China
Africa
Explore chapters and articles related to this topic
Disempowered
Published in Al Condeluci, Interdependence: The Route to Community, 2019
Even for groups of people who have access to funding through some diagnostic link (such as people with mental retardation labels), most available housing options are group homes, congregate settings, or institutionally oriented apartments. The bottom line here is that even though some of these group homes are on “main street,” they are usually run like institutions. In many regards, the deinstitutionalization that created group homes was nothing more than a process of transinstitutionalization.
Cycles of institutional reform *
Published in Phil Brown, Mental Health Care and Social Policy, 1985
Joseph P. Morrissey, Howard H. Goldman, Lorraine V. Klerman
In a number of respects, therefore, the ambiguous legacy of institutional care is now being supplanted by the ambiguous legacy of community care. In the past decade, the gap between the ideal of a community-based mental health system and its reality has widened considerably. Similar to the early private asylums, CHMCs and general hospitals have not provided the comprehensive care required for chronic as well as acute patients; social and rehabilitative services have not been put into place; and the state hospital system has been dismantled prematurely. Rather than ‘deinstitutionalization’ a process of ‘transinstitutionalization’ has occurred in many instances, with ‘back wards’ moved to nursing homes (Schmidt et al., 1977) and other residential care facilities (Reich and Segal, 1973) and ‘front wards’ moved to general hospitals and CMHCS (Windle and Scully, 1976). Thus segregation of the mentally ill persists in a new ecological arrangement.
The Traditional Public Sector: State Mental Hospitals
Published in Phil Brown, The Transfer of Care, 1985
It is true that we cannot entirely do without some form of highly structured asylum for a small portion of the mentally ill population. In addition to psychiatric needs, state hospitals still fill other important functions, such as employment, training sites, local economic support, and the public’s felt need for security (Goldman, Taube, Regier, and Witkin, 1983). Despite some earlier optimism, most adherents of deinstitutionalization did not seek the total abolition of all hospitals. In fact, the more intelligent approaches to innovative and noninstitutional care have understood that deinstitutionalization does not necessarily mean non-institutionalization, or even a large degree of personal freedom. Scheper-Hughes (1981) notes that while most of her study cohort of discharged patients lived in non-institutional settings, their lives were highly regimented by the day hospital, rehabilitation program, or sheltered workshop. The day hospital program and the parent institution, Boston State Hospital, are thoroughly connected, and the day program has become a permanent status for patients, rather than a transition to independent living. Lerman (1982) argues that although boarding home patients may feel ‘freer’ than they did in the hospital, boarding homes are new forms of social control in that many patients are involuntary in practice, and that operators are given wide latitude in supervising patients in matters such as curfews, withholding money, cashing checks, visitor privileges, and control of access to clothing. He also considers the well-documented abuse of psychiatric drugs in nursing and boarding homes to be an instance of social control which makes the home similar to the old asylum. Various scholars have remarked that we are witnessing transinstitutionalization, the mere shifting of people from one facility to another. This is one of the aspects of the transfer of care, whereby the location and some of the phenomena of institutional living change, but the underlying personal control and institutional rigidity remain.
Forensic Treatment Services in the Czech Republic: Current State and Future Challenges
Published in International Journal of Forensic Mental Health, 2020
Marek Páv, Petra Skřivánková, Chantelle Wiseman, Martina Vňuková, Šárka Blatníková, Martin Hollý
There is no systematic risk assessment requirement for patients under the FT services; this does not reflect the global developments in the last 20 years in the field of risk assessment development and use (de Vries Robbé & de Vogel, 2018; Singh et al., 2014). Absence of risk assessment can contribute to differences in expert opinion recommendations regarding FT and to regional heterogeneity in placing patients into different treatment pathways. It also causes difficulties for healthcare professionals in communicating with the justice system concerning risk level in a given patient and management proposals. Risk assessment is strongly recommended in the context of providing expertise to courts, as well as in the planning of interventions and risk management for the protective population within treatment as contemporary standards indeed recommend (Völlm et al., 2018). There is a necessity to implement The Risk-Need-Responsivity model based on the use of risk-based instruments into the treatment system (Andrews et al., 1990), as effective treatment consists of programs that follow risk, need, and responsivity principles. Use of instrument such as SAPROF counterbalancing risk assessment helps to map protective factors and incorporate them into the treatment plan (de Vries Robbé, de Vogel, & de Spa, 2011). There is also a need to integrate recovery principles into the field, supporting user participation in all stages of the treatment process (Drennan & Alred, 2012). Without evidence-based risk assessment systems, there is a danger of transinstitutionalisation of the severely mentally ill from long-term care FT to the Forensic Treatment services.
Making sense of mental health service changes
Published in Nordic Journal of Psychiatry, 2018
Hanna Putkonen, Pamela J. Taylor
We are not convinced by Juriloo and colleagues’ conclusion about ‘transinstitutionalisation’, but we do applaud their call for more research in this area. We need accurate evidence of real need in the systems and solutions that are evidence based, then scientifically tested.