the principal models of psychiatric care presently, and the residential services play an important role in this process. The authors emphasize the importance of community support, professional staff and rehabilitation programs as a condition for good outcomes.Disclosure of interestThe authors have not supplied their declaration of competing interest.