Deinstitutionalization Policies Research Articles

Why do we need to re-institutionalise social work?

The article contains arguments for the re-institutionalisation of social work in Poland, pointing out the consequences of: (1) including representatives of semi-professionals in social welfare system, (2) overload of public education employees, (3) poor mental health situation of children and adolescents, (4) the COVID pandemic-19 and mass migration from Ukraine for social welfare organisation, (5) implementation of deinstitutionalisation policy and (6) demographic and health changes of Polish society.

A Paradigm Shift on Deinstitutionalization and Dementia Care: A Narrative Review.

This narrative explores the impact of deinstitutionalization policies on the quality of life and care outcomes for individuals with Alzheimer's disease and related dementias. We offer a historical perspective on these policies, their implications on dementia care, and the barriers to deinstitutionalization. The potential benefits of deinstitutionalization, such as improved quality of life and access to community-based support and services, are highlighted. Challenges and controversies surrounding safety, caregiver burden, and resource allocation are also examined. Ethical considerations related to the autonomy and decision-making capacity of people living with dementia are discussed. We present best practices and innovative models in dementia care that balance deinstitutionalization with appropriate care. We further put forth recommendations for future research and policy development in dementia care and deinstitutionalization, emphasizing the need for a balanced approach that respects the autonomy and preferences of people living with dementia while ensuring their safety and well-being.

HOW CAN DYING, DEATH, LOSS AND BEREAVEMENT BE INCORPORATED IN THE POLICY AND PRACTICE OF AGING IN PLACE?

Abstract ‘Aging in place’ has been one of the key goals for policymakers in the last 20 years, often translated into policies of deinstitutionalization. Due to the high costs of residential care, the home has re-emerged as a key site for the provision and consumption of care and support. Several critiques of this evolution have been formulated, including the challenges ageing in place might represent for older people, leading to reduced quality of life, and the need to consider low quality of older people’s houses, meaning that older people’s homes might not be the “best” places to age. However, what has received too little attention in the whole “aging in place” discourse is the end-of-life. This symposium addresses this by illustrating that we cannot talk about ageing in place without talking about dying in place. The authors present research on how dying, death, loss and bereavement might be included in the ageing-in-place policy and practice: Doran sets the stage with a critical reflection of ageing in place and the need to reflect on joining up ageing in place and end-of-life theory and practice. Smetcoren reports on the development of a ‘maison de mourance’ in a ‘co-housing and co-caring’ project in Brussels. Dury discusses consolation spaces in Flanders and how they decrease the taboo on death, grief and loss in the neighborhood. And Stegen reports on the caring neighbourhood-movement in Belgium and how some orient themselves to becoming part of a worldwide network of ‘compassionate communities’.

The deinstitutionalization of children and adolescents in El Salvador's child protection system

BackgroundIn 2010, El Salvador introduced legislation aimed at reforming the country's Child Protective System (CPS), with a focus on promoting deinstitutionalization. ObjectiveThe study aim was to explore the impact of deinstitutionalization on the Salvadoran CPS. Participants and settingThe study was conducted in El Salvador, granting authors unique access to key informants with extensive experience in the country's CPS. Unlike the United States, which is divided into states, El Salvador is divided into departments, and CPS providers were recruited from all 14 departments. Focus groups were facilitated in the East, West, and Central zones to ensure representation from all regions. MethodsQualitative semi-structured interviews (n = 26) were conducted in June/July of 2019, which were then followed by focus groups (n = 4) in August 2019. The analysis of the data employed a combination of deductive and inductive thematic coding methods. ResultsCPS providers offered valuable insights, categorized into five main themes: (1) Strengths of El Salvador's CPS, (2) Deinstitutionalization policy encompassing socioenvironmental contextual factors, (3) Challenges in the deinstitutionalization process, including insufficient follow-up on deinstitutionalized children, (4) Recommendations from participants, highlighting the importance of enhancing stakeholder coordination/collaboration, and (5) The necessity for a paradigm shift, emphasizing the need to redefine the social contract on protecting children from child maltreatment. ConclusionsThe Salvadoran CPS requires substantial systemic changes. Encouragingly, key informants have demonstrated a commitment to reform not only the deinstitutionalization process but also the broader CPS system in El Salvador including case management and quality of care in institutional settings.

Depression and the Caregiver Burden for Schizophrenia Patients

Background and objectives: Schizophrenia is a recurring psychiatric condition that severely impairs patients' ability to function in all major spheres of their lives. Since the deinstitutionalization policy, families, especially the primary caregiver who bears a heavy physical and emotional strain, are responsible for providing care. According to estimates, caregivers' rates of depression are higher than those of the general population. The primary caregivers' burden of care, their level of depression, and related caregiver factors were all examined in this crosssectional study. Methods: After gathering socio-demographic and caregiving information, 60 consenting primary caregivers of patients with an ICD-10 diagnosis of schizophrenia were evaluated for burden of care and depression using the Burden Assessment Schedule and the Patient Health Questionnaire–9. Results: A majority of the 35 female and 25 male carers reported experiencing moderate to severe depression, and all had moderate to high levels of burden. More burden was felt by spouses (p=0.0038), older carers (p=0.01), and those with lower educational levels (p=0.01). Depression and caregiving burden had a statistically significant positive connection (p=0.000). Conclusion: Despite the ease with which psychiatric therapies are accessible in one of India's largest metropolitan areas, caregivers continue to experience stress and depression. This may affect not only the caregiver but also the patient's care and the course of the sickness.

Deinstytucjonalizacja w obszarze pomocy społecznej. Uwarunkowania, założenia i ewaluacja polityki w Unii Europejskiej

The article describes the issue of deinstitutionalisation policy in the area of social assistance in the European Union (EU). It presents the genesis, context and evolution of this policy. Based on the analysis of materials available on the official websites of the European Commission (EC), it addresses the issues involved in the assumptions of the deinstitutionalisation policy, its main stakeholders, the place it occupies in EU priorities, implementation instruments and ways of setting the boundaries of deinstitutionalisation in the area of social assistance. It discusses terminological issues, including sociological interpretations of the concept of deinstitutionalisation and the resulting connotations with Erving Goffman’s concept of total institution. It analyses the most important documents related to addressing these issues at the EU level and their implementation. It also contains selected important elements involved in monitoring and evaluating deinstitutionalisation processes in Member States before the coronavirus pandemic, considered from the perspective of common indicators for children, children with disabilities, adults with disabilities, adults with mental health problems and seniors. It presents the main barriers, trends and challenges of deinstitutionalisation processes in the EU.

Long-Term Care Homes: Carceral Spaces in Times of Crisis or Perpetually?

This article explores whether isolation and control observed during COVID-19 are a pandemic effect or a perpetual socio-spatial feature of long-term care (LTC) culture. We use narrative analysis to foreground the experiences of two women with dementia trying to leave LTC: one before and the other during the pandemic. Using the lens of affective citizenship, we argue that the spatial experiences of confinement for people living in LTC are routinely overlooked in popular discourse. We reflect upon how the segregation of older people with dementia in LTC contributes to discriminatory practices beyond these institutions and advocate for a policy of deinstitutionalization.

The Needs of Thai family caregivers and their readiness to provide care for people with psychosis: a qualitative approach

Background: After the implementation of the deinstitutionalization policy, the role of family caregivers has grown in importance and the caring responsibilities have shifted onto their shoulders. This study sought to better understand the Thai family caregivers’ needs for readiness to care for people with psychosis.

ВИКЛИКИ ДЛЯ ДИТЯЧИХ ІНСТИТУЦІЙНИХ ЗАКЛАДІВ В УКРАЇНІ У ПЕРІОД ВІЙНИ

In modern conditions of war, the question of situation for children in the institutions of Ukraine is extremely relevant. First, despite the presence of significant positive results of the deinstitutionalization policy in the form of an increase in the number of children placed in family forms of upbringing over the last decade, a large number of children continue to live in institutions. In addition, due to the war in Ukraine, thousands of children have become orphans or have lost their contact with relatives and have found themselves in difficult life circumstances. War actually destroys children's right to childhood and their usual picture of life, causes irreparable damage to their physical and mental health. The state and the public faced a new task, which is ensuring children’s safety and wellbeing during hostilities. The article examines the experience of the first months of joint work of the state and nonstate sectors in ensuring children’s safety and well-being in institutions. The authors highlight 2 key challenges for children's institutions that have been arising during the war: the need to evacuate many institutions and ensure the functioning of these institutions in wartime conditions. Therefore, the basic scenarios of evacuation of children and changes in the work of institutions for children during the war are considered. Undoubtedly, the issue of evacuating children from combat zones and ensuring proper conditions for living, education, and psychological rehabilitation is a priority for the state. The scenarios for the evacuation of children were quite different, but their success was actually determined by the level of interaction between the local authorities, the management of institutions and representatives of civil society. In general, three main directions of evacuation of children in institutional institutions can be distinguished: evacuation to other regions of Ukraine, evacuation outside Ukraine, return to the family. As for the changes in the work of children's institutional institutions in Ukraine during the war, the following categories of institutions are tentatively distinguished: 1) institutions that were evacuated within the borders of Ukraine or some of the pupils of which were returned to their families, 2) institutions that were evacuated abroad of Ukraine, 3) institutions that were not evacuated and hosted children and staff from evacuated institutions, 4) institutions that were not evacuated and did not accept children from other institutions.

On a long, narrow road: The mental health law in Turkey

This article presents the historical transformation of the mental health system and policies in the case of Turkey and discusses the challenges to their effective implementation. The mental health system in Turkey has undergone a series of reforms in three periods, namely, the institutionalization of psychiatry and hospital-based mental health services in the mid-19th century, the introduction of first-generation community-based mental healthcare services in the 1960s, and the policy of deinstitutionalization after the 1980s. In this transformation process, certain initiatives have been implemented with the participation of interested actors across periods and small but important improvements. A draft has been prepared after a series of studies were conducted with regard to mental health policies and plans. However, no results have been obtained. The necessity of the mental health law has been clear. A notion that has been known is that the mental health law, which offers a holistic perspective, positively influences the functioning of the mental health system in terms of service users and providers. However, whether or not it actually pursues these intended improvements has been subject to doubt. Until now, no mental health law has been effectively implemented in Turkey, and measuring and evaluating in which aspects the law will be successful and where it will fail have been impossible. Turkey continues to be in need of a mental health law is practical and in line with international standards for the rights of patients and supervision against coercive measures.

Burden Of Care and Depression in Caregivers of Patients with Schizophrenia

Background: Schizophrenia, a chronic psychiatric disorder affecting all major domains of a patient’s life, leads to significant disability. Since the deinstitutionalization policy, the onus of care is on families especially the primary caregiver who experiences physical and emotional burden. Depression among caregivers has been estimated to be higher than the general population. This cross-sectional study aimed to assess burden of care and depression in primary caregivers and associated caregiver variables. Methods: 75 consenting primary caregivers of patients with ICD-10 diagnosis of schizophrenia were assessed for burden of care and depression using the Burden Assessment Schedule and the Patient Health Questionnaire - 9 after collecting socio-demographic and caregiving details. Results: All the caregivers, 49 females and 26 males, had moderate to high levels of burden with a majority having moderate to severe levels of depression. Spouses (p=0.0038), older caregivers (p=0.01) and those with lower educational levels (p=0.01) experienced more burden. There was a significant positive correlation between burden of care and depression (p=0.000). Conclusion: In one of India’s largest metropolitan cities, though psychiatric services are easily available, caregivers continue to feel burdened and depressed. This can impact not just the caregiver but also care being provided to the patient and illness outcome.

The woman who chose the terreiro. Lay care and medical landscapes in mental health care in Rio de Janeiro

Brazilian mental health care reform understands mental health as a complex social process. There is a large literature production within the country focused on deinstitutionalization policy, social determinants of mental health and human rights, however, with little recognition beyond Latin American borders. In addition, cultural dimensions of mental suffering have been neglected in Brazilian debates which limits an expanded understanding of health care and users’ inclusion. This paper aims to discuss the role of cultural determinants in mental health care in Brazil. We followed a patient in the city of Rio de Janeiro who opted for therapy based on her religious beliefs—using ayahuasca in the context of the Afro Brazilian religion of Umbanda—over the treatment-as-usual in mental health. We draw on the notions of autoatención (self, domestic, and group-care in lay contexts) and medical landscapes to examine how therapeutic negotiations reflect embodied cultural traits and both social and political determinants shaping therapeutic spaces. We argue that recognizing sociocultural differences and therapeutic negotiations are key elements in making a more inclusive health practice. Moreover, this recognition enables identifying and reasoning the broader social processes framing health practices. This debate is relevant to the Brazilian mental health context and to other scenarios, especially those where local and global knowledge and practices in mental health are entangled.

Psychiatry on a Shoestring: West Africa and the Global Movements of Deinstitutionalization.

The rise of psychiatric deinstitutionalization policies in the formerly colonized world is commonly narrated as a novel and decolonial intervention imparted by Euro-American NGOs of the global mental health era of the past two decades. By contrast, this article uncovers the history of a British imperial push for deinstitutionalization that originated in West Africa in the 1930s-decades prior to the rise of global mental health policies. Colonial austerity measures, combined with British officials' observations of West African ethno-psychiatric healing practices, motivated an empire-wide policy favoring family and community care over institutional treatment for most mentally distressed colonial subjects. Global mental health policies that ideologically sanction state austerity measures for the mentally ill through community care are neither new nor decolonial. They remake colonial-era mandates for public services to operate on shoestring budgets.

Stress among caregivers of schizophrenia – a pilot analysis

Caregivers of patients with schizophrenia experience a lot of stress and emotional strain, and they are frequently required to take care of them for the rest of their lives. Having a relative with mental illness can be stressful for many families.In India, the family is an important source of support for the mentally sick. Despite their incredible fortitude in caring for their relatives, Indian families face a great deal of physical and emotional suffering. The bad feelings and subsequent strain experienced as a result of caring for a chronically ill individual are referred to as caregiver’s burden. The overall response of an organism to external demands or pressure is known as stress. Any incident or occurrence that a person perceives a danger to his or her coping skills or resources can be the source of stress, and coping is a complex process. Ignorance and misconceptions among patient caregivers, deinstitutionalization policies, and a lack of resources all contribute to a high illness burden among caregivers. Many families believe they lack the required coping techniques to assist in the management of their relatives’ mental illness. Serious mental illnesses, such as schizophrenia, have catastrophic consequences for both sufferers and their families. A pilot study was done among 28 careers of schizophrenia to examine the study’s viability and feasibility. This study advocated for a true experimental research design .Conclusion: This pilot study concludes by demonstrating the efficacy of psychosocial therapies on stress in schizophrenia careers.

Policy instrument choice under globalization: Do authoritarian states choose differently?

• New data show policy convergence among 15 ex-Soviet states in childcare deinstitutionalization. • Countries adopted policies as ‘a package’ (goals + instruments), as promoted by international actors. • Authoritarian states adopted the same policy instruments, as non-authoritarian states. • Authoritarian states adopted ‘modern’, non-coercive policy instruments, based on the agentic individual. • World culture and international advocacy appear key to childcare policy instrument choice. Do authoritarian states differ from non-authoritarian ones in their social policy choices? The paper presents new data on childcare deinstitutionalization policies in 15 ex-Soviet countries in Eastern Europe and Central Asia. The data suggest significant convergence among countries in the adoption of both deinstitutionalization policy ‘ends’ and ‘means’, despite drastic differences in political regimes. In particular, I trace the adoption of several instruments, which have been actively promoted by international organizations (e.g., foster care, case management, downsizing of institutions, etc.). The data suggest that authoritarian states in the ex-Soviet region do not differ from non-authoritarian governments in their deinstitutionalization instrument choices, suggesting that political regime is not always a major policy determinant. The results are significant because they show that authoritarian regimes can also select modern, non-coercive instruments for childcare deinstitutionalization, which are underpinned by the idea of agentic actors and the centrality of the individual.

Explaining the Cross-National Pattern of Policy Shift toward Childcare Deinstitutionalization

Why do some countries become early policy adopters and fast policy implementers? We investigate this question through the analysis of cross-national policy shift toward childcare deinstitutionalization, i.e., the transition from institutional to community-based provision for children without parental care. The article presents the newly collected data on the adoption of childcare deinstitutionalization policy by 15 countries – previously republics of the Soviet Union. Qualitative comparative analysis is employed to explore the role of national-level attributes affecting the timing of policy adoption and the rate of implementation. Expectations from political-economy and the institutional world-society perspectives on cross-national patterns of public policy adoption and implementation are incorporated in the hypotheses. Two respective groups of factors are considered: (1) the national economic system and the number of children in institutional care; policy implementation capacity (gross domestic product and government effectiveness); (2) world society ties to international organizations (IOs), conferences and European institutions; and local receptivity to world culture, operationalized as the contraceptive preference for pill. Results suggest that countries’ ties to policy-relevant international organizations are an important condition for earlier policy commitment, which is in line with institutional arguments. The findings point at the need for a more refined conceptualization of cross-national policy patterns for cases where world cultural drivers interplay with political-economic factors.

The turnaround from institutional care to local empowerment: Reply to van IJzendoorn and Bakermans-Kranenburg (2022).

This reply to van IJzendoorn and Bakermans-Kranenburg (2022) debates the relevance of deinstitutionalization policies for children in alternative care. In view of coronavirus disease (COVID-19), climate change, and conflict, the gap between available solutions and numbers of children losing parental care is increasing. This challenge calls for innovative solutions to provide care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Study on the Perception and Countermeasure of the Heads of Residential Facilities for People with Disabilities on Deinstitutionalization Policy as Institutional Environmental Change

A Study on the Perception and Countermeasure of the Heads of Residential Facilities for People with Disabilities on Deinstitutionalization Policy as Institutional Environmental Change

Caring for those who care for dependent older adults: for a necessary and urgent policy.

The situation of caregivers and family caregivers of dependent older adults is presented and discussed, highlighting their dedication, problems, and possible recommendations to value them. The task of caring is known to be eminently feminine, invisible, unpaid, but affects society as a whole. Policies of some European countries, Canada, and the United States in favor of male and female caregivers are described. However, most existing support models have gaps. The laws and regulations enacted have been poorly comprehensive, inorganic, and the family remains responsible for long-lived relatives who have lost their autonomy. In many countries, besides other measures, the tendency is to integrate the family care as the first PHC level, universalizing support to caregivers. One must not be forgotten that the tendency to keep dependent older adults at home is acquiescence to their desire, but it also hides the delegation of responsibility from the State to families through dehospitalization and deinstitutionalization policies. In Brazil, the issue has not yet entered the public policy radar, although it is urgent because of the accelerated increase of the elderly population, particularly those aged 80 and over.

The history of mental health policy in Turkey: tradition, transition and transformation.

This article offers a brief history and the evolution of mental health policy in Turkey. It aims to analyse how mental health policies were transformed and why certain policies were introduced at specific times. The modern history of mental health policy is divided into three periods: the institutionalization of psychiatry and hospital-based mental health services; the introduction of community-based mental healthcare services; and lastly, the policy of deinstitutionalization after the 1980s. These periods have been categorized in a way that basically coincides with Turkey's modern political history.