Deinstitutionalization Of Mental Health Services Research Articles

Mental health supported accommodation services in a post-deinstitutionalised era

The movement towards deinstitutionalisation of mental health services has created a space for new and community-based solutions in western countries, but the field still seems to lack coherent ideological and practical features. This is also evident for issues related to housing. The aim of this article is to examine the characteristics of supportive accommodation services for people with psychiatric disabilities in Sweden, according to the experiences of local service providers. The focus is placed on the services’ organizational setting, main orientation, and conceptual content. This article is based on a multiple case study of ten Swedish municipalities, purposely selected regarding size, location, and demographic features. Data mainly consist of interviews with key informants in the social service organisation. The results indicate the emergence of a new generation of service users with complex needs, who challenge both the organisation and the content of the service offered. Group homes and mobile housing support appeared as pillars in the service supply, but several local and pragmatically oriented solutions were also identified, as well as ambitions to scale down the extent of institutional settings. The guiding idea present at most sites is a strive towards increased autonomy among service users.

WILLINGNESS OF PROFESSIONALS WORKING IN SPECIALIZED HOSPITALS AND SOCIAL SERVICES TO WORK WITH PATIENTS AND CONSUMERS SUFFERING FROM MENTAL ILLNESSES

At the current level of development in psychiatry, in the conditions of deinstitutionalization of mental health services and increased opportunities for control of the symptoms of mental disorders, the problem related to the socialization of patients is becoming more and more relevant. More than 50% of patients with schizophrenia are in a socially active age, which gives rise to the social significance of their rehabilitation.
 International practice shows that all specialists dealing with the rehabilitation of patients with mental disorders need to undergo training, which includes the adoption of special methods and techniques. Their work is complex, long and creative.
 In Bulgaria there are many national strategies that present different programs for long-term care or only analyze the current situation and care needs. There is no clear vision of how exactly in the future and with what means and specialists this process will take place. The development of psychiatric care lags far behind the needs of the population. There is a serious risk that the lack of trained specialists can ruin the good intentions for deinstitutionalization.
 The goal of the present study is to examine the readiness of specialists working in specialized medical institutions and social services to work with patients and users suffering from mental illness.
 A survey method was used among specialists from medical institutions and social services for patients with mental and behavioral disorders.
 Most of the specialists in psychiatric hospitals in Bulgaria feel prepared to work with the mentally ill - 88.9%;
 Almost everyone believes that they need additional training.

The Right to ‘Have a Say’ in the Deinstitutionalisation of Mental Health in Slovenia

In a time when the deinstitutionalisation of mental health services has become a global and European platform and one of the main forms of care provision, a theme such as the transition of care from large institutions down to a more personal community level care might seem outlived, but the fact is that in some European countries the discussion has revolved for almost 35 years around the most basic question concerning the closure of large, asylum‐type mental health institutions. In this article, I provide a historical overview and analysis of deinstitutionalisation processes in the field of mental health in Slovenia from mid‐1980s onwards, interpreted in terms of achievements and gaps in community‐based care and in user participation in these processes. It demonstrates some of the innovative participatory practices and their potential to transform services. A thematic data analysis was used to analyse the data collected from various primary (a focus group) and secondary sources (autobiographies, newspaper articles, round table reports, blogs) that all bear witness to the different periods of deinstitutionalisation and the user perspective in it.

Supporting community-based care and deinstitutionalisation of mental health services in Eastern Europe: good practices from Bosnia and Herzegovina.

In Eastern Europe, the Swiss Agency for Development and Cooperation is supporting various post-communist states in reforming their mental health systems to ensure equal access to high-quality services in community-based settings. The approach and new care models introduced have proven successful in most of these countries, one of which is Bosnia and Herzegovina.

Community treatment orders: Are they useful?

SummaryIn the wake of the deinstitutionalisation of mental health services, community treatment orders (CTOs) have been introduced in around 75 jurisdictions worldwide. They make it a legal requirement for patients to adhere to treatment plans outside of hospital. To date, about 60 CTO outcome studies have been conducted. All studies with a methodology strong enough to infer causality conclude that CTOs do not have the intended effect of preventing relapse and reducing hospital admissions. Despite this, CTOs are still debated, possibly reflecting different attitudes to the role of evidence-based practice in community psychiatry. There are clinical, ethical, legal, economic and professional reasons why the current use of CTOs should be reconsidered.Learning Objectives• Gain an overview of the development and use of CTOs in the UK and internationally• Get up-to-date information about the evidence base for CTO effectiveness and the relative contributions of different levels of evidence• Appreciate the nature of the current controversy around the use of CTOs and become familiar with the factors in the ongoing debate about their future

Assessment of the burden on caregivers of patients with mental disorders in Jeddah, Saudi Arabia

BackgroundMental disorders are considered important public health problems not only to people with mental illness but also their caregivers. As is the case in many countries, the deinstitutionalization of mental health services in Saudi Arabia, has meant that informal caregivers are shouldering responsibilities for which they are not usually prepared; therefore, the current study was aimed at assessment of the burden on caregivers of people with mental illness.MethodsThrough a cross-sectional design, a sample of the caregivers of people with mental illness (n = 377) was selected randomly from a psychiatric hospital in Jeddah. An Arabic version of the Involvement Evaluation Questionnaire (IEQ) was used for collection of data. The data were analyzed on the subscale scores and the 27 items in two ways. First, we used the summed scores for the subscales based on the Likert scale (0–4) for univariate and multivariate statistical analyses, as recommended. We also used parametric statistics (t-tests, one-way ANOVA) because the IEQ subscale scores were fairly normally distributed.ResultsMales constituted more than one-half of the participating caregivers (55%), with a mean age of 36.6, SD = 11.4 years. As reported by the caregivers, most of the patients were males (62.7%) with a mean age of 33.8, SD = 13.7 years and a range of 17–90 years old. The total mean IEQ burden score of the caregivers was 38.4, SD = 17.5. “Tension” was significantly prominent among younger caregivers aged ≤30 years. “Worrying” was significantly higher among caregivers living with their spouse and children and those living in families with relatively fewer members (<6 members). “Urging” was significantly higher among caregivers who are living with the patient in the same household and those who had been in close contact with the patient for 28 days in the four weeks prior to the study (13.4, SD = 6.8) p < 0.05. Meanwhile, “Urging” was also significantly higher among caregivers caring for mentally ill females (13.5, SD = 6.6) and those not receiving any kind of professional support (12.8, SD = 6.7). The overall burden and the subscale scores were highest among caregivers caring for a close relative such as a parent (44.1, SD = 17.6), son/daughter (39.1, SD = 12.9), sibling (37.1, SD = 18.6), or spouse (37.1, SD = 18.6) p < 0.05.ConclusionCare for people with mental illness is burdensome for their caregivers, the magnitude of burden is potentially augmented by factors related to the patients and households. These factors should be considered when planning for preparing caregivers to cope with people with mental illness in Saudi Arabia.

‘The government is the cause of the disease and we are stuck with the symptoms’: deinstitutionalisation, mental health advocacy and police shootings in 1990s Victoria

The deinstitutionalization of mental health services in Australia happened first and most rapidly in the state of Victoria. In the final decades of the 20th Century, a period of immense economic and social policy reform accelerated this shift. Policy change appeared to be guided, at least in part, by ideals of human rights and citizenship. However, these same principles could be undermined in the vacuum of services created by deinstitutionalization and the broader restructuring of the welfare state. One expression of this paradox was a reported increase in violent encounters between police and those in states of distress and mental crises. Another example of paradox was rights-based mental health law, which both increased procedural safeguards for involuntary psychiatric intervention but also perpetuated differential treatment of persons with psychosocial disability on the basis of unfounded beliefs. This article will examine the intersections of policing and mental health policy in order to examine how boundaries of normality and disablement were contested during a transitional period of mental health law and policy.

An overview of the mental health system in Gaza: an assessment using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS).

BackgroundMental health system reform is urgently needed in Gaza to respond to increasing mental health consequences of conflict. Evidence from mental health systems research is needed to inform decision-making. We aimed to provide new knowledge on current mental health policy and legislation, and services and resource use, in Gaza to identify quality gaps and areas for urgent intervention.MethodsAs part of a mixed methods study, we used the World Health Organization’s Assessment Instrument for Mental Health Systems Version 2·2 to collect data on mental health services and resources. Data collection was carried out in 2011, based on the year 2010.ResultsGaza’s mental health policy suggests some positive steps toward reform such as supporting deinstitutionalisation of mental health services. The decrease in the number of beds in the psychiatric hospital and the progressive transition of mental healthcare toward more community based care are indicative of deinstitutionalisation. However, mental health legislation in support of deinstitutionalisation in Gaza is lacking. The integration of mental health into primary healthcare and general hospitals has not been fully achieved. Mental health in Gaza is underfunded, human rights protection of service users is absent, and human resources, service user advocacy, and mental health training are limited.ConclusionPriority needs to be given to human rights protection, mental health training, and investment in human and organisational resources. Legislation is needed to support policy and plan development. The ongoing political conflict and expected increase in need for mental health services demonstrates an urgent response is necessary.

Mental health professionals' views of the parents of patients with psychotic disorders: a participant observation study.

As a consequence of the deinstitutionalisation of mental health services, family members have become an important part of the care system. However, little is known about mental health professionals' perceptions of these family members. The aim of this study was to explore professionals' views of one particular group, the parents of patients with psychotic disorders. Because sensitive issues such as professionals' perceptions of parents can be difficult to capture via interviews or self-report instruments, we conducted participant observation of 20 multi-professional team meetings. The observations were carried out during 2011 at a psychiatric care unit specialised in working with patients with psychosis. Approximately 10 inpatients and outpatients were discussed in each team meeting. All conversations about the patients' parents were documented with field notes that were later analysed using inductive thematic analysis. Through the analysis, a complex and multi-faceted image emerged of parents as seen by mental health professionals. Some parents were described as a helpful resource, but others were thought to hinder treatment. Conflicts between staff members and parents were commonly due to their differing views on the treatment, particularly the medical treatment, of the patient. Other parents were described as causing the patient emotional pain and some parents were perceived as neglectful or abusive. These findings highlight the crucial role mental health professionals play in identifying families' particular needs and capacities to provide interventions that effectively address each specific situation. Professionals should also recognise families with adverse experiences and help parents fulfil their potential to become resources for their children with psychosis.

The effectiveness of an anti-stigma intervention in a basic police officer training programme: a controlled study

BackgroundStigma and discrimination are still prominent features of the life situation of persons with mental illness, adding to the burden of the illness, causing a lowered self-esteem, quality of life and affecting possibilities of adequate housing and work. It is also a major barrier to help seeking. The deinstitutionalization of mental health services has led to a significant increase in contacts between the police and persons with mental illness. It has been argued that police officers should be provided education and training to enable them to interact adaptively and with good outcomes with people with mental illness. The present study is investigating the effectiveness of an anti-stigma intervention in a basic police officer training programme at a university in Sweden.MethodsThe study was performed as a controlled pre-post intervention study using a comparison group, and a 6-month follow-up of the intervention group. Attitudes, mental health literacy and intentional behaviour were assessed. Main analyses were made on an intention to treat basis using repeated measures ANOVA. A total of 120 participants at a basic police officer training programme were included.ResultsTime by group analyses showed improvements in the intervention group in overall score of attitudes and regarding the subscale Open minded and pro integration, in intentional behaviour (willingness to work with) and in 4 out of 6 items assessing mental health literacy. At the 6-month follow-up the intervention group had, as compared to baseline, improved attitudes in both overall score and in two of the subscales. Intentional behaviour had also improved in terms of an increased willingness to live or work with a person with mental health problems. Mental health literacy had improved in 3 out of 6 items.ConclusionsThe anti-stigma intervention proved to be effective in changing attitudes, mental health literacy and intentional behaviour. Improvements mainly endured at the 6-month follow-up. The intervention seems promising in facilitating encounters between the police and persons with mental illness. Further studies are needed to disentangle the relative effectiveness of the components of the intervention before further implementation.

The role ofUbuntuin families living with mental illness in the community

AbstractBackground: Families living with mental illness are a vulnerable group in the community. In the African culture, it is accepted that families are embedded safely in a community. In accordance with the principles of Ubuntu, people with mental illness should be well supported and cared for by their families and the wider community. Traditionally, people with mental illness are institutionalised, out of sight of the family and the general population. However, the deinstitutionalisation of mental health services has changed the structure and mode of caring for people with mental illness. The family and community are now regarded as the dominant care givers and providers.Method: A qualitative grounded theory method was used.Results: This article discusses research in progress that demonstrates how families in the community experienced stigma and isolation in the community, as well as crime. There was little support from the community in assisting families to shoulder their burden of care. In this artic...

The Impact of the Process of Deinstitutionalization of Mental Health Services in Canada: An Increase in Accessing of Health Professionals for Mental Health Concerns

This research evaluates accessing of community-based mental health services in relation to the ongoing process of deinstitutionalization of mental health services in Canada. From 1998/1999 to 2002/2003, the process of deinstitutionalization decreased in intensity among the provinces that implemented deinstitutionalization earlier and increased in intensity among the provinces that implemented deinstitutionalization later. By 2002/2003, average days of care per 1,000 population in psychiatric units in general hospitals exceeded days of care in psychiatric hospitals (transinstitutionalization). Accessing of community-based mental health services by individuals with higher levels of psychological distress increased in all provinces from 1998/1999 to 2002/2003.

The economic consequences of deinstitutionalisation of mental health services: lessons from a systematic review of European experience.

Many European mental health systems are undergoing change as community-centred care replaces large-scale institutions. We review empirical evidence from three countries (UK, Germany, Italy) that have made good progress with this rebalancing of care. We focus particularly on the economic consequences of deinstitutionalisation. A systematic literature review was conducted using a broad search strategy in accordance with established guidelines. We searched the International Bibliography of the Social Sciences, Health Management Information Consortium, British Nursing Index and PUBMED/Medline to 2008. The on-line search was supplemented by advice and assistance from contacts with government departments, European Commission, professional networks and known local experts. Community-based models of care are not inherently more costly than institutions, once account is taken of individuals' needs and the quality of care. New community-based care arrangements could be more expensive than long-stay hospital care but may still be seen as more cost-effective because, when properly set up and managed, they deliver better outcomes. Understanding the economic consequences of deinstitutionalisation is fundamental to success. Local stakeholders and budget controllers need to be aware of the underlying policy and operational plan. Joint planning and commissioning or devolving certain powers and responsibilities to care managers may aid development of effective and cost-effective care. People's needs, preferences and circumstances vary, and so their service requirements and support costs also vary, opening up the possibility for purposive targeting of services on needs to improve the ability of a care system to improve well-being from constrained resources. As the institutional/community balance shifts, strategic planning should also ensure that the new care arrangements address the specific contexts of different patient groups. Decision-makers have to plan a dynamic community-based system to match the needs of people moving from institutions, and must take the long view.

Crossing the line: should the threshold for admission of mentally disordered offenders be lowered?

Despite repeated support from central government, the policy of diversion from custody remains at best a partial success. One reason for this may be the conflict between this policy and the move towards community-based mental health services. This paper explores the criteria that might be applied when deciding whether or not to admit a mentally disordered offender to hospital, and the differences between these and the criteria which might apply in a community setting. The authors conclude that there are compelling reasons why the threshold for admission of offender patients should be different from that for non-offender patients, and that the principle of deinstitutionalisation of mental health services should be modified when applied to forensic populations.

The Impact of Deinstitutionalizing Psychiatric Services on the Accessing of Mental Health Services by People with Higher Levels of Psychological Distress

Even though the policy of deinstitutionalization of mental health services purports to improve access to community-based services, there is a paucity of research that evaluates the impact of this policy on the general community. The research in this study builds on an empirical analysis of 40 years of the process of deinstitutionalization of mental health services in Canada (Sealy &amp; 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 improving the accessing of mental health services by people with increased levels of psychological distress, while taking into consideration various social correlates. Data about the accessing of mental health services were obtained in the National Population Health Survey (Statistics Canada, 1996, 2001). Results identify that provinces that implemented deinstitutionalization earlier show improved access of community mental health services and fewer social inequalities of access. Nevertheless, the majority of people who have higher levels of psychological distress have not accessed mental health services.

Multi-presenter mental health patients in emergency departments--a review of models of care.

Only a small proportion of the treatment of mental illness occurs in an institution or hospital. By far the most significant treatment happens in the community and in the patient's own social and family environment. However, de-institutionalisation of mental health services has brought increasing numbers of patients to the emergency department in need of psychiatric assistance. The traditional service model of emergency departments, focusing on physical illness and injury, is being challenged. The literature review identified numerous psychiatric service models in place but dramatically highlighted the lack of a specific service model addressing psychiatric patients who present on multiple occasions [multi-presenters] in emergency departments. At present, accurate data on the effects of multi-presentation of psychiatric disorders are not available. Recent international and local research into models of service delivery management and best practice is examined.

Commentary: deinstitutionalization of mental health services in South Australia--out of the frying pan, into the fire?

Community Health StudiesVolume 9, Issue 1 p. 62-68 Free to Read COMMENTARY: DEINSTITUTIONALIZATION OF MENTAL HEALTH SERVICES IN SOUTH AUSTRALIA — OUT OF THE FRYING PAN, INTO THE FIRE? Dianne Jones, Dianne Jones St. Corantyn, East Terrace, AdelaideSearch for more papers by this author Dianne Jones, Dianne Jones St. Corantyn, East Terrace, AdelaideSearch for more papers by this author First published: February 1985 https://doi.org/10.1111/j.1753-6405.1985.tb00542.xCitations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume9, Issue1February 1985Pages 62-68 RelatedInformation

Labeling theory and community care of the mentally ill in California: the relationship of social theory and ideology to public policy.

The practical merit of a labeling theory approach to mental illness is examined and assessed through an exploration of its application in terms of public policy, i.e., community mental health policy in the state of California since 1968. Primary focus is placed on the impact of the deinstitutionalization of mental health services in that state, and the release of former mental patients into the community. Similarities in the fundamental ideological underpinnings of labeling theory, an associated conspiratorial model of mental illness, and contemporary California mental health policy, are presented and examples of policy input by labeling theorists and researchers are detailed. The impact of the California policy on the mentally ill is generally negatively assessed in terms of three major criteria: (1) rehabilitation; (2) reintegration; and (3) quality and continuity of care. The "translation" of several theoretical misconceptions regarding mental illness, caused by putting labeling theory into official policy, is suggested to lie at the root of many of the policy's implementation problems. The uses of social science theory and research are discussed, and caution is advised in the translation and application of social scientific theory and research to public policy proposals and programs.

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.