Deinstitutionalization Research Articles

An ‘Academic Workplace’ on Deinstitutionalization. Partnering practice, policy, and academia to radicalise De-Institutionalization and inclusion as a socio-spatial and cross-policy issue.

De-institutionalization (DI) is framed and recognized internationally as a lever for the realisation of inclusion for citizens with disabilities. In international research, policy and practice, DI is predominantly framed as the dismantling of institutional care to pursue inclusive living, housing, and working in the community. We can hereby, among others, refer to the checklist recently developed by the European Expert Group on the Transition from Institutional to Community-based Care (2019) or the Guidelines on Deinstitutionalization as described by the UN Committee on the Rights of Persons with Disabilities (2022). The renewed emphasis on DI is also promoted in Flanders (the Dutch-speaking region of Belgium), which has a very slow response to DI compared to a.o. the Nordic countries. 
 Although DI is widely promoted, there is no consensus as to how to conceptualise and address DI. Quite recently, sharp critiques are formulated as ambiguities and complexities can be seen both in th goals and implementation process 
 (https://www.ohchr.org/sites/default/files/documents/hrbodies/crpd/cfi-deinstitutionalization/submissions/2022-07-06/Academic_W_Ghent_Uni-06-07-2022.docx). 
 Research shows that persons with disabilities who are physically integrated in the community do not necessarily have the experience of belonging in society; that repressive institutional cultures continue to come into play when people with disabilities live in the community; that there is a risk of not having access to (specialised) care and support; and that they risk lacking social and financial benefits or meaningful interactions and relationships in society. This phenomenon is referred to in international research as 'institutionalisation at home', 'community institutions', ‘extitutions’ or 'asylums without walls'. DI thus refers not only to the location and nature of the architectural and spatial embedding, but also to an institutional culture/professionalism and autonomy.
 Therefore, there is an urgency in Flanders to support innovation in policy and practice and to gather knowledge on conceptions and strategies of DI. In that spirit, the Flemish Agency for People with Disabilities provided funds to establish the Academic Workplace De-Institutionalization (AWDI) at Ghent University. In this lecture we provide an insight in this unique collaboration between practice, policy and academia to tackle the challenges mentioned before, to inspire policy and generate new insights with regard to DI. In the coming years, the AWDI is committed to connecting the experiential knowledge of people with disabilities, their networks, professionals, policymakers but also architects and urban planners to stimulate innovation in the field and policy and create qualitative living environments. The AWDI will do so by conducting a variety of action research projects, setting up learning networks in which all relevant voices are involved and building up and disseminating knowledge. Thus, this lecture refers to the central theme “Engaging everybody: caring neighbourhoods and compassionate communities” “but it also tackles the topics described under "Change management implementation: macro, meso and micro level”. 

Deinstitutionalization of children in residential care facilities: Experiences and perceptions of professionals in Ghana

AbstractAccording to the literature, the success of deinstitutionalization (DI) practices in low‐ and middle‐income countries (LMICs) is dependent on key factors including, a well‐functioning family‐based alternative care and social protection system, adequate funding and resources, and professional and other stakeholders' engagement and support. Following a practice research qualitative method, the study explored practitioner's experiences and perceptions on the status of Ghana's ongoing DI efforts and their recommendations for improving implementation. The study's main themes were establishing the need for residential homes for children (RHCs), RHCs not being an ideal family environment and RHCs as respite. Family marital problems, poor financial situation, stigma attached to some children in care, abusive parents and a lack of suitable alternatives when families have a crisis were identified as key factors that impede DI implementation in Ghana. The findings suggest the need for a progressive approach towards DI implementation in LMICs, with the first step being the re‐positioning of RHCs as respite care centres while progressively developing other alternative family‐based care options (such as kinship care) for children.

Вплив новітніх концепцій державного управління в країнах ЄС на розвиток системи соціальної роботи

Розглянуто досвід та інноваційні методи управління і стандартні процедури вдержавному управлінні країн Європейського Союзу та їх вплив на ефективність надання соціальних послуг. Зроблено аналіз розповсюдження неоліберальних політичних переконань та принципів нового державного управління (далі – NPM) у європейських країнах із початку 80-х рр. ХХ ст. і до сьогодні, що суттєво вплинуло на існуючу систему соціальної роботи. Виокремлено дієві інструменти: інформатизація, дебюрократизація, децентралізація, деінституціалізація, деконцентрація (аутсорсинг), приватизація та запровадження економічних механізмів регулювання управлінських процесів і сервісне адміністрування, які можна впровадити у реформування державного управління системою соціальної роботи в українському суспільстві.

Deinstitutionalization and the Constitution

Deinstitutionalization and the Constitution

EU mental health governance and citizen participation: a global governmentality perspective

Over the last three decades, a system of European Union mental health governance (EUMHG) emerged, via instruments including strategies for action, joint actions, pacts and high-level expert groups. It sponsored multiple projects, initiatives and research, and involved state, non-state and European institutional actors. This paper attempts to understand how EUMHG operated and the structure of political relations within it, attending especially to opportunities for citizen participation. It adopts a global governmentality approach that focuses on practices and discourses. It finds that EUMHG practices including benchmarks, best practices and risk-thinking reinforced larger EU policy goals of market-optimisation, and that the central discourses of de-institutionalisation (DI) and community mental health (CMH) shifted meaning over time, first apprehending mental health as a public-health goal, then targeting mental ill-health as a burden to states. Finally, it finds that non-governmental organisations' (NGOs) work within EUMHG rendered them both objects and subjects of government. Through these dynamics, citizens usually were positioned outside governance, and NGO identities were altered, though CMH's transformative potential remained. Citizen participation in EUMHG was heavily conditioned. NGO and citizen power will need vigilant protection in any future EUMHG.

The Deinstitutionalization of Teacher Promotion System : Focused on the Changes in Teachers’ Perception on the Promotion System

The Deinstitutionalization of Teacher Promotion System : Focused on the Changes in Teachers’ Perception on the Promotion System

Global deinstitutionalisation policy in the post-Soviet space: A comparison of child-welfare reforms in Russia and Kazakhstan

This article compares how the global policy of deinstitutionalisation (DI) of child welfare travelled, was translated and institutionalised in two post-Soviet countries – Russia and Kazakhstan. These countries share a Soviet legacy of child-welfare systems dominated by residential care and have recently introduced similar DI reforms based on the global child rights framework. However, despite similar institutional legacies and post-Soviet conditions, the DI reforms have produced different outcomes in terms of the scope and pace of the institutionalisation of DI policy. In Russia, the DI of child welfare has been a fast-moving and sweeping reform, while in Kazakhstan, the implementation of DI has been an incremental and gradual process. We argue that the institutionalisation of the DI policy in two post-Soviet contexts was an outcome of the interplay between structural factors and the agency of policy actors who translated global DI ideology into domestic policy discourses. Yet, they were ‘sold’ with quite different discursive frames – one nationalist, another one trans-nationalist – in these two countries. We claim that the geopolitical position of a country is also a significant factor for framing and thus, in the end, in how child-welfare systems have been reformed.

장애인 탈시설화 정책의 주요 쟁점과 과제 : 서울시를 중심으로

본 연구의 목적은 최근 이슈가 되고 있는 장애인 거주시설 탈시설화 정책의 주요 경과 및 쟁점 분석을 통해 향후 장애인 거주시설 탈시설화 정책 실현을 위한 개선방안을 제안하는 것이다. 연구방법으로는 Gilbert와 Terrell(2005)의 사회복지정책분석 방법 중 과정분석방법을 사용하여 장애인 탈시설화 정책 이슈의 개념과 배경에 대해 살펴보고, 서울시 장애인 거주시설 탈시설화 정책과 관련된 주요 쟁점을 중심으로 거시적인 흐름과 개선방안을 탐색하고자 하였다. 연구 결과, 시설중심의 탈시설화 지원 정책의 문제, 탈시설 후 지역사회 정착 위한 인력 및 지원서비스 부족 등이 문제점으로 나타났다. 이에 따른 제언으로는 첫째, 탈시설 정책의 방향은 ‘시설에서 지역사회로의 자립을 지향’해야 한다는 점, 둘째, 탈시설-개인별 지원체계 구축을 위한 탈시설지원센터 설치가 필요한 점, 셋째, 탈시설 장애인의 주거선택권 보장 위한 다양한 주거서비스 확보, 넷째, 탈시설 장애인에 대한 활동지원서비스 확대 다섯째, 탈시설 후 주간활동 지원을 위한 서비스 확대, 끝으로 가족 등 비공식 돌봄 제공자에 대한 지원 등이 필요한 것으로 나타났다.

Управління сферою запобігання соціальному сирітству в Україні у контексті впровадження принципів деінституціалізації

Розглянуто питання запобігання соціальному сирітству, розвиток нових та реформування існуючих соціальних послуг для дітей та сімей із дітьми, що стали привертати значну увагу в наукових колах та різноманітних структурах усіх рівнів, які працюють із дітьми. Зазначено, що підвищення якості життя дітей є не лише питанням часу, а його велінням. Проаналізовано прогресивні світові процеси стосовно захисту прав дітей, зумовлені Конвенцією ООН “Про права дитини”, які стимулюють суттєві зміни в законах, політиці та практиці підтримки та захисту дитинства. Зауважено, що такі цілеспрямовані дії суттєво поширюються в багатьох державах світу. Доведено, що на сьогодні Україна робить перші кроки у напрямку деінституціалізації та створення власної моделі формування соціальних послуг, яка стане основою запобігання соціальному сирітству серед дітей. Проаналізовано існуючу модель управління сферою захисту прав дітей у контексті запобігання соціальному сирітству та впровадження принципів ДІ-реформи.

The Role of Affordances in the Deinstitutionalization of a Dysfunctional Health Management Information System in Kenya: An Identity Work Perspective

Improving the state of citizens’ health is an urgent priority in many low and middle income countries (LMICs), and health management information systems (HMIS) are widely seen as valuable tools for pursuing this priority. Yet, the potential of HMIS has been difficult to materialize in the LMIC context since routines and practices that work against effective use of HMIS are often deeply embedded in historical institutions and, consequently, are difficult to change. Using a longitudinal case study of HMIS in Kenya, we investigate the crucial role of identity work as a mechanism that links information technology (IT) affordances to institutions. In particular, our study revealed four types of identity work (disruptive, legitimizing, reinforcing, and transformative) that, through different affordances, led to distinct institutional consequences in terms of either maintaining or deinstitutionalizing existing dysfunctional HMIS-related routines and practices. We demonstrate the importance of context for theorizing the societal and development impact of IT and the role of IT materiality in influencing deinstitutionalization.

THE NEW ITALIAN RESIDENTIAL FORENSIC PSYCHIATRIC SYSTEM (REMS). A ONE-YEAR POPULATION STUDY

The process of deinstitutionalization of the Italian forensic psychiatric system consisted mainly of the replacement of forensic psychiatrichospitals with the Residences for the Execution of Security Measures (REMS), and with community treatment of forensic psychiatricpatients. The 30 existing REMS are regional-based community residential facilities with no more than 20 patients each, designed to accomplisha preeminent therapeutic/rehabilitative purpose, with limited duration of treatment and the absence of police officers. Thepresent study aims to describe the clinical, criminological, and treatment characteristics of the REMS patient population between June2017 and June 2018. The health managers of the 28 participating REMS provided data through an ad-hoc form relating to N = 730patients (80 females), with average age of 41.7 (SD 11.8) years with a mean long history of disease. The patients were mostly already inpsychiatric care at crime time (82.2%), and 48.4% had previous criminal convictions. Most patients suffered from schizophrenia (33.0%),personality disorder (32.0%) and substance-related and addictive disorders (21.4%). Significant psychiatric comorbidity emerged. Thecrimes underlying the measure were homicide/attempted homicide (26%), personal injury/threats/harassment (24%), domestic violence(29%), property crime (12%), violence against a public official (7%), stalking (7%), sexual crimes (4%), and misdemeanors (1%). Most ofthe victims were family members (45%), followed by previously unknown persons (31%). The most frequently used therapeutic approachwas pharmacotherapy (98%), followed by psychiatric rehabilitation (81%) and psychotherapy (57%). We found a significant degree of variabilityof aggressive behavior in the REMS as measured by the Modified Overt Aggression Scale, with a predominance of verbal andphysical aggression, but no gender differences emerged. Among recorded critical events we found absconding (5.3%), involuntary admissionto civil hospital (5.9%) and physical restraint (4.1%). The REMS-based Italian forensic psychiatric system has some criticalities that shouldbe deepened and addressed in order to preserve aspects of the protection of patients and the community.

The assistance model in mental health in Brazil: an integrating review

The process of psychiatric reform in Brazil gave way to a crisis of the current assistance model, centered only on the psychiatric hospital, which had a hygienist objective more than care and health promotion. Soon, to change the standard of care for the mentally ill, a struggle was necessary. The present study aimed to make a brief analysis of the care model in mental health in Brazil. The methodology used is an integrative bibliographical review, where 14 articles were selected through the descriptors: Mental Health, Health Care, History of Public Health, between 1997 and 2014 and having as a guiding question: What is the trajectory of the care models mental health? The studies were compared and grouped by content similarity, in the form of empirical categories, and three categories were constructed for analysis, considering the trajectory of models of mental health care in Brazil, as specified: Manicomial Model, Psychiatric Reform and Model of Assistance in Brazil. The manicomial model was the only way of treating the Psychiatric Hospitals and Hospitals. The Psychiatric Reform presents itself in a second moment seeking to reduce the number of psychiatric hospitals and increase the Psychosocial Care Centers (CAPS) to attend the population that manifests some psychic suffering, and finally, the current model that advocates the de-institutionalization in which the CAPS are the reference for mental health care. We conclude that the model of assistance to individuals with mental disorders has evolved significantly and positively in Brazil, abandoning the exclusion model to give place to rehabilitation and integration in society of individuals affected by mental disorders.

Ethnography, Neighborhood Effects, and the Rising Heterogeneity of Poor Neighborhoods across Cities

In the 1980s and 1990s, researchers came to understand poor urban neighborhoods as blighted, depopulated areas, based on important ethnographic observations in a handful of cities. This image helped inform influential theories of social isolation and de–institutionalization. However, few scholars have examined whether those observations were representative of poor neighborhoods nationwide—and whether they are representative today. Based on a descriptive analysis of the largest 100 U.S. metropolitan areas using normalized census tract boundaries, we document an important transformation in the conditions of poor neighborhoods. We find that the depopulation in poor neighborhoods often reported in cities such as Chicago and Baltimore was, in fact, typical across cities in 1990. Today, it is not. Moreover, heterogeneity across cities has increased: The experience of neighborhood poverty is likely to depend more today than in 1990 on the city in question. In fact, the most typically studied cities, such as Chicago, Baltimore, Philadelphia, and Milwaukee, are increasingly atypical in this respect. Addressing today's core questions about neighborhood effects, how and why they matter, requires paying far greater attention to heterogeneity, conducting more ethnographic observation in ostensibly unconventional cities, and addressing the historically extreme conditions in a newly unique subset of cities.

Party System Deinstitutionalization: The 1997–98 Colombian Elections in Historical Perspective

Taking the 1997-98 electoral season as its case study, this article seeks to determine whether Colombia’s party system is undergoing deinstitutionalization. The resilience of the Liberal Party and the lack of an organized alternative to the traditional parties may mean that Colombia is in the process of party system transformation.

Abuso de las medidas y medidas abusivas. Crítica al pensamiento bibliométrico hegemónico

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Rediseñando el sistema de protección a la infancia en Chile. Entender el problema para proponer modelos de cuidado alternativos y ayudar a la reunificación familiar

Chile ha intentado avanzar hacia la desinstitucionalizacion de la primera infancia, pero la falta de alternativas validadas hace que los centros residenciales sigan siendo la principal solucion para estos menores separados de sus padres debido a situaciones de abuso o negligencia. El objetivo de este analisis de politica es abordar el problema de la internacion con una propuesta de tres niveles: elaborar una mejor comprension de los problemas para disenar soluciones adaptadas a cada situacion, crear modelos de cuidado alternativos como solucion

Economical and social return of psychosocial rehabilitation model based in needs. The SROI project

Introduction Psychosocial Rehabilitation has demonstrated to be a key factor in the process of deinstitutionalisation, recovery and social inclusion of people affected by a Severe Mental Disorder. Nevertheless, there are few studies about social and economical return of this rehabilitation. The Fundacion Agustin Serrate is a Non-Governmental Organization (NGO), which has been working, since 1995, with psychosocial rehabilitation in Huesca, a small province in the north of Spain. Objective The aim of this study is to determine and recognize the return and the impact that a rehabilitation and intervention model has in people with a severe mental disorder, on their families and on society. Methods Three services in its model of rehabilitation: day care centre, integration work centre and supervised houses. The SROI (Social Return Of Investment) methodology is a tool to make decisions based on the optimization of the social and work impacts of social projects. The study was done by meetings, workshops, interviews and questionnaires with all groups of interest (patients, families, psychiatrist…) Results A total of 208 users were attended in different services (65% men and 35% women). The age average was 45.8years. Sixty-eight percent of people had a diagnosis of schizophrenia and schizoaffective disorder. For each euro of investment, the organization returned to society 3.15euros (social return and economic). The users and their families improved their quality of life (individual and familiar). Conclusions The principal conclusion is that Psychosocial Rehabilitation is financially profitable for the society and governments; and it is useful for improving the quality of life of patients and their families.

Efforts to accelerate deinstitutionalization of the public health center in a revised Law related to Mental Health and Welfare of the Persons with Mental Disorders.

Efforts to accelerate deinstitutionalization of the public health center in a revised Law related to Mental Health and Welfare of the Persons with Mental Disorders.

The process and inspiration of deinstitutionalization of mental health institutions of USA and other countries

During past 50 years,has achieved a great progress and derived some profound lessons worthy of learning and studying for our country.This article introduces the deinstitutionalization processes of mental health institutions,reinstitutionalization and the inspiration for Chinese mental health reform.Introduced the paper are the reform of deinstitutionalization of mental health institutions in USA and some other countries,and the concept of such a reform,pointing out inspirations of such a reform for mental health reform in China. Key words: Mental health; Deinstitutionalization; Reinstitutionalization; Reform

Deinstitutionalization: a challenge for the Mental Health policy in Campos dos Goytacazes, RJ

O processo de Reforma Psiquiátrica brasileira, ainda em trânsito, é considerado um grande avanço no contexto da política de saúde mental por questionar e elaborar propostas visando à ruptura com o modelo clássico de tratamento, pautado no saber da psiquiatria e asilamento. Sob a perspectiva de desinstitucionalização, tais propostas são voltadas para a criação de uma rede de serviços, de base territorial e caráter multiprofissional, substitutivos ao hospital psiquiátrico. Desta forma, este artigo analisa a política de saúde mental em Campos dos Goytacazes a partir das propostas da Reforma Psiquiátrica.