Did you mean: deinstitutionalized
-
Journal of Medical Internet Research Dec 2021Care policies emphasize deinstitutionalization and aging in place in response to demographic changes. Different eHealth technologies are one way to achieve this aim.... (Review)
Review
BACKGROUND
Care policies emphasize deinstitutionalization and aging in place in response to demographic changes. Different eHealth technologies are one way to achieve this aim. However, there is a need to better understand older adults' needs for eHealth services, and thus, these health solutions require further exploration.
OBJECTIVE
The purpose of this systematic literature review is to appraise, synthesize, and summarize the literature on older adults' (aged ≥60 years) eHealth learning and use in real home settings, particularly in rural and remote areas, with a focus on the social and cultural context.
METHODS
A systematic search was conducted in January 2020 using 4 academic databases. The studies by means of qualitative thematic analysis to identify the barriers, enablers, and support practices involved in the domestication process were examined. In addition, we identified the various meanings attached to eHealth technologies for older adults living in rural and remote areas.
RESULTS
In total, 31 empirical studies published between 2010 and 2020 were included in this review. A total of 17 articles included participants from rural and remote areas. The most regularly reported barriers related to older adults' learning to use and use of eHealth were health-related difficulties, such as cognitive impairment or impaired hearing. The most reported enabler was the support provided for older adults in learning and use of eHealth. Support mainly comprised older adults' own digital competences, which were distributed with their social network. It was found that eHealth technology is needed for rural and remote areas to facilitate access and reduce logistical barriers to health care services.
CONCLUSIONS
The literature review provided information and practical implications for designers, health care providers, and policy makers. On the basis of these findings, eHealth technologies should be easy to use, and adequate support should be provided to older adults for use.
Topics: Aged; Diagnostic Tests, Routine; Humans; Independent Living; Technology; Telemedicine
PubMed: 34860664
DOI: 10.2196/23804 -
BMC Psychiatry May 2018Post-deinstitutionalisation, mental health supported accommodation services have been implemented widely. The available research evidence is heterogeneous in nature and...
BACKGROUND
Post-deinstitutionalisation, mental health supported accommodation services have been implemented widely. The available research evidence is heterogeneous in nature and resistant to synthesis attempts, leaving researchers and policy makers with no clear summary what works and for whom. In this context, we undertook a comprehensive systematic review of quantitative studies in order to synthesise the current evidence on mental health and psychosocial outcomes for individuals residing in mental health supported accommodation services.
METHODS
Using a combination of electronic database searches, hand searches, forward-backward snowballing and article recommendations from an expert panel, 115 papers were identified for review. Data extraction and quality assessments were conducted, and 33 articles were excluded due to low quality, leaving 82 papers in the final review. Variation in terminology and service characteristics made the comparison of service models unfeasible. As such, findings were presented according to the following sub-groups: 'Homeless', 'Deinstitutionalisation' and 'General Severe Mental Illness (SMI)'.
RESULTS
Results were mixed, reflecting the heterogeneity of the supported accommodation literature, in terms of research quality, experimental design, population, service types and outcomes assessed. There is some evidence that supported accommodation is effective across a range of psychosocial outcomes. The most robust evidence supports the effectiveness of the permanent supported accommodation model for homeless SMI in generating improvements in housing retention and stability, and appropriate use of clinical services over time, and for other forms of supported accommodation for deinstitutionalised populations in reducing hospitalisation rates and improving appropriate service use. The evidence base for general SMI populations is less developed, and requires further research.
CONCLUSIONS
A lack of high-quality experimental studies, definitional inconsistency and poor reporting continue to stymie our ability to identify effective supported accommodation models and practices. The authors recommend improved reporting standards and the prioritisation of experimental studies that compare outcomes across different service models.
Topics: Deinstitutionalization; Housing; Humans; Mental Disorders; Mental Health Services; Psychiatric Rehabilitation
PubMed: 29764420
DOI: 10.1186/s12888-018-1725-8 -
Frontiers in Psychiatry 2020Mental health rehabilitation services provide essential support to people with complex and longer term mental health problems. They include inpatient services and...
Mental health rehabilitation services provide essential support to people with complex and longer term mental health problems. They include inpatient services and community teams providing clinical input to people living in supported accommodation services. This systematic review included international studies evaluating the effectiveness of inpatient and community rehabilitation services. We searched six online databases for quantitative studies evaluating mental health rehabilitation services that reported on one or both of two outcomes: move-on to a more independent setting (i.e. discharge from an inpatient unit to the community or from a higher to lower level of supported accommodation); inpatient service use. The search was further expanded by screening references and citations of included studies. Heterogeneity between studies was too great to allow meta-analysis and therefore a narrative synthesis was carried out. We included a total of 65 studies, grouped as: contemporary mental health rehabilitation services ( = 34); services for homeless people with severe mental health problems ( = 13); deinstitutionalization programmes ( = 18). The strongest evidence was for services for homeless people. Access to inpatient rehabilitation services was associated with a reduction in acute inpatient service use post discharge. Fewer than one half of people moved on from higher to lower levels of supported accommodation within expected timeframes. Inpatient and community rehabilitation services may reduce the need for inpatient service use over the long term but more high quality research of contemporary rehabilitation services with comparison groups is required. This review was prospectively registered on PROSPERO (ID: CRD42019133579).
PubMed: 33519552
DOI: 10.3389/fpsyt.2020.607933 -
Developmental Medicine and Child... Jun 2014The aim of this review was to systematically review and synthesize observational evidence of associations between children's naturally varying contact with people with... (Review)
Review
AIM
The aim of this review was to systematically review and synthesize observational evidence of associations between children's naturally varying contact with people with disabilities and their attitudes towards disability.
METHOD
A comprehensive search was conducted across multiple databases. Studies were included if they measured children's contact with people with disabilities and their attitudes towards disability. Qualitative research and studies that experimentally varied the amount of contact children had were excluded. Data were synthesized in a narrative review.
RESULTS
There were 35 studies that met the inclusion criteria: 22 of these reported a statistically significant association between contact with people with disabilities and more positive attitudes towards disability; two studies reported a negative association between contact and attitudes; and 11 studies reported no association. Incomplete reporting of the methods and results across studies limited the conclusions that could be drawn.
INTERPRETATION
Studies identified in this review generally indicate that children's contact with people with disabilities is associated with more positive attitudes towards disability. There is a need for more rigorous research to examine the effect of children's contact with people with disabilities on their attitudes towards disability.
Topics: Adolescent; Attitude; Child; Crime Victims; Deinstitutionalization; Disabled Children; Disabled Persons; Humans; Peer Group; Prejudice; Psychological Distance; Self Concept; Social Behavior; Social Identification
PubMed: 24219501
DOI: 10.1111/dmcn.12326 -
Acta Medica Portuguesa Dec 2011Forensic psychiatry has experienced a significant development in the last few decades. Several mechanisms underlie this shift, including deinstitutionalization of mental... (Review)
Review
BACKGROUND AND AIMS
Forensic psychiatry has experienced a significant development in the last few decades. Several mechanisms underlie this shift, including deinstitutionalization of mental health patients and extraordinary progress in neurosciences, imaging technologies and psychology, just no name a few. This development has put in evidence specific needs for training and education. A review and comparison of forensic psychiatry training in several European countries, U.S.A. and Brazil is made.
METHODS
A mixed approach was used, including a) systematic literature review (Pubmed search, 1989-2009) and cross-reference search and inclusion; b) specific online sites search (e.g. medical associations or scientific societies responsible for forensic psychiatry training); c) direct contact with psychiatrists and forensic psychiatrists.
RESULTS AND CONCLUSIONS
Forensic psychiatry training is still a heterogeneous field. While not all countries have specialization, subspecialization or competency certification in forensic psychiatry, there has been, however, a definite shift towards its individuation as a specific technico-scientific area. This contributes to an improvement in quality standards and promotes research. Notwithstanding, forensic training in general adult and child psychiatry's residencies should continue to be strengthened as it is likely that most forensic activities will remain at their care in the near future.
Topics: Forensic Psychiatry; Humans; Internship and Residency; Models, Educational; Portugal
PubMed: 22863492
DOI: No ID Found -
CNS Spectrums Apr 2020We aimed to systematically review risk factors for criminal recidivism in individuals given community sentences. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We aimed to systematically review risk factors for criminal recidivism in individuals given community sentences.
METHODS
We searched seven bibliographic databases and additionally conducted targeted searches for studies that investigated risk factors for any repeat offending in individuals who had received community (non-custodial) sentences. We included investigations that reported data on at least one risk factor and allowed calculations of odds ratios (ORs). If a similar risk factor was reported in three or more primary studies, they were grouped into domains, and pooled ORs were calculated.
RESULTS
We identified 15 studies from 5 countries, which reported data on 14 independent samples and 246,608 individuals. We found that several dynamic (modifiable) risk factors were associated with criminal recidivism in community-sentenced populations, including mental health needs (OR = 1.4, 95% confidence interval (CI): 1.2-1.6), substance misuse (OR = 2.3, 95% CI: 1.1-4.9), association with antisocial peers (OR = 2.2, 95% CI: 1.3-3.7), employment problems (OR = 1.8, 95% CI: 1.3-2.5), marital status (OR = 1.6, 95%: 1.4-1.8), and low income (OR = 2.0, 95% CI: 1.1-3.4). The strength of these associations was comparable to that of static (non-modifiable) risk factors, such as age, gender, and criminal history.
CONCLUSION
Assessing dynamic (modifiable) risk factors should be considered in all individuals given community sentences. The further integration of mental health, substance misuse, and criminal justice services may reduce reoffending risk in community-sentenced populations.
Topics: Deinstitutionalization; Forensic Psychiatry; Humans; Mental Disorders; Mentally Ill Persons; Recidivism; Socioeconomic Factors
PubMed: 31218975
DOI: 10.1017/S1092852919001056 -
Frontiers in Psychiatry 2023Various mental health hospital models have been tested in Chile since its foundation. The institutional model with the Asylum and the Madhouse prevailed during the...
INTRODUCTION
Various mental health hospital models have been tested in Chile since its foundation. The institutional model with the Asylum and the Madhouse prevailed during the nineteenth century and much of the twentieth. But is deinstitutionalizing all psychiatric patients the solution?
EVIDENCE ACQUISITION
A PubMed, Epistemonikos, Lilacs, and Google Scholar Scoping Review was carried out in the last 5 years using the PRISMA-P method and the Scoping review search strategy. The MeSH terms ("Psychiatry/history" AND "Chile") OR ("Mental disorders" AND "therapy") were used during the search. Finally, papers focused on clinical trial therapy evaluation were excluded, and we emphasized the effects of historical evidence.
EVIDENCE SYNTHESIS
We identified 35 primary studies, and we counted the number of articles included in the review that potentially met our inclusion criteria and noted how many studies had been missed by our search. We analyzed 10 primary studies and 10 primary historical resources that were included in this study.
CONCLUSION
The state must become a guarantor and be responsible for its psychiatric patients and provide professional and humanitarian support to its patients, be it through community psychiatry, day hospitals, devices such as mental health clinics, or psychiatric institutes dedicated to teaching and research. Patients should not be left to the free will of their direct relatives, but rather the state should strengthen the primary care system.
PubMed: 37795511
DOI: 10.3389/fpsyt.2023.1114738 -
BMJ Open Sep 2019To review systematically the evidence on the costs and cost-effectiveness of deinstitutionalisation for adults with intellectual disabilities.
OBJECTIVE
To review systematically the evidence on the costs and cost-effectiveness of deinstitutionalisation for adults with intellectual disabilities.
DESIGN
Systematic review.
POPULATION
Adults (aged 18 years and over) with intellectual disabilities.
INTERVENTION
Deinstitutionalisation, that is, the move from institutional to community settings.
PRIMARY AND SECONDARY OUTCOME MEASURES
Studies were eligible if evaluating within any cost-consequence framework (eg, cost-effectiveness analysis, cost-utility analysis) or resource use typically considered to fall within the societal viewpoint (eg, cost to payers, service-users, families and informal care costs).
SEARCH
We searched MEDLINE, PsycINFO, CENTRAL, CINAHL, EconLit, Embase and Scopus to September 2017 and supplemented this with grey literature searches and handsearching of the references of the eligible studies. We assessed study quality using the Critical Appraisals Skills Programme suite of tools, excluding those judged to be of poor methodological quality.
RESULTS
Two studies were included; both were cohort studies from the payer perspective of people leaving long-stay National Health Service hospitals in the UK between 1984 and 1992. One study found that deinstitutionalisation reduced costs, one study found an increase in costs.
CONCLUSION
A wide-ranging literature review found limited evidence on costs associated with deinstitutionalisation for people with intellectual disabilities. From two studies included in the review, the results were conflicting. Significant gaps in the evidence base were observable, particularly with respect to priority populations in contemporary policy: older people with intellectual disabilities and serious medical illness, and younger people with very complex needs and challenging behaviours.
PROSPERO REGISTRATION NUMBER
CRD42018077406.
Topics: Adult; Cost-Benefit Analysis; Deinstitutionalization; Health Care Costs; Humans; Intellectual Disability; Quality of Life
PubMed: 31542732
DOI: 10.1136/bmjopen-2018-025736 -
BMJ Open Apr 2019To review systematically the evidence on how deinstitutionalisation affects quality of life (QoL) for adults with intellectual disabilities.
OBJECTIVE
To review systematically the evidence on how deinstitutionalisation affects quality of life (QoL) for adults with intellectual disabilities.
DESIGN
Systematic review.
POPULATION
Adults (aged 18 years and over) with intellectual disabilities.
INTERVENTIONS
A move from residential to community setting.
PRIMARY AND SECONDARY OUTCOME MEASURES
Studies were eligible if evaluating effect on QoL or life quality, as defined by study authors.
SEARCH
We searched MEDLINE, PsycINFO, CENTRAL, CINAHL, EconLit, Embase and Scopus to September 2017 and supplemented this with grey literature searches. We assessed study quality using the Critical Appraisal Skills Programme suite of tools, excluding those judged to be of poor methodological quality.
RESULTS
Thirteen studies were included; eight quantitative studies, two qualitative, two mixed methods studies and one case study. There was substantial agreement across quantitative and qualitative studies that a move to community living was associated with improved QoL. QoL for people with any level of intellectual disabilities who move from any type of institutional setting to any type of community setting was increased at up to 1 year postmove (standardised mean difference [SMD] 2.03; 95% CI [1.21 to 2.85], five studies, 246 participants) and beyond 1 year postmove (SMD 2.34. 95% CI [0.49 to 4.20], three studies, 160 participants), with total QoL change scores higher at 24 months comparative to 12 months, regardless of QoL measure used.
CONCLUSION
Our systematic review demonstrated a consistent pattern that moving to the community was associated with improved QoL compared with the institution. It is recommended that gaps in the evidence base, for example, with regard to growing populations of older people with intellectual disability and complex needs are addressed.
PROSPERO REGISTRATION NUMBER
CRD42018077406.
Topics: Adult; Deinstitutionalization; Humans; Intellectual Disability; Quality of Life
PubMed: 31028039
DOI: 10.1136/bmjopen-2018-025735