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The corruption of medical morality under advanced capitalism
Published in Therese Feiler, Joshua Hordern, Andrew Papanikitas, Marketisation, Ethics and Healthcare, 2018
The ethic of deinstitutionalisation – the policy of treating physically and mentally disabled people in the community rather than in a public institution – seems a humanitarian measure designed to enable these people to lead the life they much prefer. But the compliant reality is about spending cuts and de facto privatisation.
Crisis assessment and resolution
Published in Chambers Mary, Psychiatric and mental health nursing, 2017
Julie Taylor, Mrs M, Mr M, Miss M
Advances in treatments in the 1950s and 1960s, such as the introduction of phenothiazine drugs and electroconvulsive therapy (ECT), enabled patients to be managed more effectively in the community. There was a peak of around 150,000 beds in 1955 which had reduced to around 22,300 by 2012;3 between 1998 and 2012 alone, there was a 39 per cent reduction in the number of beds.4 This has been underpinned by a gradual programme of de-institutionalization, and a growing focus on services providing community-based care.
Chronic Disorders and Families: An Overview
Published in Froma Walsh, Carol Anderson, Chronic Disorders and the Family, 2014
There is, however, an increasing commitment to the notion of developing programs for families of patients with severe disorders. The movement for deinstitutionalization placed many chronically ill psychiatric patients with their families in the community rather than in hospitals. In psychiatry, this phenomenon was strengthened by policies of utilization review, treatment contracts, and informed consent, all of which emphasize the briefest possible hospital stays. In medicine, health care advances increasingly have resulted in the indefinite extension of the lives of patients who will never be well. In cither case, the expectation that families will be the primary caretakers of patients who once required twenty-four hour care by a group of professionals has precipitated increased pressure for changes in the support programs and resources provided by hospitals and community health programs.
Assisted living for mentally ill—a systematic literature review and its recommendations
Published in Nordic Journal of Psychiatry, 2022
Joel Ketola, Erfan Jahangiri, Helinä Hakko, Pirkko Riipinen, Sami Räsänen
For decades there has been a global shift from psychiatric inpatient treatment to outpatient care and active rehabilitation, including housing services. This has been a trend in Nordic countries, as well [5,6]. The main goal of deinstitutionalization has been to participate people with mental disorders in society and therewith improve human rights and quality of life (QoL). Knapp et al. has stated that deinstitutionalization has not generated cost savings but it has been cost-effective when compared to hospital treatment [7]. Globally, the reduction of hospital beds has had a major effect on people suffering from psychotic disorders since individuals have moved from asylums to society [8,9].
Social care for older people – a blind spot in the Norwegian care system
Published in Social Work in Health Care, 2020
Walter Schönfelder, Helga Eggebø, Mai Camilla Munkejord
The process of deinstitutionalization is intertwined with two other processes, both with significant consequences for the provision of care. First, the distinction between health and social care has increasingly become unclear, with nursing staff focusing mainly on health-related issues and home helpers performing practical, household tasks (Vabø, 2009). Furthermore, there has been a tendency to deliver increasingly more healthcare services and less practical assistance (Mørk et al., 2016, p. 4). As a result, social care is addressed only implicitly in this distribution of care work, without being safeguarded by specific minimum or quality standards. Second, since the 1990s, public service delivery in Norway has increasingly been organized according to the principles of new public management (NPM). Regarding the particular adoption of these principles within health and social care delivery and their consequences, Vabø claimed that before the advent of NPM, “home care staff, including skilled nurses, were typical social professionals” (2012: 286). The extent to which nursing staff actually lived up to this claim before the introduction of NPM is debatable, as the need for more person-centered, holistic and flexible care service performance has been repeatedly emphasized in government white papers over the course of several decades (Helse- og omsorgsdepartementet, 2014; Sosial- og helsedepartementet, 1994, 1997, 2000). Despite various reforms, the professional basis for the provision of care services as well as the main challenges for providing high quality and person-centered care services remained unchanged. Therefore, our interest in this article is to investigate how social care appears in accounts given by professional caregivers.
Risky Business? A Year-Long Study of Adult Voluntary Admissions Who Leave Psychiatric in-Patient Care without Informing Staff
Published in Issues in Mental Health Nursing, 2020
Jennifer Donnelly, Adam Kavanagh, Gráinne Donohue
Deinstitutionalization and an increased public awareness of mental health issues have served to reduce fear and stigmatization of psychiatric service users. Human rights groups have pushed for increased integration and a move away from locked doors within mental health services (Mental Health Commission, 2017). There is much debate on what is considered best practice when it comes to locking doors, given the duty that mental health service providers have to protect service users and others especially during acute phases of illness. In reality however and with the current culture of litigation and responsibility, mental health services must assess and manage risk.