Abstract
Background: The deinstitutionalization process is complex, long-term and many countries fail to achieve progress and consolidation. Informing decision-makers about appropriate strategies and changes in mental health policies can be a key factor for it. This study aimed to develop an evidence brief to summarize the best available evidence to improve care for deinstitutionalized patients with severe mental disorders in the community.Methods: We used the SUPPORT (Supporting Policy Relevant Reviews and Trials) tools to elaborate the evidence brief and to organize a policy dialogue with 24 stakeholders. A systematic search was performed in 10 electronic databases and the methodological quality of systematic reviews (SRs) was assessed by AMSTAR 2.Results: Fifteen SRs were included (comprising 378 studies and 69,736 participants), of varying methodological quality (3 high-quality SRs, 2 moderate-quality SRs, 7 low-quality SRs, 3 critically low SRs). Six strategies were identified: (i). Psychoeducation; (ii). Anti-stigma programs, (iii). Intensive case management; (iv). Community mental health teams; (v). Assisted living; and (vi). Interventions for acute psychiatric episodes. They were associated with improvements on a global status, satisfaction with the service, reduction on relapse, and hospitalization. Challenges to implementation of any of them included: stigma, the shortage of specialized human resources, limited political and budgetary support.Conclusions: These strategies could guide future actions and policymaking to improve mental health outcomes.
Highlights
The deinstitutionalization process is complex, long-term and many countries fail to achieve progress and consolidation
Deinstitutionalization is the procedure of shifting the care and support from long-stay psychiatric hospitals to community mental health services for patients diagnosed with severe mental disorders [1]
Sixty-five studies were selected and examined in detail; fifteen Systematic reviews (SR) met the scope of this evidence brief and were selected to develop the policy strategies, while fifty studies were excluded
Summary
The deinstitutionalization process is complex, long-term and many countries fail to achieve progress and consolidation. This study aimed to develop an evidence brief to summarize the best available evidence to improve care for deinstitutionalized patients with severe mental disorders in the community. Deinstitutionalization is the procedure of shifting the care and support from long-stay psychiatric hospitals to community mental health services for patients diagnosed with severe mental disorders [1]. Improving Care for Deinstitutionalized People services to reduce dependence, isolation and other behaviors that make it difficult for patients to adjust to life outside of care [2]. Many challenges remain in lowand middle-income countries, Eastern Europe, and Eastern and Southeastern Asian countries [5, 6]
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