Deinstitutionalisation
From Wikipedia, the free encyclopedia
Deinstitutionalisation is the practice of moving people (especially those with mental disorders and developmental disability) from mental institutions into community-based or family-based environments.
The idea took hold in various countries in the 1950s and 1960s[1] as a cost saving measure, or a sensible alternative to state hospitals, as long as the discharged patients were serviced in their new community health centers and were able to take their necessary medications. New psychiatric medications were thought to have made it also possible to release this population into the community safely. [2]
In many parts of the developed world, in the early part of the 20th century, people with mental disorders, mental retardation and other developmental disabilities received services in large public institutions or were cared for by their families with very little financial and social support from the government. In the 1960s, through class action lawsuits and the scrutiny of institutions through disability activism, the appalling conditions and the poor treatment of patients in these institutions were revealed.
This led to a debate about deinstitutionalizing those who are capable of living in the community and developing a more flexible service delivery system to serve them.
Because many previously institutionalised people are unable to earn sufficient income to maintain independent housing, deinstitutionalization is thought to have caused widespread homelessness in the United States and some other countries.[3]
While many mentally ill people can be successfully integrated into the community, some will be at a higher risk of suicide, while others with psychotic disorders, such as paranoid schizophrenia may be aggressive to family, neighbours and strangers.
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[edit] Around the world
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[edit] Asia
[edit] Africa
[edit] Europe
[edit] North America
In the United States, a significant catalyst was the Community Mental Health Act of 1963.
It has been used by some governments and their agencies to save money by closing down, scaling back or merging psychiatric inpatient units. One possible result of this could be that patients who need to, and often want to be admitted to hospital cannot find beds or are discharged before they have fully recovered. Community support services for the mentally ill are a partial solution to this problem, providing care without institutionalisation where possible, although this too can become problematic as it is not necessarily a cheaper option or always an effective one.
In 1999, the Supreme Court of the United States ruled in L.C. & E.W. v. Olmstead that states are required to provide community-based services for people with mental disabilities if treatment professionals determine that it is appropriate and the affected individuals do not object to such placement.
Some studies estimate that approximately 10% of prisoners incarcerated in the US are individuals with severe psychiatric disorders. This exceeds the number of patients in psychiatric facilities, and does not provide equivalent treatment.
[edit] See also
[edit] References
- ^ Scherl D.J., Macht L.B., "Deinstitutionalization in the absence of consensus", Hospital and Community Psychiatry, 1979 Sep;30(9):599-604 [1]
- ^ Rochefort, D.A., "Origins of the 'Third psychiatric revolution': the Community Mental Health Centers Act of 1963", Journal of Health Politics, Policy and Law, 1984 Spring;9(1):1-30. [2]
- ^ Feldman, S., "Out of the hospital, onto the streets: the overselling of benevolence", Hastings Center Report, 1983 Jun;13(3):5-7. [3]
[edit] Bibliography
- Borus, J.F., "Sounding Board. Deinstitutionalization of the chronically mentally ill", New England Journal of Medicine, 1981 Aug 6;305(6):339-42. [4]
- Pepper, B., Ryglewicz, H., "The role of the state hospital: a new mandate for a new era", Psychiatric Quarterly, 1985 Fall-Winter;57(3-4):230-57. [5]
- Sharfstein, S.S., "Community mental health centers: returning to basics", American Journal of Psychiatry. 1979 Aug;136(8):1077-9. [6]
- Torrey, E. Fuller, M.D. and Zdanowicz, Mary, Esq., "Why deinstitutionalization turned deadly", Oped, The Wall Street Journal, August 4, 1998. [7]
- Torrey, E. Fuller, M.D. and Zdanowicz, Mary, Esq., "Deinstitutionalization hasn’t worked: 'We have lost effectively 93 percent of our state psychiatric hospital beds since 1955'", Oped, The Wall Street Journal, July 9, 1999. [8]
- Deinstitutionalization of Persons with Developmental Disabilities: A Technical Assistance Report for Legislators.
- E. Fuller Torrey and Mary Zdanowicz (August 4, 1998). Why deinstitutionalization turned deadly. Wall Street Journal
- Deinstitutionalization: A Psychiatric 'Titanic'. PBS Frontline
- Out of the Shadows: Confronting America's Mental Illness Crisis by E. Fuller Torrey, M.D. (New York: John Wiley & Sons, 1997).
