Effects of Deinstitutionalization on Public Attitudes and on the Work Force
Phil Brown in The Transfer of Care, 1985
Deinstitutionalization has altered the secluded nature of mental health treatment, making it far more visible, both in its planning and its outcomes. To the extent that deinstitutionalization has been the primary outcome of recent policies, both justified and unjustified public attention has been widespread. Previous chapters have examined the effects of recent mental health policy in terms of the institutional arrangements, ranging from psychiatric facilities to nursing homes. This chapter will discuss various effects which are not so readily apparent. I begin with a discussion of public attitudes toward mental illness in general, and opposition toward deinstitutionalization in particular. This involves general public attitudes, specific burdens on communities and other social institutions, ex-patient crime, and economic loss to communities. Next I address alterations in the lower levels of the work force, particularly psychiatric aides.
Affirm Recovery
Sandra Rasmussen in Developing Competencies for Recovery, 2023
Deinstitutionalization from mental hospitals, a national movement beginning in the mid-1960s, resulted in more individuals living in the community. Simultaneously, a recovery approach gained impetus as a social movement due in large part to a perceived failure of traditional mental health/addiction services. Moreover, the realization that people recover surfaced. Influenced in part by the philosophy of Alcoholics Anonymous and social movements of the 60s and 70s, the New Freedom Commission on Mental Health established by President George W. Bush proposed a shift from the traditional medical psychiatric model of care toward the concept of recovery. The report, Achieving the Promise: Transforming Mental Health Care in America, boldly recommended recovery from mental illness as the expected goal of this transformed system of care.
Cycles of institutional reform *
Phil Brown in Mental Health Care and Social Policy, 1985
Current evidence indicates that like earlier attempts at institutional reform, deinstitutionalization as practiced in the 1970s failed to develop a system of humane care for the chronically mentally ill. This assessment will be supported by a review of the parallels in the cycles of institutional reform, in the context of the fundamental social forces that have conditioned American social policy toward the care of the mentally ill. This review, in turn, will highlight the enduring functions of state mental hospitals and the fundamental changes required for the dissolution of the two-class system of care in this country. Short of a major technological breakthrough in understanding the causes and cures of mental disorders, progress toward the development of a truly humane system of mental health care requires a commitment of societal resources commensurate with the personal and social costs of these intractable problems. Moreover, such a system will remain elusive until mechanisms are developed to overcome the fragmentation of the current service network and the penchant to polarize the organizational and ideological approaches to the problem of mental illness.
“Abusing Addiction”: Our Language Still Isn’t Good Enough
Published in Alcoholism Treatment Quarterly, 2019
Robert D. Ashford, Austin M. Brown, Brenda Curtis
Between mental health and SUDs, stigma has evolved in different ways. Beginning in the late 1970s, deinstitutionalization drove a widening of educational resources concerning mental health. The medicalization of mental health and psychopharmacotherapy contributed to increased exposure to the causes and symptoms of mental health disorders, which likely peaked with the advent and widespread use of antidepressant medications in the 1990s. However, the rate of stigma has remained relatively stable and has actually increased in some categories related to mental health and violence (Pescosolido, 2013). Increased knowledge sophistication has not directly translated to reduced stigma across the public sphere, though some decrease in stigma can be seen in some areas, such as the language used to describe individuals that have a mental health disorder (i.e., person-first language) (Brown & Bradley, 2002).
Developing the Right Skills to Meet the Mental Health Needs of Older Adults
Published in Issues in Mental Health Nursing, 2023
Judith Anderson, Sancia West, David Lees, Michelle Cleary
The mental health system, too, has evolved with a lack of effective structure and workforce planning. Deinstitutionalisation has been implemented worldwide (Cummins, 2020) and provided improvements in patient care and new opportunities for mental health nurses (Walsh et al., 2012). However, the system may be experienced as complex, fragmented, inaccessible, or simply unsuitable. The provision of care across the diversity of mental healthcare settings has been accompanied with changes to regulation and funding, including the exclusion of mental health nurses from some funding sources, which has exacerbated issues of accessibility (Lakeman et al., 2020). Mental health nursing, too, faces challenges as an ‘emotionally demanding’ specialty with high rates of burnout, reduced staff satisfaction and attrition (Hippel et al., 2019; Scanlan & Still, 2019). For some mental health nurses there is a sense of an ‘inability to help’ service users in the most effective ways (Hippel et al., 2019), of a loss of identity, and of division within the profession (Cleary et al., 2014; Harrison et al., 2014). Such factors may contribute to an overall reduction in job satisfaction in the sector (Scanlan et al., 2021).
Argentina: A mental health system caught in transition
Published in International Journal of Mental Health, 2021
Dermot J. Hurley, Martin Agrest
As a result of deinstitutionalization, the number of psychiatric beds has markedly decreased in most Western countries. However, concerns have been raised about re-institutionalization as evidenced by the increase in forensic units, homeless shelters and community based institutional settings (Steadman et al. 2011). In Argentina, for example, according to Moldavsky et al. (2011), the decreasing number of public psychiatric inpatient beds has given rise to a larger number of private psychiatric inpatient beds. This has led some to argue that a process of trans-institutionalization is taking place, whereby patients who would have formally been institutionalized, end up in residential homes, forensic hospitals and prisons (Saxena et al., 2003). Such concerns have triggered a call for further comparative research to evaluate new forms of institutionalized care in the community (Fakhoury & Priebe, 2002). It is generally agreed that a comprehensive organized system of care is necessary, and that a balanced care approach would combine brief acute hospital admission with follow-up services in the community (Killaspy, 2006; McDaid & Thornicroft, 2005). The movement from institutional to community psychiatry has been the subject of extensive research, covering key areas such as residential housing, supported employment, social integration and social skills training (Roessler, 2006). Deinstitutionalization requires a fundamental change in mind set beginning with a re-visioning of what mental health means, an understanding of the concept of recovery, the reallocation of mental health funds, a commitment to community-based programs and a balance between community and hospital care (Thornicroft & Tansella, 2004). These issues will be explored further in the discussion portion of this paper.
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