Did you mean: deinstitutionalized
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History of Psychiatry Dec 2023A new psychiatric institution emerged in the late nineteenth and early twentieth centuries: the psychopathic hospital. This institution represented a significant...
A new psychiatric institution emerged in the late nineteenth and early twentieth centuries: the psychopathic hospital. This institution represented a significant development in the history of psychiatry, as it marked the profession's reorientation from asylum-based to hospital-based care, and in this way presaged the deinstitutionalization movement that would begin half a century later. Psychopathic hospitals were also an important marker of psychiatry's efforts to redefine its professional boundaries and respond to its vociferous critics. This entailed both a rapprochement with general medicine in an effort to assert its scientific bona fides and a redefinition of its scope of practice to absorb non-certifiable 'borderland' cases in order both to emphasize non-coercive treatment and to enlarge the profession's boundaries.
Topics: Humans; Psychiatry; Hospitals, Psychiatric
PubMed: 37691414
DOI: 10.1177/0957154X231194910 -
Cadernos de Saude Publica Oct 2016The term "territory" and its correlates have become commonplace in the field of Mental Health since the psychiatric reform, a potentially emancipatory milestone in... (Review)
Review
The term "territory" and its correlates have become commonplace in the field of Mental Health since the psychiatric reform, a potentially emancipatory milestone in non-hospital-centered ideals. However, in a previous empirical study, we found a lack of consistent concepts and practices (corresponding to the use of this term) in the territorial reinsertion of persons with mental illness. To clarify the term's various uses and its possible correlations in practice, we have conducted a systematic survey of scientific articles and official documents, comparing them to each other and with the concept of territory from Critical Geography. We conclude that in the Mental Health field in Brazil, despite numerous and repeated critical efforts, a functional notion of territory has prevailed, overlooking power relations and symbolic appropriations, increasing the tendency of subjecting the reinsertion of persons with mental illness to a given territory rather than favoring socio-spatial transformations for the coexistence of differences.
Topics: Deinstitutionalization; Health Care Reform; Humans; Mental Disorders; Mental Health; Terminology as Topic; Territoriality
PubMed: 27759792
DOI: 10.1590/0102-311X00059116 -
Ciencia & Saude Coletiva Jan 2022The aim of the current article is to identify scientific evidence about advances, possibilities, and challenges of using the Back Home Program (BHP) to... (Review)
Review
The aim of the current article is to identify scientific evidence about advances, possibilities, and challenges of using the Back Home Program (BHP) to deinstitutionalize former psychiatric hospitalization patients. This study is an integrative review based on the scientific literature available in the Virtual Health Library and the PubMed portal, as well as in the Cinahl, ScienceDirect, Web of Science, Scopus, and PsycINFO databases. The analysis of all nine selected studies was based on the interpretation of discursive practices observed in public domain materials. Results have shown that the investigated program is an undeniable social achievement and civilizing advance, and that it contributes to deinstitutionalization, as it helps to change beneficiaries' lives, with emphasis on their new consolidated place in society and on the dispensability of psychiatric hospitals. However, the program needs to overcome some challenges, such as access and equitable distribution in the national territory, professional training, and the involvement of individuals in the appropriation of benefits. It is crucial to emphasize the need to develop strategies to promote autonomy, citizenship, access to a broad mental health network of assistance and care resources, patients' return to family life, and insertion in the labor market.
Topics: Citizenship; Deinstitutionalization; Hospitalization; Hospitals, Psychiatric; Humans
PubMed: 35043925
DOI: 10.1590/1413-81232022271.19862021 -
Journal of the National Medical... Apr 1979This paper treats the issue of the treatment of the chronically mentally disabled. The author challenges the feasibility of plans for the treatment of the chronically...
This paper treats the issue of the treatment of the chronically mentally disabled. The author challenges the feasibility of plans for the treatment of the chronically disabled outside of mental institutions and questions whether in actuality there has been a sufficient commitment (moral, professional, and financial) to the local noninstitutional care of this population. The history of treatment of the mentally disabled over the past three centuries is reviewed. The failure of the community mental health center movement during the 1960s is described, and the reasons for that failure are presented. A note of extreme caution is sounded as behavioral scientists and mental health planners devise methods of caring for the chronic population, lest courses be embarked upon that have been given inadequate consideration and planning.
Topics: Deinstitutionalization; Humans; Intellectual Disability; Mental Health Services
PubMed: 439176
DOI: No ID Found -
The Milbank Quarterly Mar 2015POLICY POINTS: A retrospective analysis of federally funded homeless research in the 1980s serves as a case study of how politics can influence social and behavioral... (Review)
Review
UNLABELLED
POLICY POINTS: A retrospective analysis of federally funded homeless research in the 1980s serves as a case study of how politics can influence social and behavioral science research agendas today in the United States. These studies of homeless populations, the first funded by the National Institute of Mental Health, demonstrated that only about a third of the homeless population was mentally ill and that a diverse group of people experienced homelessness. This groundbreaking research program set the mold for a generation of research and policy characterizing homelessness as primarily an individual-level problem rather than a problem with the social safety net.
CONTEXT
A decade after the nation's Skid Rows were razed, homelessness reemerged in the early 1980s as a health policy issue in the United States. While activists advocated for government-funded programs to address homelessness, officials of the Reagan administration questioned the need for a federal response to the problem. In this climate, the National Institute of Mental Health (NIMH) launched a seminal program to investigate mental illness and substance abuse among homeless individuals. This program serves as a key case study of the social and behavioral sciences' role in the policy response to homelessness and how politics has shaped the federal research agenda.
METHODS
Drawing on interviews with former government officials, researchers, social activists, and others, along with archival material, news reports, scientific literature, and government publications, this article examines the emergence and impact of social and behavioral science research on homelessness.
FINDINGS
Research sponsored by the NIMH and other federal research bodies during the 1980s produced a rough picture of mental illness and substance abuse prevalence among the US homeless population, and private foundations supported projects that looked at this group's health care needs. The Reagan administration's opposition to funding "social research," together with the lack of private-sector support for such research, meant that few studies examined the relationship between homelessness and structural factors such as housing, employment, and social services.
CONCLUSIONS
The NIMH's homelessness research program led to improved understanding of substance abuse and mental illness in homeless populations. Its primary research focus on behavioral disorders nevertheless unwittingly reinforced the erroneous notion that homelessness was rooted solely in individual pathology. These distortions, shaped by the Reagan administration's policies and reflecting social and behavioral scientists' long-standing tendencies to emphasize individual and cultural rather than structural aspects of poverty, fragmented homelessness research and policy in enduring ways.
Topics: Behavioral Research; Deinstitutionalization; Financing, Government; History, 20th Century; Ill-Housed Persons; Humans; Interviews as Topic; Mentally Ill Persons; National Institute of Mental Health (U.S.); Needs Assessment; Organizational Case Studies; Politics; Public Policy; Research Support as Topic; Retrospective Studies; Substance-Related Disorders; United States; Urban Renewal
PubMed: 25752353
DOI: 10.1111/1468-0009.12108 -
Health Research Policy and Systems Mar 2022While calls for institutionalization of evidence-informed policy-making (EIP) have become stronger in recent years, there is a paucity of methods that governments and... (Review)
Review
BACKGROUND
While calls for institutionalization of evidence-informed policy-making (EIP) have become stronger in recent years, there is a paucity of methods that governments and organizational knowledge brokers can use to sustain and integrate EIP as part of mainstream health policy-making. The objective of this paper was to conduct a knowledge synthesis of the published and grey literatures to develop a theoretical framework with the key features of EIP institutionalization.
METHODS
We applied a critical interpretive synthesis (CIS) that allowed for a systematic, yet iterative and dynamic analysis of heterogeneous bodies of literature to develop an explanatory framework for EIP institutionalization. We used a "compass" question to create a detailed search strategy and conducted electronic searches to identify papers based on their potential relevance to EIP institutionalization. Papers were screened and extracted independently and in duplicate. A constant comparative method was applied to develop a framework on EIP institutionalization. The CIS was triangulated with the findings of stakeholder dialogues that involved civil servants, policy-makers and researchers.
RESULTS
We identified 3001 references, of which 88 papers met our eligibility criteria. This CIS resulted in a definition of EIP institutionalization as the "process and outcome of (re-)creating, maintaining and reinforcing norms, regulations, and standard practices that, based on collective meaning and values, actions as well as endowment of resources, allow evidence to become-over time-a legitimate and taken-for-granted part of health policy-making". The resulting theoretical framework comprised six key domains of EIP institutionalization that capture both structure and agency: (1) governance; (2) standards and routinized processes; (3) partnership, collective action and support; (4) leadership and commitment; (5) resources; and (6) culture. Furthermore, EIP institutionalization is being achieved through five overlapping stages: (i) precipitating events; (ii) de-institutionalization; (iii) semi-institutionalization (comprising theorization and diffusion); (iv) (re)-institutionalization; and (v) renewed de-institutionalization processes.
CONCLUSIONS
This CIS advances the theoretical and conceptual discussions on EIP institutionalization, and provides new insights into an evidence-informed framework for initiating, strengthening and/or assessing efforts to institutionalize EIP.
Topics: Delivery of Health Care; Health Policy; Humans; Knowledge; Organizations; Policy Making
PubMed: 35246139
DOI: 10.1186/s12961-022-00820-7 -
Ciencia & Saude Coletiva Jan 2022
Topics: Brazil; Community Mental Health Services; Deinstitutionalization; Hospitals, Psychiatric; Humans; Mental Disorders; Mental Health; Mental Health Services
PubMed: 35043919
DOI: 10.1590/1413-81232027271.20912021 -
Administration and Policy in Mental... Nov 2021Outpatient civil commitment (OCC) requires people with severe mental illness (SMI) to receive needed-treatment addressing imminent-threats to health and safety. When... (Review)
Review
Outpatient civil commitment (OCC) requires people with severe mental illness (SMI) to receive needed-treatment addressing imminent-threats to health and safety. When available, such treatment is required to be provided in the community as a less restrictive alternative (LRA) to psychiatric-hospitalization. Variance in hospital-utilization outcomes following OCC-assignment has been interpreted as OCC-failure. This review seeks to specify factors accounting for this outcome-variation and to determine whether OCC is used effectively. Twenty-five studies, sited in seven meta-analyses and subsequently published investigations, assessing post-OCC-assignment hospital utilization outcomes were reviewed. Studies were grouped by structural pre-determinants of hospital-utilization and OCC-implementation-i.e. deinstitutionalization (bed-availability), availability of a less restrictive alternative to hospitalization, and illness severity. Design quality at study completion was ranked on causal-certainty. In OCC-follow-up-studies, deinstitutionalization associated hospital-bed-cuts, when not taken into account, ensured lower hospital-bed-day utilization. OCC-assignment coupled with aggressive case-management was associated with reduced-hospitalization. With limited community-service, hospitalizations increased as the default option for providing needed-treatment. Follow-up studies showed less hospitalization while on OCC-assignment and more outside of it. Studies using fixed-follow-up periods usually found increased-utilization as patients spent less time under OCC-supervision than outside it. Comparison-group-studies reporting no between-group differences bring more severely ill OCC-patients to equivalent use as less disturbed patients, a success. Mean evidence-rank for causal-certainty 2.96, range 2-4, of 5 with no study ranked 1, the highest rank. Diverse mental health systems yield diverse OCC hospital-utilization outcomes, each fulfilling the law's legal mandate to provide needed-treatment protecting health and safety.
Topics: Commitment of Mentally Ill; Day Care, Medical; Hospitalization; Hospitals; Humans; Mental Disorders
PubMed: 33534072
DOI: 10.1007/s10488-021-01112-y -
The American Psychologist Apr 2013Over the past 40 years, the assessment and scientific study of capacity in older adults has emerged as a distinct field of clinical and research activity for... (Review)
Review
Over the past 40 years, the assessment and scientific study of capacity in older adults has emerged as a distinct field of clinical and research activity for psychologists. This new field reflects the convergence of several trends: the aging of American society, the growing incidence and prevalence of dementia, and the patient rights, deinstitutionalization, and disability rights movements. Because of these forces, capacity issues now permeate the fabric of everyday life, whether in the form of guardianship petitions, questions of capacity to consent to treatment, the ability to make a new will, or participation in human research. In seeking to resolve these issues, families, clinicians, and legal professionals increasingly turn to psychologists to assess a capacity and to provide empirically supported judgments that properly balance autonomy and protection for the individual. Psychologists have taken a leading role in the development of functional assessment instruments that measure important aspects of the capacity construct. In addition, psychology has been a major contributor to the scientific study of capacity. In collaboration with colleagues from medicine and law, psychologists have articulated crucial theoretical frameworks that integrate legal, clinical, and ethical dimensions of the capacity problem. This article focuses on the evolution of theory, law, science, and practice in the evaluation of capacity in older adults and its recent culmination in a series of interdisciplinary handbooks sponsored by the American Psychological Association and the American Bar Association.
Topics: Aged; Aging; Cognition Disorders; Humans; Mental Competency; Societies, Scientific; United States
PubMed: 23586491
DOI: 10.1037/a0032159