Attacks on custodialism offered the hope of more humane treatment approaches. Mental health planners thought that the costs of state hospital care could be reduced by discharging patients into the community. For state governments, this involved a shift of costs and responsibility to the federal government. This shift was accompanied by an increase in cost-effective planning at both state and federal levels. Cost-effective planning uses corporate-style standardization techniques to provide precise, measured types of treatment to certain categories of patients. Such planning is primarily oriented to balanced ledgers of the government budget, rather than meeting specific human needs. The shift in costs also increases profits in the private sector. This is most noticeable in the nursing and boarding home industry where entrepreneurs derive large returns from a newly custodialism mainly funded by government reimbursements. The institutional overuse of psychiatric drugs is continued in community programs. Cost-effective approaches also involve firing mental health staff and increasing the workload of those remaining. Community mental health centers and state hospital deinstitutionalization programs have largely failed to meet most of their promises such as noninstitutional treatment, more humane care, prevention, and rehabilitation. These failures have produced the beginning of a delegitimation of the new mental health approaches. This delegitimation is also used as part of more general attacks on social services so prevalent in this period of economic crisis. This reinforces the reliance on cost-effective plans which do not benefit clients. It also poses the danger of increasing the number of persons classified as psychological misfit among the marginal underclass. Even though this is an unintended effect, it can then be used to deflect onto these victims popular resentment against big business and the government. Further, the growth of such a misfit group, along with
Searight, H R; Handal, P J
There is a substantial research data base which indicates that the majority of the chronically mentally ill can function outside of institutional settings. A number of community support programs have been implemented and positively evaluated. However, despite this evidence, large-scale deinstitutionalization of these patients has not occurred. Instead, patients have been relocated to new institutional placements such as nursing homes and single-room only hotels (SRO's). The role of Medicaid and Supplemental Security Income (SSI) in mental health care appears to have contributed to limited placement options. In addition, deinstitutionalization has created ambiguity around the degree of dependence and social role status of these patients. Recommendations are made to provide the deinstitutionalized mentally ill with a viable social role using existing financial resources.
Lucena, Marcela Adriana da Silva; Bezerra, Adriana Falangola Benjamin
This study addresses mental health and, based on a conceptual review, offers considerations on the management of deinstitutionalization processes regarding individuals interned in long-stay psychiatric institutions. Elements concerning asylum formation and logic are discussed, along with the mechanisms necessary for the effective change in paradigm and practices, with deinstitutionalization and psychosocial rehabilitation as the core issues. Reflections are offered regarding management actions committed to the psychosocial model, linking such actions to the application of the components of care and going beyond the articulation of the tools of mental health policy. Theoretical reflection offers suggestions referring to the qualification processes of mental health professionals, deinstitutionalization in the management of the Unified Health System and tripartite action with co-accountability in actions and financing. The final considerations recognize the bureaucratic obstacles in the public realm and propose facing these challenges as a management challenge, along with processes of change that can radically commit to the lives of people, thereby broadening the discussion to the ethical realm.
Fuller Torrey, E
The deinstitutionalization of individuals with serious mental illness was driven by 4 factors: public revelations regarding the state of public mental hospitals, the introduction of antipsychotic medications, the introduction of federal programs to fund patients who had been discharged, and civil libertarian lawyers. The result is approximately 3.2 million individuals with untreated serious mental illness living in the community. Beginning in the 1970s in the United States, there began to be reported increasing incidents of violent behavior, including homicides, committed by these untreated individuals. Such incidents became more numerous in the 1980s and 1990s, and have further increased since the turn of the century. Existing studies suggest that individuals with untreated severe mental illness are responsible for at least 10% of all homicides and approximately half of all mass killings. Studies have also shown that when these individuals are treated, the incidence of violent behavior decreases significantly. Examples of treatment mechanisms that have proven effective include assisted outpatient treatment (AOT), conditional release, and mental health courts.
Mainieri Paulon, Simone
Full Text Available Establishing alternative mental health care has been facing several difficulties. We need to examine the subjective processes that may be supporting archaic and criticized practices in this area. The aim of this article is to analyze the relationship between the concepts of subjectivity, nihilism and institutionality in order to overcome the impasse in which deinstitutionalization finds itself. Taking Foucault and Deleuze as theoretical tools to understand the constitution of singularity, this paper focuses on the deinstitutionalization process in order to bring it closer to the Nietzschean project of transvaluation of values.
Weinberg, Richard B.
This paper reviews the rationale for social network programs in the effort to deinstitutionalize the mentally ill. Stress and mental health problems are discussed in terms of biological and social determinants, measurement techniques, and coping mechanisms. Supportive relationships as buffers to stress are examined and the concepts of social…
Full Text Available This paper presents national and international documents, as well as the current situation of the institutionalized and deinstitutionalized care, principles and aims in the process of the deinstitutionalization of people with disabilities and children with developmental disabilities and their problems in the Republic of Macedonia. Recommendations and activities were presented to enhance the level of psycho-social support of the biological families for taking care of children with developmental disabilities and increase the compensation, as preconditions for decrease of the need for stay in institutions for social care.Strategic directions and activities for the process of deinstitutionalization of people with disabilities, participants in carrying out this process in the Republic of Macedonia were presented. The activities and the dynamic of carrying out the process of deinstitutionalization of people with disabilities in the Republic of Macedonia, planned in three phases for the period from 2008 to 2018, were also given.
Zimmerbauer, Kaj; Paasi, Anssi
Regions as well as their identities and borders are social and discursive constructs that are produced and removed in contested, historically contingent and context-bound processes of institutionalization and deinstitutionalization. This article studies the deinstitutionalization of regions in the context of municipality amalgamations and the…
Nsabimana, Epaphrodite; Martin-Sölch, Chantal
Negative effects of institutionalization and positive effects of deinstitutionalization on children’s wellbeing have been well documented. However, the majority of reports on institutional care rely on adult interviews and there is a wide disparity of results and methodologies in few result-oriented studies of deinstitutionalization outcome. In addition, though all over the world, especially in developed countries, many children in orphanage have parents; little is known about on the effect o...
Treas, Judith; Lui, Jonathan; Gubernskaya, Zoya
BACKGROUND Consistent with the deinstitutionalization-of-marriage thesis, studies report a decline in support for marital conventions and increased approval of other relationship types. Generalizations are limited by the lack of cross-national research for a broad domain of attitudes on marriage and alternative arrangements, and by the lack of consensus on what counts as evidence. OBJECTIVE Acknowledging the conceptual distinction between expectations for behavior inside and outside marriage, we address the deinstitutionalization debate by testing whether support for marital conventions has declined for a range of attitudes across countries. METHODS Based on eleven International Social Survey Program items replicated between the late 1980s and the 2000s, OLS regressions evaluate attitude changes in up to 21 countries. RESULTS Consistent with the deinstitutionalization argument, disapproval declined for marital alternatives (cohabitation, unmarried parents, premarital and same-sex sex). For attitudes on the behavior of married people and the nature of marriage the results are mixed: despite a shift away from gender specialization, disapproval of extramarital sex increased over time. On most items, most countries changed as predicted by the deinstitutionalization thesis. CONCLUSIONS Attitude changes on ‘new relationships’ and marital alternatives are compatible with the deinstitutionalization of marriage. Beliefs arguably more central to the marital institution do not conform as neatly to this thesis. Because results are sensitive to the indicators used, the deinstitutionalization of marriage argument merits greater empirical and conceptual attention. PMID:26052248
Full Text Available Background: Consistent with the deinstitutionalization-of-marriage thesis, studies report a decline in support for marital conventions and increased approval of other relationship types. Generalizations are limited by the lack of cross-national research for a broad domain of attitudes on marriage and alternative arrangements, and by the lack of consensus on what counts as evidence. Objective: Acknowledging the conceptual distinction between expectations for behavior inside and outside marriage, we address the deinstitutionalization debate by testing whether support for marital conventions has declined for a range of attitudes across countries. Methods: Based on eleven International Social Survey Program items replicated between the late 1980s and the 2000s, OLS regressions evaluate attitude changes in up to 21 countries. Results: Consistent with the deinstitutionalization argument, disapproval declined for marital alternatives (cohabitation, unmarried parents, premarital and same-sex sex. For attitudes on the behavior of married people and the nature of marriage the results are mixed: despite a shift away from gender specialization, disapproval of extramarital sex increased over time. On most items, most countries changed as predicted by the deinstitutionalization thesis. Conclusions: Attitude changes on 'new relationships' and marital alternatives are compatible with the deinstitutionalization of marriage. Beliefs arguably more central to the marital institution do not conform as neatly to this thesis. Because results are sensitive to the indicators used, the deinstitutionalization of marriage argument merits greater empirical and conceptual attention.
Kliewer, Stephen P.; McNally Melissa; Trippany, Robyn L.
Deinstitutionalization has had a significant impact on the mental health system, including the client, the agency, and the counselor. For clients with serious mental illness, learning to live in a community setting poses challenges that are often difficult to overcome. Community mental health agencies must respond to these specific needs, thus…
Shen, Gordon C; Snowden, Lonnie R
Policies generate accountability in that they offer a standard against which government performance can be assessed. A central question of this study is whether ideological imprint left by policy is realized in the time following its adoption. National mental health policy expressly promotes the notion of deinstitutionalization, which mandates that individuals be cared for in the community rather than in institutional environments. We investigate whether mental health policy adoption induced a transformation in the structure of mental health systems, namely psychiatric beds, using panel data on 193 countries between 2001 and 2011. Our striking regression results demonstrate that late-adopters of mental health policy are more likely to reduce psychiatric beds in mental hospitals and other biomedical settings than innovators, whereas they are less likely than non-adopters to reduce psychiatric beds in general hospitals. It can be inferred late adopters are motivated to implement deinstitutionalization for technical efficiency rather than social legitimacy reasons.
ABSTRACT: This article analyses the issues of the deinstitutionalization of youth, and the development of community based services, using some historical data and some of the principles of community psychology. The basic premise is that there is no such thing as a social vacuum. All programs are implemented and function in an elaborate social context. RESUMO: Este artigo analisa as questões referentes à desinstitunalização dos jovens e ao desenvolvimento de serviços ...
Wilcox, W Bradford; Cherlin, Andrew J; Uecker, Jeremy E; Messel, Matthew
We examine trends in religious attendance by educational group, with an emphasis on the "moderately educated:" individuals with a high-school degree but not a 4-year college degree. We conduct multivariate ordinary least-squares (OLS) regression models using data from the General Social Survey (from 1972 to 2010) and the National Survey of Family Growth (from 1982 to 2008). We find that religious attendance among moderately educated whites has declined relative to attendance among college-educated whites. Economic characteristics, current and past family characteristics, and attitudes toward premarital sex each explain part of this differential decline. Religion is becoming increasingly deinstitutionalized among whites with moderate levels of education, which suggests further social marginalization of this group. Furthermore, trends in the labor force, American family life, and attitudes appear to have salient ramifications for organized religion. Sociologists of religion need to once again attend to social stratification in religious life.
The U.S. government has a long tradition of providing direct care services to many of its most vulnerable citizens through market-based solutions and subsidized private entities. The privatized welfare state has led to the continued displacement of some of our most disenfranchised groups in need of long-term care. Situated after the U.S. deinstitutionalization era, this is the first study to examine how immigrant Filipino women emerged as owners of de facto mental health care facilities that cater to the displaced, impoverished, severely mentally ill population. These immigrant women-owned businesses serve as welfare state replacements, overseeing the health and illness of these individuals by providing housing, custodial care, and medical services after the massive closure of state mental hospitals that occurred between 1955 and 1980. This study explains the onset of these businesses and the challenges that one immigrant group faces as owners, the meanings of care associated with their de facto mental health care enterprises, and the conditions under which they have operated for more than 40 years.
Soares, Marden Marques; Bueno, Paula Michele Martins Gomes
This study aimed to discuss the close relationship between mental health, the criminal justice system and the prison system, whose specific interfaces are the HCTP (Hospital de Custódia e Tratamento Psiquiátrico, or Judicial Psychiatric Hospital) conflict and the person with mental disorder in conflict with the law. There will be presented extensive discussions on the Penal Execution Law and the Brazilian Psychiatric Reform Law, as well as cross-sector actions taken by the judiciary and the federal government (Brazilian National Health System - SUS and National Social Assistance System - SUAS) to bring the criminal justice system and the prison system to the anti-asylum combat. Two successful experiences in the states of Minas Gerais and Goiás will also be presented for they reflect the emergence of a new strategy on public health policy: The Evaluation Service and Monitoring Therapeutic Measures for the Person with Mental Disorder in Conflict with the Law, device connector between systems, willing to operate in the process of deinstitutionalization of people with mental disorders of HCPT.
Haberfellner, Egon Michael; Grausgruber, Alfred; Grausgruber-Berner, Rosemarie; Ortmair, Margarethe; Schöny, Werner
The study was intended to evaluate the therapeutic and healthcare services utilized by 116 former long-stay patients after an average of 42.9 months of deinstitutionalization during a follow-up time of (1/2) year and to calculate the costs thus incurred. 116 patients and their caregivers were interviewed during a period of 6 months using the German version of the Client Sociodemographic and Service Receipt Inventory. On average, 3.3 institutions/facilities were contacted per patient, most often by younger patients living in group homes and least often by patients in psychiatric nursing homes. During the 6-month follow-up time costs of euro 14,665 were incurred per patient. Of these costs, 87.2 % were for the residential facilities. The costs of outpatient care accounted for 41.4 % of the costs that would have been incurred for inpatient care in a psychiatric hospital. Deinstitutionalization of psychiatric long-stay patients in Upper Austria provided for considerable reductions in costs while maintaining a high quality of care.
Full Text Available The article reconstructs the trajectories of young people in a peripheral neighborhood of Buenos Aires, analyzing practices and subjective valuations about school, work and family. In a context of deep transformations in the condition of youth, this research analyzes the breakdown of the linear model of the transition to adulthood. It also describes the paradoxes in the process of deinstitutionalization of the life course, offering a glimpse into the increasing relevance of new relational supports in shaping youth trajectories.
Andrey Yu. Mikhailov
Full Text Available This article is based on the methodology of intellectual history examines the process of secularization of Orthodoxy in the late Russian Empire 1860 – 1910-ies. The focus of the formulation of a scientific problem: consideration of secularization as indoctrination Orthodoxy and de-institutionalization of the Synod Church. Under the first attempt to synthesize the doctrine Orthodoxy with modernist ideologies (socialism, nationalism, secularism (laicism, under the second – the erosion of the church as an institution by dividing into various inner-group. As a consequence of early modern rationalization to 1830–1840 there are three ways of indoctrination orthodoxy as synthesis with modern ideology. Firstly, synthesis with a modernist nationalism in its evolution from the "civilian" to the "political". The concept of late imperial political nationalism (N.P. Ignatiev, A.A. Kireev, tied to version of neoslavyanofily (new slavyanofily (N.P. Aksakov, D.A. Khomyakov and civilizational theory (L. Leontiev, N.I. Danilevsky tried synthesize Orthodoxy and nationalism in the spirit of religious interpretation of the nation and society. Secondly, with social theories of modern European socialism and positivism. (archimandrite Fedor (Bukharev, S.N. Bulgakov, archimandrite Michael (Semenov, and others.. Thirdly, with a modernist secularism (laicism and liberalism: P.V. Valuev, D.A. Tolstoy, K.P. Pobedonostsev. De-institutionalization of the Synodal Church took place in the following ways. In the period of early modernity (1700–1840, konfessionaliztion (die Konfessionalisierung, happened embedding religious institution in the state organism (nationalization on the practical and theoretical level. The evolution from the early modernity to late modernity (1830–1860 itself has raise the question of the "internal" secularization as activation of layman or parishioner. Theory A.S. Khomyakov (new criteria and the nature of the Church as a divine
Kallert, T W; Stoll, A; Leisse, M; Winiecki, P
Within the deinstitutionalization process of a large psychiatric hospital, the development of two cohorts of patients with chronic schizophrenia is compared over a two-year period: patients living in the hospital's nursing-home area (n = 50) vs. patients already released to two social therapeutic hostels (n = 51). Results of the cohort study were compared with assessments of nurses working in the nursing home (n = 55), focusing on their subjective views of the deinstitutionalization process and its impact on their working conditions. Patients are assessed through yearly home-visits in their place of residence. The instruments used measure several outcome parameters: psychopathology, social disabilities, subjective quality of life, and normative needs for care. Concurrent staff assessments were conducted using standardized survey instruments focusing on current working conditions and quality of teamwork. Nineteen nurses participated in qualitative interviews evaluating the deinstitutionalization process. For all measures, patients living in the nursing home show significantly worse outcomes. Furthermore, during the study period 34 % experienced a change in their living situation with which they were dissatisfied. Needs for care and the number of areas of "unmet" need increased significantly for this subgroup. Patients living in social therapeutic hostels demonstrate stable levels of psychopathological symptoms, social disabilities, and needs for care. Assessments indicating a deterioration in patients' subjective quality of life focus mainly on areas important for social contacts. Regarding "personal concerns" and "insecurity at work", ratings from nursing home staff were significantly worse than those of a reference group from several other health care institutions (n = 224). Staff showed a tendency to give higher ratings for their opportunities to participate in decisions, in contrast with the low ratings for chances to improve their knowledge in the workplace, a
Frederick W. Hickling
Full Text Available OBJECTIVE: To consider whether or not deinstitutionalization and the integration of community mental health care with primary health care services have reduced stigma toward mental illness in Jamaica. METHODS: A qualitative study of 20 focus groups, with a total of 159 participants grouped by shared sociodemographic traits. Results were analyzed using ATLAS.ti software. RESULTS: Participant narratives showed that stigma had transitioned from negative to positive, from avoidance and fear of violent behavior during the period of deinstitutionalization to feelings of compassion and kindness as community mental health services were integrated with Jamaica's primary health care system. The Bellevue Mental Hospital and homelessness were identified as major causes of stigma. CONCLUSIONS: Attitudes toward the mentally ill have improved and stigma has decreased since the increase of community involvement with the mentally ill. This reduction in stigma seems to be a result of the rigorous deinstitutionalization process and the development of a robust community mental health service in Jamaica.OBJETIVO. Evaluar si el externamiento psiquiátrico y la integración de los servicios comunitarios de salud mental con los servicios de atención primaria de salud han reducido el estigma respecto de las enfermedades mentales en Jamaica. MÉTODOS. Estudio cualitativo de 20 grupos de opinión con un total de 159 participantes agrupados según sus características sociodemográficas. Se analizaron los resultados con el software ATLAS.ti. RESULTADOS: Los relatos de los participantes revelaron que, cuando los servicios comunitarios de salud mental se integraron con el sistema de atención primaria de salud de Jamaica, el estigma había pasado de negativo a positivo y de la evitación y el temor a un comportamiento violento durante el período de externamiento a sentimientos de compasión y amabilidad. Las principales causas de estigma identificadas fueron el modelo de
Maria Stella Brandão Goulart
Full Text Available Esta pesquisa investigou como o processo de Reforma da Política de saúde mental repercutiu no mais antigo hospital psiquiátrico público de Belo Horizonte, o Instituto Raul Soares, resultando em iniciativas institucionais que procuravam responder à crítica aos asilos e à cultura manicomial que emergiu desde os anos 60 (século XX, em Minas Gerais. Trata-se de um esforço historiográfico, realizado em 2007, que trabalhou com fontes documentais e orais (entrevistas com psiquiatras, psicólogos, enfermeiros e outros, recuperando informações sobre as décadas de 60, 70 e 80. O referencial teórico foi o da Análise Institucional. Foram enfocadas iniciativas instituintes que tomaram a forma de projetos assistenciais e de formação que objetivavam a reestruturação do hospital: o Ambulatório Central Roberto Resende; a Residência em Psiquiatria, o Projeto Guimarães Rosa e o Hospital Dia. São evidenciados os paradigmas de referência e o contraditório processo de desinstitucionalização.The aim of the present research is to determine how the mental health Policy Reform affected the Raul Soares Institute, the first public psychiatric hospital (asylum in Belo Horizonte, tracing institutional initiatives that aimed to respond to criticisms on the mental houses and their set of procedures in usage since the 1960s, in the state of Minas Gerais. The research became a historiographic effort, carried out in 2007, dealing with oral and documental sources (interviews with psychiatrists, psychologists, nurses and others and collecting information about facts that occurred in the 1960s, 1970s and 1980s. Institutional analysis was taken as the theoretical support. The present study focused on initiatives that assumed the format of assisting and constitutional projects that aimed to remodel the Raul Soares Institute. In addition, paradigms of references and the contradiction-marked process of deinstitutionalization were made evident.
Rothman, David J.
This vignette from the author's book, "The Reform of the Asylum: Between Conscience and Convenience in Progressive America," provides historical evidence of resistance to community placement of the mentally disabled. Resistance is due to the social convenience of custodial care and the self-interest of institutions and their employees.…
Full Text Available O presente trabalho teve como objetivo relatar uma experiência de ensino da disciplina Enfermagem Psiquiátrica na Faculdade de Enfermagem da Universidade Regional do Rio Grande do Norte (FAEN-URRN, desenvolvida desde meados da década de 1980 até meados da década de 1990, sob a ótica da desinstitucionalização e dos direitos de cidadania do doente mental, ancorados na discussão sobre saúde e sociedade, utilizando-se o método de discussão teórica, compilação de textos e confronto da teoria/prática em atuação de campo. Dos resultados obtidos, constatou-se que a base teórico-metodológica do materialismo histórico e dialético como fio condutor do processo de captação do ensino-aprendizagem possibilitou melhor compreensão da totalidade, além de incentivar posteriormente uma revisão crítica do curso de enfermagem da FAEN-URRN e da atuação do enfermeiro em saúde mental.The present paper aimed at reporting an educational experience in Psychiatric Nursing Course at the College of Nursing of the Regional University of Rio Grande do Norte (FAEN-URRN, in the period from the middle of 80's to the middle of 90's, under the de-institutionalization view and the mental patient citizenship rights, anchored in the discussion on health and society. The theoretical discussion, compilation of texts and confrontation of the theory/practice in field performance were the method utilized. Among these results, it was evident the methodological-theatrical base of the historical and dialectic materialism, as a conducting wire of the attainment of the teach-learning process, making possible a better comprehension on the totality and a posterior critical review of the nursing program of FAEN-URRN and the nurse performance in mental health.
Afetos, sabores e trilhas: a oficina de culinária como operador clínico da desinstitucionalização / Affections, flavors and trails: a culinary workshop as a promoter resource of the deinstitutionalization
Viviani Cristina Costa
Full Text Available Este artigo discorre sobre a utilização de uma oficina de culinária como recurso operador da desinstitucionalização. Trata-se de um relato de experiência da intervenção proposta por terapeutas ocupacionais com pessoas internadas por longo período em enfermarias de um hospital psiquiátrico universitário, no município do Rio de Janeiro. Discutem-se fragmentos da trajetória de quatro participantes que exemplificaram, através de seus percursos na oficina de culinária, questões relacionadas ao processo de desinstitucionalização, criação de redes, contratualização e fomento da autonomia. Percebeu-se que as atividades realizadas foram potencializadoras dessas questões ao permitirem transcender a rotina instituída e massificadora da internação e possibilitar novas e diferentes formas de estar na vida e de estabelecer conexões diversas. A intervenção terapêutica ocupacional permitiu a análise e a adaptação das atividades, o manejo das relações que se estabeleceram a partir delas, tendo em vista o compromisso com os processos de inclusão, participação social, bem como demais ocupações. This article discusses the use of a cooking workshop as a promoter resource of the deinstitutionalization. It is an experience report about an intervention offered by occupational therapists to assist people hospitalized for long periods in University psychiatric hospital, in the city of Rio de Janeiro. We discuss the fragments of trajectory of four workshop participants who exemplified issues related to the process of deinstitutionalization, networking, contractualization and increased autonomy. It was noticed that the activities offered potentiated these issues by allowing transcend the hospital routine and enabled new and different ways of being in life and establish several connections. The occupational therapy intervention allowed the analysis and adaptation of the activities, the management of relationships established from
Desinstitucionalização em saúde mental e práticas de cuidado no contexto do serviço residencial terapêutico De-institutionalization of mental health and care practices in the context of home-based care
Ana Karenina de Melo Arraes Amorim
Full Text Available Os serviços residenciais terapêuticos (SRT no Brasil são considerados estratégicos e imprescindíveis no processo de desinstitucionalização de egressos de longas internações psiquiátricas que perderam vínculos sociais e familiares. No entanto, muitos são os problemas e desafios que este serviço evidencia no contexto mais amplo da atenção à saúde. Este artigo procura analisar alguns desses problemas e desafios a partir da experiência do SRT de Natal, Rio Grande do Norte, e de contribuições da literatura do campo. Propostos com base na idéia de que os encontros entre loucura e cidade são potentes no sentido da desconstrução da " lógica manicomial" , os SRT são problematizadores do modelo de atenção em saúde vigente, pois exigem a desconstrução das formas rígidas e hegemônicas de morar e cuidar. Pretende-se problematizar essa " lógica manicomial" que atravessa os limites dos manicômios concretos e se atualiza no cotidiano dos serviços substitutivos em certas práticas e na frágil articulação da rede de saúde mental. A falta de articulação efetiva entre SRT e Centro de Atenção Psicossocial (CAPS dá lugar a dispositivos biopolíticos no cotidiano através dos quais essa lógica opera. Discutimos, então, os riscos de captura por esta lógica e indicamos algumas das possibilidades de desconstrução, defendendo uma clínica que possibilite encontros potentes com a cidade e a construção de " redes de trabalho afetivo" produtoras de vida e liberdade.In Brazil, the home-based care services (HCS are considered strategic and essential in the de-institutionalization process of patients who passed years in psychiatric hospitals and lost their family and social links. However, this service faces a series of problems and challenges in the wider context of health care. This article seeks to analyze some of these problems and challenges based on the experience of the home-based care service in Natal RN and on the
Rafael Gustavo Maluf
Full Text Available This study investigated the satisfaction level of psychiatric patients in the therapeutic residential services of Barbacena-MG. Total population comprised 154 individuals, of which 45 were sampled. Subjects were interviewed with the SATIS-BR scale and a sociodemographic questionnaire. Results showed a high degree of satisfaction with the service for the global score and its three dimensions staff competence and understanding, help received, infrastructure. Results were not related to sociodemographic and clinical variables analyzed individually. Multivariate analysis indicated higher satisfaction for literate patients and for those that underwent some other form of treatment (e.g., hydrogymnastics and fitness activities besides medications or occupational therapy. We conclude that the therapeutic residence services appear to be a viable alternative for mental health public policy, from the patients' perspective.
Full Text Available Since the 1990s, affirmative action opponents have targeted colleges’ and universities’ race-conscious admissions policies and secured bans on the practice in eight states. Although scholarly and media attention has focused on these dynamics at a handful of elite institutions, little is known about race-conscious admissions across the broader field of higher education. We provide a descriptive, quantitative account of how different types of colleges and universities responded to this political context. Through analysis of almost 1,000 selective colleges and universities, we find a dramatic shift in stated organizational policy starting in the mid-1990s. In 1994, 60 percent of selective institutions publicly declared that they considered race in undergraduate admissions; by 2014, just 35 percent did. This decline varied depending on status (competitiveness and sector (public or private. Race-conscious admissions remain the stated policy of almost all of the most elite public and private institutions. The retreat from race-conscious admissions occurs largely among schools lower in the status hierarchy: very competitive public institutions and competitive public and private institutions. These patterns are not explained by implementation of state-level bans. We suggest that the anti–affirmative action movement had a diffuse impact whose effects varied across different strata of American higher education.
Alison A Hillman
Full Text Available El 17 de diciembre de 2003, en una decisión sin precedente, la Comisión Interamericana de Derechos Humanos pidió medidas urgentes de auxilio para proteger la vida y salud de 460 personas que estaban detenidas en el hospital neuropsiquiátrico estatal del Paraguay. Por primera vez la Comisión convocó a la toma inmediata de medidas críticas para combatir una serie de abusos que se venían cometiendo en una institución psiquiátrica. La entidad conocida por Mental Disability Rights International (MDRI, o Agencia Internacional para los Derechos de Personas con Discapacidad Mental y el Center for Justice and International Law (CEJIL, o Centro de Justicia y Derecho Internacional intercedieron ante la Comisión Interamericana a favor de dos niños, Julio y Jorge, que por más de cuatro años habían estado encerrados en celdas de dos metros cuadrados, sin acceso a un baño, así como a favor de otras 458 personas recluidas en la institución en condiciones igualmente inhumanas y denigrantes. Desde diciembre de 2003, la MDRI y el CEJIL, junto con la Organización Panamericana de la Salud, han venido luchando por conducto de la Comisión para lograr cambios fundamentales no solamente en las condiciones imperantes y en el tratamiento de las personas recluidas en el hospital, sino también en la estructura de los servicios de salud mental en el Paraguay.
["Should the staff's attitude towards the patients remain unchanged, I will not guarantee anything." Protest masculinity and coping of "rebellious patients" at the Heidelberg University Psychiatric Hospital on the eve of deinstitutionalization].
This article analyses the illness experiences of male patients from the Heidelberg University Psychiatric Hospital during the protests against Psychiatry in the year 1973. Protest is one of the most important expressions of masculinity in socially disadvantaged men, such as men with mental disorders. The analysis of 100 medical records shows that some patients tried to construct themselves as men in a way that was explicitly motivated by antipsychiatric ideas: They questioned psychiatric authority, behaved "sexually inappropriate", or used drugs. On the eve of psychiatric reform in West Germany those patients were well aware that the alternative--complying with the treatment--would put them at considerable risk. In addition to the usual inference of hegemonic or normative masculinities as risk-factors, the behavior of those ,,rebellious patients" has to be interpreted as individual coping strategies.
Deinstitutionalization revisited: a 5-year follow-up of a randomized clinical trial of hospital-based rehabilitation versus specialized assertive intervention (OPUS) versus standard treatment for patients with first-episode schizophrenia spectrum disorders
Nordentoft, Merete; Øhlenschlæger, Johan; Thorup, Anne Amalie Elgaard
BACKGROUND: The effects of hospital-based rehabilitation including weekly supportive psychodynamic therapy compared with specialized assertive intervention and standard treatment has not previously been investigated in first-episode psychosis. The aim of the study was to examine long-term effect...... in a special part of the Copenhagen OPUS trial and randomized to either the specialized assertive intervention program (OPUS), standard treatment or hospital-based rehabilitation. RESULTS: It was a stable pattern that patients randomized to hospital-based rehabilitation spent more days in psychiatric wards...
Saúde mental, mudança social e discurso bioético: uma face da desinstitucionalização revelada em uma notícia de jornal Mental health, social change and bioethical discourse: a view of deinstitutionalization revealed in a newspaper
Márcia Andrade Pinho
Full Text Available Na contemporaneidade, desafios e dilemas bioéticos em saúde mental estão exigindo estudos e reflexões. Este trabalho pretende contribuir com a discussão sobre a atual política de saúde mental, especialmente a questão da reinserção social de portadores de transtornos mentais. É importante que essa construção na comunidade e na cultura avance em sintonia com uma "rede" de saúde mental que possa responder por essa assistência e, assim, afrontar o risco de uma mera desospitalização irresponsável, pois, caso contrário, estaremos diante de um quadro de desassistência. Por acreditar que o discurso jornalístico possibilita uma compreensão mais abrangente de certos aspectos acerca dos significados, recursos e práticas que vêm sendo utilizadas no cotidiano, propõe-se aqui analisar um texto jornalístico, tendo como referencial a Análise do Discurso Crítico que, juntamente com os conceitos bioéticos, permitirá o entendimento da forma pela qual esse processo vem ocorrendo.Nowadays, challenges and bioethical dilemmas in mental health are demanding studies and reflections. This paper aims to contribute to the discussion on the current mental health policy, especially the issue of social reintegration of people with mental disorders. It is important that this construction in community and culture go in line with a mental health "network" able to account for such assistance and thus face the risk of a mere irresponsible dehospitalization; otherwise, we will face a situation of lack of assistance. Believing that media discourse provides a more comprehensive understanding of certain aspects about the meanings, practices and resources that have been used in everyday life, it is proposed here to analyze a journalistic text, taking in consideration the Critical Discourse Analysis which, together with the bioethical concepts, would allow the understanding of the way in which this process is occurring.
A contribuição da atenção domiciliar para a configuração de redes substitutivas de saúde: desinstitucionalização e transformação de práticas Home care's contribution to alternative health care networks: deinstitutionalization and transformation of practices
Laura C. M. Feuerwerker
Full Text Available OBJETIVO: Identificar o estado da arte da atenção domiciliar no âmbito do sistema público de saúde no Brasil, analisar o seu potencial de inovação no sentido da integralidade e da humanização da atenção e indicar pistas para a sua ampliação. MÉTODOS: Sete experiências de cuidado domiciliar em cinco municípios brasileiros foram analisadas por meio de estudos de caso, com base em entrevistas com os cinco gestores municipais e os sete coordenadores dos serviços, com todos os componentes das equipes de atenção domiciliar e com os usuários e os familiares dos 27 casos selecionados. Todas as entrevistas foram gravadas e depois transcritas. Foram ainda analisados documentos produzidos pelos serviços (proposta política, relatórios de gestão, relatórios de avaliação, rotinas e protocolos de atenção, observados atendimentos (ao menos um de cada uma das equipes em todos os sete serviços e analisados os casos traçadores. RESULTADOS: Foram identificados os seguintes tipos de atendimento domiciliar: cuidado paliativo, cuidado a pacientes com AIDS, cuidado a portadores de feridas e lesões de pele, acompanhamento de bebês prematuros, acompanhamento de acamados crônicos, antibioticoterapia endovenosa como complementação do tratamento para infecções agudas. São aspectos a destacar: a qualidade e a humanização da atenção, o trabalho em equipe, o desenvolvimento de vínculo e a responsabilização por parte dos trabalhadores e a participação efetiva dos cuidadores e das famílias na produção dos projetos terapêuticos. CONCLUSÃO: As iniciativas examinadas mostraram que a atenção domiciliar é possível até em ambientes economicamente precários e que pode contribuir efetivamente para a produção de integralidade e de continuidade do cuidado, devendo ser ampliada no âmbito do sistema público de saúde.OBJECTIVE: To identify state-of-the-art home care within Brazil's public health system, evaluate its potential for improving the comprehensiveness and humanization of care, and identify areas for expanding this care modality. METHODS: Seven home care initiatives were examined and cases were analyzed through interviews with five municipal services managers, seven service coordinators, all home-care team members, and with the service recipients, as well as the family members of the 27 cases selected. All of the interviews were recorded and transcribed. We also analyzed documents created by the home care services (policy manuals, management reports, evaluation reports, and care protocols, observed each team providing care (at least once for each of the seven service types, and analyzed the selected cases. RESULTS: The following types of home care were identified: palliative, AIDS, skin lesions/wounds, premature infant, bedridden patient, and supplemental intravenous antibiotic therapy for acute infection. The following positive aspects should be highlighted: the quality and humanization of care, team work, the bond developed with patients and family, the sense of responsibility taken on by the health workers, and the effective participation of caretakers and families in carrying out therapy plans. CONCLUSION: The initiatives examined show that home care is possible even in economically disadvantaged environments and that it may effectively contribute to providing integrated and continued care. Home care should be expanded in the context of the public health system.
Cuidar no paradigma da desinstitucionalização: A sustentabilidade do idoso dependente na família El cuidado en el paradigma de desinstitucionalización: la sostenibilidad de las personas mayores dependientes en la família Caring in the deinstitutionalization paradigm of: sustaining dependent elders in the family
Full Text Available Este estudo teve como objectivos caracterizar famílias com um idoso dependente em contexto familiar e identificar apoios sociais das famílias com um idoso dependente. Foi realizado um estudo exploratório descritivo de natureza qualitativa. Recorremos à entrevista semi-estruturada para colheita de informação (elaboração de genograma e ecomapa. Seleccionamos uma amostra intencional de 108 famílias de um concelho, de uma região Norte de Portugal. A colheita de dados ocorreu no período de Outubro 2007 a Junho de 2008. Os resultados mostraram que as famílias com idosos dependentes são predominantemente famílias nucleares e envelhecidas, com apoios formais e informais restritos. Nas fontes informais, a figura dos filhos foi a mais relatada seguindo-se os vizinhos e amigos, enquanto, nas formais foram referidas as unidades de saúde e profissionais de saúde: médico, enfermeiro, fisioterapeuta, farmacêutico e assistente social.Este estudio tiene como objetivo caracterizar a las familias con un anciano dependiente en contexto familiar e identificar los apoyos sociales de las familias con un anciano dependiente. Se realizó un estudio exploratorio descriptivo de naturaleza cualitativa. Hemos recurrido a la entrevista semi-estructurada para recopilar información (elaboración de genograma y ecomapa. Se seleccionó una muestra intencional de 108 familias de una región al norte de Portugal. Los datos fueron recolectados entre Octubre de 2007 y Junio de 2008. Los resultados mostraron que las familias con personas mayores con dependencia son en su mayoría familias nucleares y envejecidas, con un apoyo limitado formal e informal. En las fuentes informales, la figura de los hijos fue la más relatada, siguiéndose los vecinos y amigos, mientras que en las formales fueron referidas las unidades de salud y profesionales de la salud: médico, enfermero, fisioterapeuta, farmacéutico y asistente sociales.This study main objectives were to describe families living with a dependent elder and to identify the social support of these families. We carried out a qualitative exploratory study using semi-structured data collection methods (development of eco-maps and genograms. We selected a sample of 108 families in a region of northern Portugal. Data collection took place from October 2007 to June 2008. The results showed that families with dependent elders are predominantly older nuclear families, with limited formal and informal support. With regard to informal sources, family relationships were the most reported, followed by neighbours and friends, while for formal sources the most mentioned were healthcare facilities and healthcare professionals: doctors, nurses, physiotherapists, pharmacists and social workers.
problematic. To comment on mental health systems in Africa, .... be an option for assisting with both de-stigmatization and ... deinstitutionalization with a reduction in both chronic and ... such as the family, societal change, bullying in schools,.
Gurses, Kerem; Giones, Ferran; Mehta, Kandarpkumar
We study the deinstitutionalization of a controversial practice that had previously reached a level of international diffusion. We draw on international diffusion and deinstitutionalization theory to study the emergence and diffusion of the third-party ownership practice in the soccer industry. We...... use an inductive case study combining archival and interview data to study the determinants of the international diffusion of a controversial practice at a global scale, the contestation, and finally the deinstitutionalization process that resulted from the ban of the practice. We find...... that the opacity of the practice can be a diffusion driver, locally and at the international level, nevertheless the opacity also may lead to different meaning creation attempts and potential discursive battles between actors, and eventually to deinstitutionalization of the practice. This article advances our...
Trappenburg, M J
Traditional welfare states were based on passive solidarity. Able bodied, healthy minded citizens paid taxes and social premiums, usually according to a progressive taxation logic following the ability to pay principle. Elderly, fragile, weak, unhealthy and disabled citizens were taken care of in institutions, usually in quiet parts of the country (hills, woods, sea side). During the nineteen eighties and nineties of the twentieth century, ideas changed. Professionals, patients and policy makers felt that it would be better for the weak and fragile to live in mainstream society, rather than be taken care of in institutions outside society. This might be cheaper too. Hence policy measures were taken to accomplish deinstitutionalization. This article discusses the implications of deinstitutionalization for distributive justice. It is argued that the weakest among the weak and fragile stand to lose from this operation. For able bodied citizens deinstitutionalization entails a move from passive to active solidarity. Rather than just pay taxes they have to actively care for and help the needy themselves. The move from passive to active solidarity tends to take advantage of benevolent citizens and burden the socioeconomically disadvantaged. This may be a reason to reconsider the policy move toward deinstitutionalization.
Priebe, Stefan; Frottier, Patrick; Gaddini, Andrea; Kilian, Reinhold; Lauber, Christoph; Martinez-Leal, Rafael; Munk-Jorgensen, Povl; Walsh, Dermot; Wiersma, Durk; Wright, Donna
Objective: Although mental health reforms in the 20th century were characterized by deinstitutionalization, previous research suggested a new era of reinstitutionalization in six European countries between 1990 and 2002. This study aimed to establish whether there has been a trend in Europe toward
Wexler, Alice; Derby, John
In this article, we use a disability studies lens to examine ways in which the artworks of disabled people are bonded in a common sociopolitical experience. We analyze the history surrounding institutional art and the emergence of community art centers at the time of deinstitutionalization in the late 20th century. As a result of this…
Gurses, Kerem; Giones, Ferran; Mehta, Kandarpkumar
We use international diffusion, deinstitutionalization, and power theory to explain the diffusion and ban of the third-party ownership (TPO) practice in the soccer industry. We use an inductive case study combining archival and interview data to identify the mechanisms that lead to the diffusion,...
Staley, Georgiana M.
Probation and parole officers supervise a disproportionate amount of offenders with mental illness. Many causes contribute to this over-representation ranging from deinstitutionalization, to co-occurring disorders, to homelessness. It appears there may be a lack of training specifically for probation and parole officers on the topic of mental…
In Japan, there is a growing network of self-advocacy groups. Some groups are involved in campaigning. Other groups are involved in social events and education. The age of de-institutionalization is gradually arriving and community living for people with learning difficulties is becoming an urgent political issue. Self-advocacy groups can help…
Tossebro, Jan; Bonfils, Inge S.; Teittinen, Antti; Tideman, Magnus; Traustadottir, Rannveig; Vesala, Hannu T.
The authors discuss recent developments in services for people with intellectual disabilities (ID) in the Nordic countries. They note that all of the countries saw important reforms during the 1990s, regarding both deinstitutionalization and decentralization. However, they posit that the litmus test of the reforms is not what happens during reform…
Homelessness is a complex policy issue that all local governments face. But, at the same time, local authorities often have very little influence on the causes of homelessness, such as de-institutionalization, drug addiction, and release from detention or evictions. Seen in a European context,
Silver, Larry B.
This article compares the ideals of the regular education initiative to provide services for learning-disabled students within the regular classroom to the ideals and resulting negative effects (e.g., homelessness) of the deinstitutionalization of the mentally ill during the 1960s. Resistance to efforts to decrease or eliminate special education…
Baker, Elizabeth H.; Sanchez, Laura A.; Nock, Steven L.; Wright, James D.
This study contributes to research on the deinstitutionalization of marriage and changing gender ideologies by focusing on a unique group of marriage innovators. With quantitative and qualitative data from the Marriage Matters project (1997-2004), this study used a symbolic interactionist perspective to compare covenant- and standard-married…
Brennan, Damien; Murphy, Rebecca; McCallion, Philip; McCarron, Mary
Background: Changing family sociodemographic factors, increased life expectancy for people with an intellectual disability, deinstitutionalization and policy prioritization of the family as the principal care provider, presents new challenges to care sustainability. Method: A qualitative study design was employed, entailing focus groups and…
Uchtenhagen, Ambros A.
Social psychiatry started over a century ago under the auspices of mental and racial hygiene, but after World War II it embraced concepts of community-based care and de-institutionalization. The major psychiatric reforms in the second half of the last century were mainly based on such concepts,
Lambri, Maria; Chakraborty, Apu; Leavey, Gerard; King, Michael
Objectives. Deinstitutionalization of long-term psychiatric patients produced various community-based residential care facilities. However, inner-city areas have many patients with severe mental illness (SMI) as well as deprivation, unemployment, and crime. This makes meeting their community needs complex. We undertook a needs assessment of service provision and consonance between service users’ evaluation of need and by care workers. Design. Cross-sectional study with random sample of SMI s...
1. With deinstitutionalization and changes in legal rights of patients, care of patients with severe mental illness has shifted from a hospital-based to a community-centered system. 2. Families often serve as an extension of the mental health system, providing important case management functions such as assessment, monitoring, crisis management, and advocacy. 3. Symbolic interactionism provides a framework for understanding the role of meaning in individual and family responses to the disruption of life that results from severe mental illness.
Evaluación de la efectividad de un programa de gestión de casos para pacientes esquizofrénicos en centros de salud mental / Assessment of the effectiveness of a case management programme for schizophrenic patients in mental health centres
[eng] The psychiatric deinstitutionalization leaded to an increase of community resources for persons with Severe Mental Illness (SMI). These resources include the so-called case management programs that aim to organize, coordinate and integrate the resources available for patient care through continuous contact with one or more key workers. The Mental Health Strategy of the Spanish National Health System (2007) recommends case management programs for the coordination, access and use of menta...
Kalapos, Miklós Péter
According to the Penrose's law, outlined on the basis of a comparative study of European statistics, there is an inverse relationship between the number of psychiatric beds and prison population. Based on international data, interrelationship among prison, asylum, psychiatric disease and criminal action are investigated in the present study, paying particular attention to the event of deinstitutionalization. Prevalence of mental and addictive diseases as well as psychological disturbances in prison is characterized by epidemiological data. As proposed by Penrose, an inverse relationship between the number of psychiatric beds and prison population can be observed in Hungary, too. To get a deeper insight into the mainstream of the events, economic, sociological, philosophical, as well as therapeutic aspects initializing deinstitutionalization are highlighted in the course of analysis. On the basis of data, it can be assumed that members the same population are confined to both systems. The author arrives at the conclusion that deinstitutionalization has in fact led to trans-institutionalization, because of, on one hand, the limited capacity of community treatment facilities; on the other hand, the community treatment itself cannot provide adequate treatment options to those suffering from severe, chronic mental diseases or comorbid states. In addition, the rate of financial support and the methods for prevention and treatment are insufficient to protect patients from the effects of revolving door.
Full Text Available The Walk-out went on the road with the intention of condemning total institutions. Total institutions have been defined as peace time crimes because they deprive their inhabitants freedom and do not provide for their needs. Deinstitutionalization is an alternative to enclosure. The start of the process of deinstitutionalisation in Slovenia in the field of mental health are described. Special attention is also paid to the Italian experience with the closure of the mental health hospitals and the establishment of community services. Since deinstitutionalization has stopped in Slovenia it has been decided to promote it within a movement. People with the experience of total institutions, social workers and others merged in the movement. On the road twenty six round tables or public debates were organized. They have shown that the goal of deinstitutionalization is declared by everyone, the main obstacles to it are the lack of finances and collaboration between services. Since most of the institutions are in a process of restoration or have just been restored it is believed that deinstitutionalisation in reality is not promoted by the institutions.
Breddam, Claus; Wang, August G; Aggernaes, Karin Helle
INTRODUCTION: The deinstitutionalization of psychiatric hospitals has triggered a development of social institutions for mentally ill persons. In 1987 the psychiatric institution Sundbygård was changed for this purpose, and in 2001 enlarged. A survey in 1998 showed that the residents were mainly...... people suffering from schizophrenia with need for intensive psychiatric treatment. The usage of psychiatric hospital beds for residents increased from an average of 7.7 beds per day in 1998 to 10.2 beds in 2003. It was necessary to repeat the survey from 1998, this time adding an analysis of predictive...
Tyler, Marshall W; Zaldivar-Diez, Josefa; Haggarty, Stephen J
The discovery of haloperidol catalyzed a breakthrough in our understanding of the biochemical basis of schizophrenia, improved the treatment of psychosis, and facilitated deinstitutionalization. In doing so, it solidified the role for chemical neuroscience as a means to elucidate the molecular underpinnings of complex neuropsychiatric disorders. In this Review, we will cover aspects of haloperidol's synthesis, manufacturing, metabolism, pharmacology, approved and off-label indications, and adverse effects. We will also convey the fascinating history of this classic molecule and the influence that it has had on the evolution of neuropsychopharmacology and neuroscience.
Zlotnick, Cheryl; Zerger, Suzanne; Wolfe, Phyllis B
In the 1980s, the combined effects of deinstitutionalization from state mental hospitals and the economic recession increased the number and transformed the demographic profile of people experiencing homelessness in the United States. Specialized health care for the homeless (HCH) services were developed when it became clear that the mainstream health care system could not sufficiently address their health needs. The HCH program has grown consistently during that period; currently, 208 HCH sites are operating, and the program has become embedded in the federal health care system. We reflect on lessons learned from the HCH model and its applicability to the changing landscape of US health care.
Neely-Barnes, Susan Louise; Elswick, Susan E
The philosophy of inclusion for people with intellectual and developmental disabilities (IDD) has evolved over the last 50 years. Over time, inclusion research has shifted from a focus on deinstitutionalization to understanding the extent to which individuals with IDD are meaningfully involved in the community and social relationships. Yet, there has been no agreed on way to measure inclusion. Many different measurement and data collection techniques have been used in the literature. This study proposes a brief measure of inclusion that can be used with family members and on survey instruments.
Buck, Jeffrey A
As Medicaid has emerged as the primary funder of public mental health services, its character has affected the organization and delivery of such services. Recent changes to the program, however, promise to further affect the direction of changes in states' mental health service systems. One group of changes will further limit the flexibility of Medicaid mental health funding, while increasing provider accountability and the authority of state Medicaid agencies. Others will increase incentives for deinstitutionalization and community-based care and promote person-centered treatment principles. These changes will likely affect state mental health systems, mental health providers, and the nature of service delivery.
Full Text Available This article aims to contribute to the questioning and critical discussion of the recent sociological theorization often presenting the contemporary family as an ‘ephemeral’, ‘fluid’ and ‘fragile’ reality. Empirically, the family was conceptualized through the lens of family rituals, combined with a qualitative, intensive and in-depth methodological approach. The main argument presented here is that the theories of deinstitutionalization, individualization and risk are insufficient for understanding the nowadays family, and one needs a more textured approach, capturing its meaning while being simultaneously a physical, relational and symbolic space
Kok, Gerjo; Gurabardhi, Zamira; Gottlieb, Nell H; Zijlstra, Fred R H
Stakeholder theory may help health promoters to make changes at the organizational and policy level to promote health. A stakeholder is any individual, group, or organization that can influence an organization. The organization that is the focus for influence attempts is called the focal organization. The more salient a stakeholder is and the more central in the network, the stronger the influence. As stakeholders, health promoters may use communicative, compromise, deinstitutionalization, or coercive methods through an ally or a coalition. A hypothetical case study, involving adolescent use of harmful legal products, illustrates the process of applying stakeholder theory to strategic decision making. © 2015 Society for Public Health Education.
Full Text Available The care issue brings together a number of social issues. From the legal classification of care, through the problem how to support, the amount of benefits to the scope of protection of caregivers. One of the most noteworthy problems in care for the disabled persons is the duty of providing social insurance for caregivers. The publication focuses on the issue of payment of contributions. Carers’ insurance status is complex and unstable. The difficulty of evaluation is related to the lack of the final shape of long-term care system in deinstitutionalized conditions.
Roberta Pereira Casagrande
Full Text Available The Psychiatric Reform, through the deinstitutionalization process and the creation of substitutive services to the hospitalocentric model, invited families to share part of the responsibility in the care for people with mental disorders. With this change, family members have become essential to the social reintegration of individuals with mental disorders, but without receiving any type of training or orientation on it. Objectives: To investigate the contribution of Occupational Therapy regarding the support and assistance to relatives of people with mental disorders in the context of the Psychiatric Reform and Deinstitutionalization. Methodological Procedures: The discussion presented is based on a non-systematic national and international scientific literature review of book chapters and papers published in the databases Bireme and Medline between 2001 and 2011. Results: It was possible to observe that when the family receives support to deal with the difficulties inherent to the family member with mental disorder, their emotional charge is relieved. It was also found that Occupational Therapy presents a very meaningful theoretical framework concerning this type of assistance, derived from a consistent practice that seems little explored. Conclusions: There is a gap in the services related to the development of programs to attend family necessities, because the burden placed on families of individuals with mental disorder cannot be denied, especially after the Psychiatric Reform, and Occupational Therapy can meaningfully contribute to this work through its practice.
Charles, Nickie; Harris, Chris
This paper explores the ways in which the work-life balance choices made by heterosexual couples differ in different generations, how such choices are gendered, and the extent to which 'individualization' provides an adequate conceptualization of the effects of social change on heterosexual couples. It argues that processes of individualization need to be seen in the context of changing social institutions, and that it is the de-institutionalization of 'the family' and the life course that is leading to a de-gendering of work-life balance choices. The paper draws on findings from a restudy of the family and social change and a study of the gender dimensions of job insecurity both of which were carried out in the same geographical location. The studies provide evidence of generational change in work-life balance choices and increasing occupational differentiation between heterosexual partners. This leads to a situation where increasingly choices are made which blur gendered boundaries and which has been made possible by a process of de-institutionalization of the male breadwinner family. Our findings support the contention that processes of individualization are more apparent amongst younger than older generations and that, because of changes external to the family, there is more negotiation and pragmatism amongst younger generations about work-life choices.
López Gómez, Daniel
Full Text Available The deinstitutionalization of society is in part associated with the growing implementation of new information and communication technologies. These new technologies bring about new collective formations. if the social sciences are succesfully to understand the impact of these technologies, we will need new ways of thinking about institutions and power. We shall take the case of telephone helplines as a test-bed for Foucault's proposals for understanding institutions' operation of power. Specifically, we use the Foucaultian notion that space, body and norms are constitutive elements of the corporeality of institutions. We report how this applies to the case of telephone helplines, and we claim that Foucault's concepts do not go far enough. Instead, we propose the new concept of 'extitution'. Extuition helps understand new anatomies of power anatomy and new kinds of social practices.
Daniel López Gómez
Full Text Available The deinstitutionalization of society is in part associated with the growing implementation of new information and communication technologies. These new technologies bring about new collective formations. if the social sciences are succesfully to understand the impact of these technologies, we will need new ways of thinking about institutions and power. We shall take the case of telephone helplines as a test-bed for Foucault's proposals for understanding institutions' operation of power. Specifically, we use the Foucaultian notion that space, body and norms are constitutive elements of the corporeality of institutions. We report how this applies to the case of telephone helplines, and we claim that Foucault's concepts do not go far enough. Instead, we propose the new concept of 'extitution'. Extuition helps understand new anatomies of power anatomy and new kinds of social practices.
By the 1990s, sociology faced a frustrating paradox. Classic work on mental illness stigma and labeling theory reinforced that the “mark” of mental illness created prejudice and discrimination for individuals and family members. Yet that foundation, coupled with deinstitutionalization of mental health care, produced contradictory responses. Claims that stigma was dissipating were made, while others argued that intervention efforts were needed to reduce stigma. While signaling the critical role of theory-based research in establishing the pervasive effects of stigma, both claims directed resources away from social science research. Yet the contemporary scientific foundation underlying both claims was weak. A reply came in a resurgence of research directed toward mental illness stigma nationally and internationally, bringing together researchers from different disciplines for the first time. The author reports on the general population’s attitudes, beliefs, and behavioral dispositions that targeted public stigma and implications for the next decade of research and intervention efforts. PMID:23325423
Full Text Available Although Cambodia adopted a modern democratic constitution in 1993, Prime Minister Hun Sen has consolidated an autocratic regime in which elections are the only way political competition plays out, and even that competition is limited. Freedom of expression, horizontal and vertical control mechanisms, and civil participation have been reduced to almost zero by the Royal Government of Cambodia. Irrespective of the deinstitutionalization of liberal principles, the European Commission and some EU member states still perceive Cambodia as moving toward democratization. In the case of Cambodia, the difficulty of external democracy promotion is compounded by the limited impact of formal state institutions, which are completely undermined by kinship relations, personal networks, clientelism and nepotism. However, one can observe not only non-effective efforts toward European democracy promotion, but also increasing human rights violations due to trade facilitations, namely the EU’s “Everything But Arms” initiative.
Caqueo-Urízar, Alejandra; Rus-Calafell, Mar; Urzúa, Alfonso; Escudero, Jorge; Gutiérrez-Maldonado, José
Family interventions for schizophrenia have been amply demonstrated to be effective and are recommended by most of the international clinical guidelines. However, their implementation in the clinical setting as well as in treatment protocols of patients with psychosis has not been fully achieved yet. With the increasing deinstitutionalization of patients, family has begun to assume the role of care performed by psychiatric hospitals, with a high emotional cost for caregivers as well as the recognition of burden experiences. Families have been the substitute in the face of the scarcity of therapeutic, occupational, and residential resources. For this reason, the viability of patients’ care by their families has become a challenge. This article aims to discuss the most important aspects of family interventions, their impact on families, and the most important challenges that need to be overcome in order to achieve well-being and recovery in both patients and caregivers. PMID:25609970
Fabíola Lisboa da Silveira Fortes
Full Text Available Objective: analyzing the strategies adopted by mental health nurses for professional qualification in a Psychosocial Care Center. Methods: a historical-social study with written documents and interviews with ten health professionals linked to the Psychosocial Care Center. Data analysis followed chronological order of the facts, and the emerging themes were triangulated and based on concepts that support Brazilian psychiatric reforms. Results: for professional qualifications, nurses invested in participating in congresses, seminars and symposiums; conducting study groups in order to develop new practical skills for mental health some nurses participated more frequently in workshops and followed other professionals for better insertion in this new context. Conclusion: the nurses approached interdisciplinary care to reconfigure their practices, investing in intellectual empowerment and faced the challenge of transforming mental health care in a deinstitutionalized practice.
Manuela Elisabeth Kuehr
Full Text Available Children and youth are considered cornerstones of development in post-conflict state-building practices. In the case of Rwanda, the government has engaged in an ambitious state-initiated deinstitutionalization project that anticipates the closure of all officially registered orphanages between 2012 and 2014. As a consequence, all orphans within institutional care will return to their extended families or be placed with foster parents to be given the opportunity to grow up within a Rwandan family environment. By investigating the lived realities of orphans before their departure from the orphanage, it becomes apparent that there is no “one size fits all” approach to systems of child care as historical and psychosocial dynamics play a crucial role.
Breddam, Claus; Wang, August G; Aggernaes, Karin Helle
INTRODUCTION: The deinstitutionalization of psychiatric hospitals has triggered a development of social institutions for mentally ill persons. In 1987 the psychiatric institution Sundbygård was changed for this purpose, and in 2001 enlarged. A survey in 1998 showed that the residents were mainly...... people suffering from schizophrenia with need for intensive psychiatric treatment. The usage of psychiatric hospital beds for residents increased from an average of 7.7 beds per day in 1998 to 10.2 beds in 2003. It was necessary to repeat the survey from 1998, this time adding an analysis of predictive...... factors for readmission to psychiatric ward. In the following, we will present the results of such an analysis. METHODS: The psychiatrist in charge of treatment evaluated the residents by the same methods as used in 1998 for demographic and clinical information in cooperation with the staff. While in 1998...
Owuor, John; Larkan, Fiona
People with intellectual disability (ID), are some of the most stigmatized and marginalized social groups. Ongoing global initiatives such as the United Nations Convention on the Rights of Persons with Disabilities (UNCPD) and Strategic Development Goals (SDGs) aim to accelerate their inclusion into the society. In many high-income countries, deinstitutionalization of care for people with ID forms part of the broader social inclusion agenda for people with ID into the society. Access to appropriate assistive technology (AT) can mediate the ongoing normalization/inclusion efforts for people with ID. AT can enable users with ID to access societal processes such as education, employment, socialization or independent living. Effective use of AT can also enhance the formation and/or maintenance of interpersonal relationships by people with ID, thus promote their social support.
Full Text Available The work of early pioneers like Dorothea Dix was instrumental in the establishment of institutions dedicated especially for the care of the mentally ill. Originally from the United States, she became acquainted with the idea of humane treatment of the mentally ill during her visit to England. After her return to the United States, she conducted a statewide investigation of care for the insane poor in Massachusetts and began to extensively lobby for reforms and establishment of more state-funded institutions for the care of mentally ill. Her efforts led to setting up of several mental health institutions, which became the cornerstone of care of psychiatrically ill, and for training of mental health care providers. Though subsequently, the hegemony of the institutions was challenged, and the era of deinstitutionalization was ushered in, the work of Dorothea Dix is important as it vouched for humane care of patients with mental illnesses.
Band-Winterstein, Tova; Smeloy, Yael; Avieli, Hila
Increasing numbers of aging parents are finding themselves in the role of caregiver for their mentally ill adult child due to global deinstitutionalization policy. The aim of this paper is to describe the daily aging experience of parents abused by an adult child with mental disorder and the challenges confronting them in this shared reality. Data collection was performed through in-depth semi-structured interviews with 16 parents, followed by content analysis. Three major themes emerged: (a) old age as a platform for parent's vulnerability facing ongoing abuse; (b) "whose needs come first?" in a shared reality of abusive and vulnerable protagonists; (c) changes in relationship dynamics. Old age becomes an arena for redefined relationships combining increased vulnerability, needs of both sides, and its impact on the well-being of the aging parents. This calls for better insights and deeper understanding in regard to intervention with such families.
Horan, M E; Muller, J J; Winocur, S; Barling, N
In the last forty years deinstitutionalization has transferred the care of people with a serious mental illness from the psychiatric hospitals to community based facilities. More recently it has been questioned whether these new facilities offer the anticipated benefits of quality of life. This study examines the Quality of Life (QOL) of people diagnosed with schizophrenia living in two different accommodation facilities, hostels and boarding houses. QOL is examined from the resident's perspective. Lehman's (1988b) QOL Interview was used to measure objective, subjective, and global QOL of 60 participants in three hostels and two boarding house clusters. Hostel and boarding house data were compared and results showed that residents preferred boarding house accommodation. Overall, residents of both accommodation facilities reported satisfaction with QOL, and indicated that they regard them as asylum or sanctuary from the outside world.
Full Text Available The purpose of this article is to consider the paradigm shift "from the Hospital to the Community" and find adequate intervention strategies for promoting mental health and preventing mental illness, as well as its early detection. The psychiatric nurse in the community has an important role in this area of activity and must develop skills in order to promote the bio-psycho-social rehabilitation of people in their environment. Several issues will be addresses, including the role of the family as the change in the fight against stigma and discrimination, the importance of collaboative work with primary health care and the techniques used in psychotherapy. Procedures and interventions used in other countries, including Britain and Canada, where the deinstitutionalization of patients with mental problems is a longstanding reality, will be reviewed.
Gregoric, Aleksandra; Oxelheim, Lars; Randoy, Trond
In this empirical study, we investigate the variation in firms’ response to institutional pressure for gender-balanced boards, focusing specifically on the preservation of prevailing practices of director selection and its impact on the representation of women on the board of directors. Using 8...... members appears to be associated with a lower share of female directors, although we cannot establish wether this reflects discrimination or a desire to maintain critical competencies. With this paper we add to the theoretical understanding of the factors underlying female board appointments by adopting...... an institutional theory lens to study female board representation. Viewing the demands for gender-balanced boards in terms of societal pressure for the de-institutionalization of the prevailing norms and practices, we highlight preferences for maintaining established practices as a potentially important barrier...
Tiago Pires Marques
Full Text Available This paper analyzes the impact of the hegemonic paradigm of global mental health (GMH on Portugal. We specifically argue that GMH in Portugal has effected a change of priorities in health policies, favoring the prevention and treatment of common mental disorders to the detriment of the deinstitutionalizing process. Diffused through the media, this model has negative effects, such as the medicalization of social suffering, the reorganization of mental health policy areas according to utilitarian criteria, and the risk of greater invisibility of users with serious psychiatric diagnoses. However, the GMH approach, bringing to the frontline the impact of all social policies on mental health, represents a new opportunity to politically address social suffering. Characterized as a semi-peripheral country, Portugal may be representative of observable trends in similar countries.
Wilcox, W. Bradford; Cherlin, Andrew J.; Uecker, Jeremy E.; Messel, Matthew
Purpose We examine trends in religious attendance by educational group, with an emphasis on the “moderately educated:” individuals with a high-school degree but not a 4-year college degree. Methodology We conduct multivariate ordinary least-squares (OLS) regression models using data from the General Social Survey (from 1972 to 2010) and the National Survey of Family Growth (from 1982 to 2008). Findings We find that religious attendance among moderately educated whites has declined relative to attendance among college-educated whites. Economic characteristics, current and past family characteristics, and attitudes toward premarital sex each explain part of this differential decline. Implications Religion is becoming increasingly deinstitutionalized among whites with moderate levels of education, which suggests further social marginalization of this group. Furthermore, trends in the labor force, American family life, and attitudes appear to have salient ramifications for organized religion. Sociologists of religion need to once again attend to social stratification in religious life. PMID:25657484
Kumazaki, Hirokazu; Kobayashi, Hiroyuki; Niimura, Hidehito; Kobayashi, Yasushi; Ito, Shinya; Nemoto, Takahiro; Sakuma, Kei; Kashima, Haruo; Mizuno, Masafumi
Remitted schizophrenic patients living in the community often encounter difficulties in their daily lives, possibly leading to the development of social anxiety symptoms. Although several studies have reported the significance of social anxiety as a comorbidity in patients with schizophrenia, few longitudinal data are available on the development of social anxiety symptoms in patients with remitted schizophrenia, especially in association with the process of "deinstitutionalization." The aims of this study were to assess the social anxiety symptoms in remitted outpatients with schizophrenia and to examine whether the development of social anxiety symptoms was associated with psychotic symptoms, social functioning, or subjective quality of life. Fifty-six people with schizophrenia who were discharged through a deinstitutionalization project were enrolled in this longitudinal study and prospectively assessed with regard to their symptoms, social functioning, and subjective quality of life. The severity of social anxiety symptoms was measured using the Liebowitz Social Anxiety Scale (LSAS). Global/Social functioning and subjective quality of life were evaluated using the Global Assessment of Functioning Scale, the Social Functioning Scale, and the World Health Organization-Quality of Life 26 (WHO-QOL26). Thirty-six patients completed the reassessment at the end of the 5-year follow-up period. The mean LSAS total score worsened over time, whereas other symptoms improved from the baseline. The mean WHO-QOL26 score in the worsened LSAS group was significantly lower than that in the stable LSAS group. At baseline, WHO-QOL26 scores were associated with an increase in the severity of social anxiety symptoms. In community-dwelling patients with remitted schizophrenia, a lower subjective quality of life might lead to the development of social anxiety symptoms, both concurrently and prospectively. To achieve a complete functional recovery, additional interventions for social
Full Text Available The Republic of Moldova started the process of deinstitutionalization of children with disabilities/and special educational needs and their inclusion in biological families and mainstream community based services. Alongside with the deinstitutionalization, inclusion of children with special educational needs in regular community schools became a strategic direction of the educational policies in Moldova. In 2014, the Alliance of NGOs in the field of Social Protection of Family and Child conducted a research on assessment of inclusive education models implemented in pilot schools with the aim to identify positive practices, learned lessons and challenges in developing policies in the field of evidence-based education2 The research was conducted in 20 pilot schools from 12 counties. There were interviewed 200 teachers, 20 school managers, 360 students (162 pupils with SEN, 112 students studying in classes with children with SEN and 86 children studying in classes with no students having SEN. 10 focus group discussions with caregivers, students, teachers, parents (all in total 100 participants and 6 interviews with the general directorates of education and mayors were conducted. The article is focused on comparative analysis of perceptions, attitudes and behaviors of students with SEN and typical students regarding the inclusion of children with SEN in regular schools. The author concluded that the implementation of inclusive education resulted in rather positive changes in respective schools: provision with materials, modern devices, improvement of teaching quality and methods, change in the behaviors of children with SEN and in typical children; the typical children have positive attitudes and perceptions regarding the inclusion of children with SEN in their regular community schools; the level of school satisfaction of both: children with SEN and typical children is pretty high; the social and learning environment in pilot schools is friendly
Full Text Available Abstract There exists a disconnection between evolving policies in the policy arenas of mental health, housing, and income support in Canada. One of the complexities associated with analysing the intersection of these policies is that federal, provincial, and municipal level policies are involved. Canada is one of the few developed countries without a national mental health policy and because of the federal policy reforms of the 1970s, the provincial governments now oversee the process of deinstitutionalization from the hospital to the community level. During this same period the availability of affordable housing has decreased as responsibility for social housing has been transfered from the federal government to the provincial and/or municipal levels of government. Canada also stands alone in terms of being a developed nation without national housing policy instead what is considered "affordable" housing is partially dependant upon individuals' personal economic resources. As well, over the past decade rates of income supports have also been reduced. Psychiatric survivors have long been identified as being at risk for homelessness, with the disconnection existing between housing, income and mental health policies and the lack of a national policy in any of these policies areas further contributing to this risk.
Full Text Available Deinstitutionalization movement in the West brought about community care movement of mentally ill. Because of this, caring for the mentally ill became an important aspect. In resource-rich countries, caregiving is done by trained persons and in resource-poor country (like India, caregiving was done by untrained family members. Cross-cultural factors such as interdependence and greater family involvement in care have contributed for family members′ decision-making in caregiving in India. Nevertheless, cross-cultural similarities in caregiving are more striking than differences. Genuine caregiving of mentally ill will make significant difference to the recipient. In India, majority of the persons with mental illness are cared by family members. Family members lack knowledge about the nature of the illness, have little support and advice by the medical professional, and have difficulties in understanding illness-related behavior. Hence, in India, there is need to develop effective, user-friendly, educational modules in all languages; to increase the knowledge of the carers about the mental illness, and help in decreasing their distress.
Ana González Rodríguez
Full Text Available Los programas de continuidad de cuidados surgen a finales de los años 70 en EEUU, en respuesta a los problemas detectados durante del proceso de desintitucionalización de los hospitales psiquiátricos. Desde entonces, se han extendido por todo el mundo, con variaciones y peculiaridades según las regiones, convirtiéndose en piedra angular de la atención a las personas con enfermedad mental grave y persistente. En este artículo se revisa el origen de estos programas, su desarrollo a lo largo de más de treinta años, la filosofía que los ha guiado en su devenir, así como los éxitos y fracasos en su desarrollo.The case management programs arise in the late 70's in the U.S., in response to problems identified during the process of deinstitutionalization of psychiatric hospitals. Since then, the case management and the assertive community treatment programs have spread throughout the world, with variations and particularities in different regions, becoming the cornerstone of the community care for people with severe and persistent mental illness. This article reviews the origins of these programs in U.S., their development for over thirty years around the world, the philosophy and objectives that have guided its evolution, as well as successes and failures in their development.
Stip, Emmanuel; Rialle, Vincent
In light of the advent of new technologies, we proposed to reexamine certain challenges posed by cognitive remediation and social reintegration (that is, deinstitutionalization) of patients with severe and persistent mental disorders. We reviewed literature on cognition, remediation, smart homes, as well as on objects and utilities, using medical and computer science electronic library and Internet searches. These technologies provide solutions for disabled persons with respect to care delivery, workload reduction, and socialization. Examples include home support, video conferencing, remote monitoring of medical parameters through sensors, teledetection of critical situations (for example, a fall or malaise), measures of daily living activities, and help with tasks of daily living. One of the key concepts unifying all these technologies is the health-smart home. We present the notion of the health-smart home in general and then examine it more specifically in relation to schizophrenia. Management of people with schizophrenia with cognitive deficits who are being rehabilitated in the community can be improved with the use of technology; however, such technology has ethical ramifications.
Glassman, Paul; Caputo, Anthony; Dougherty, Nancy; Lyons, Ray; Messieha, Zakaria; Miller, Christine; Peltier, Bruce; Romer, Maureen
Many people with special needs (PSN) have difficulty having good oral health or accessing oral health services because of a disability or medical condition. The number of people with these conditions living in community settings and needing oral health services is increasing dramatically due to advances in medical care, deinstitutionalization, and changing societal values. Many of these individuals require additional supports beyond local anesthesia in order to receive dental treatment services. The purpose of this consensus statement is to focus on the decision-making process for choosing a method of treatment or a combination of methods for facilitating dental treatment for these individuals. These guidelines are intended to assist oral health professionals and other interested parties in planning and carrying out oral health treatment for PSN. Considerations for planning treatment and considerations for each of several alternative modalities are listed. Also discussed are considerations for the use of combinations of modalities and considerations for the repeated or frequent use of these modalities. Finally, the need to advocate for adequate education and reimbursement for the full range of support alternatives is addressed. The Special Care Dentistry Association (SCDA) is dedicated to improving oral health and well being of PSN. The SCDA hopes that these guidelines can help oral health professionals and other interested individuals and groups to work together to ensure that PSN can achieve a "lifetime of oral health."
Letícia Gomes da Silva
Full Text Available With the psychiatric reform movement, reflecting on the rehabilitation of users of mental health services in society has become essential. Aiming to include users of mental health services in solidarity economy enterprises and seeking ways to promote this inclusion, career guidance was taken as a potential tool. This research project aimed to investigate the potential of the process of career guidance as a strategy for the inclusion of these users in solidary economy enterprises. Semi-structured interviews were used for data collection. The participants were two users of mental health services that were members of the career orientation program held in 2010, the technician responsible for the solidarity economy enterprise, and two non-users of mental health services. We also carried out an analysis of the minutes of the career guidance meetings, and the data from this analysis were used to complement the data obtained in the interviews. Data analysis was based on the theoretical assumptions of solidarity economics and guidance for vocation and deinstitutionalization. The results converge toward career guidance as a facilitator of the insertion of users of mental health services in solidarity economy enterprises. Although some limitations have been found indicating the need to conduct new studies, results suggest that career guidance is a viable alternative to facilitate the inclusion of this population.
Schizophrenia is a complex mental disease leading to many deficits that needs a broad range of therapeutic interventions. The recent data raises the importance of the cognitive revalidation even though other interventions are also necessary in the treatment. The asylums of the former century have experienced a slow and continuous process of patient's deinstitutionalization. The global knowledge of the disorder having progressed, new multidisciplinary and multidimensional models of managing are now proposed. The psychiatric rehabilitation is one of those models having as goal the global taking charge of the disease, from the managing of the symptoms to the return to a life with good quality. The great specificity of this rehabilitation work is that it's multidisciplinary and involves a strong collaboration between the medical and the psychosocial intervening party's around a common therapeutic project. This model brings up the notion of recovery witch is, not the cure but, the experience that a patient acquires as he accepts the situation and as he recovers the feeling of being able to get going again.
Thornicroft, Graham; Deb, Tanya; Henderson, Claire
This paper aims to give an overview of the key issues facing those who are in a position to influence the planning and provision of mental health systems, and who need to address questions of which staff, services and sectors to invest in, and for which patients. The paper considers in turn: a) definitions of community mental health care; b) a conceptual framework to use when evaluating the need for hospital and community mental health care; c) the potential for wider platforms, outside the health service, for mental health improvement, including schools and the workplace; d) data on how far community mental health services have been developed across different regions of the world; e) the need to develop in more detail models of community mental health services for low‐ and middle‐income countries which are directly based upon evidence for those countries; f) how to incorporate mental health practice within integrated models to identify and treat people with comorbid long‐term conditions; g) possible adverse effects of deinstitutionalization. We then present a series of ten recommendations for the future strengthening of health systems to support and treat people with mental illness. PMID:27717265
Kageyama, Masako; Yokoyama, Keiko; Nagata, Satoko; Kita, Sachiko; Nakamura, Yukako; Kobayashi, Sayaka; Solomon, Phyllis
Family violence is a serious concern in the era of deinstitutionalization in Japan. Consequently, we aimed to clarify the rate of family violence among patients with schizophrenia, and differences by sex and relationship to the patient. We asked households belonging to a family group association to complete a self-administered mail survey. Of 350 households that responded, data for 302 were analyzed. The rate of violence toward any family member was 60.9% over the lifetime and 27.2% in the past year. Order of lifetime rates for family members from highest to lowest was 51.0% for mothers, 47.0% for fathers, 30.7% for younger sisters, 23.8% for spouses, 19.5% for younger brothers, 18.2% for older sisters, 17.1% for older brothers, and none for children. Younger sisters were more likely to be victims compared to other siblings. Fathers and older brothers were likely to be victims when patients were male. © 2015 APJPH.
Cardoso Clareci Silva
Full Text Available Interest in quality of life in mental health care has been stimulated by the deinstitutionalization of psychiatric patients as well as a parallel interest in understanding the scope of their daily lives. This study aims to investigate the socio-demographic and clinical variables related to low quality of life, using a cross-sectional design to evaluate quality of life by means of the QLS-BR scale. We interviewed a sample of 123 outpatients from a reference mental health center in Divinópolis, Minas Gerais State, Brazil, clinically diagnosed with schizophrenia. Univariate and multivariate logistic regression analyses were carried out. The results showed that low quality of life is associated with one or more of the following: male gender, single marital status, low income plus low schooling, use of three or more prescribed psychoactive drugs, psychomotor agitation during the interview, and current follow-up care. The study identifies plausible indicators for the attention and care needed to improve psychiatric patient treatment.
Antonio Bernal Guerrero
Full Text Available Building a professional teacher identity is affected by the framework of the social changes of our time. These are associated with complex mechanisms of deinstitutionalization and reorganization which produce considerable emotional burnout. We have carried out an investigation of teaching well-being linked to the phenomenon called engagement. This is presented as a way to combat teachers’ malaise and foster well-being. There is a paucity of studies on the delimiting of substantive descriptors for the evaluation of engagement in university teaching. We have therefore done an exploratory qualitative study in theUniversityofSeville. In doing this, we have used the biographic-narrative method and the interview technique in order to progress in this educational line. The results of the study appear to reflect that there are certain factors which influence well-being: institutional stability, labor conditions, social recognition and the improvement of the teachers’ training. Likewise, a series of evaluation indicators connected with the personal level are outlined: an active willingness toward enhancement, a capacity to set up optimal relations, perseverance, an enthusiastic link with the profession and an emotional balance expressed in reconciling different areas of life.
Full Text Available The apparent freeing of information access and knowledge accumulation that was the promise of modern communications technology – the Internet, World Wide Web and mobile digitized telecommunications – heralded the opportunity to attain some of the ideals that have been expounded for liberal education, open and lifelong learning, informed democratic decision-making and overall an increasingly informed populace and participative, well-educated electorate. The prospects for a democratization of knowledge acquisition had broad appeal – de-institutionalizing formal education, enhancing learner choice and ‘de-experting’ authoritative knowledge sources. Failings of intellectual imagination, political will and insight together with the inappropriate organization of resources have limited such aspirations. Escaping the constraints of formal, institutionalized education and established forms of knowledge ‘transfer’ may be more difficult to accomplish than has been anticipated. Achieving the promised flexibility and adaptability in human learning may be hampered by the problem of balancing an epistemological dilemma between the efficient management of information and intellectual freedom. This paper addresses the connected issues of the costs and benefits of online encyclopedism, the production and management of intellectual capital within information systems, and the influence of the more latent metaphors for knowledge management which have subtle consequences for social order and social control.
The reliable and disaggregated data on children deprived of family care, living in different forms of public care is essential information to implement the UN Guidelines on Alternative Care of Children and its principle on necessity and suitability. At the same time all needed information and data would also be needed on all forms of support, universal, targeted and specialized services provided or not provided to children and their families locally to prevent separation of children, on different forms of informal care. While there have been many efforts made to prevent institutionalization of children worldwide especially in the most developed countries, placement of children out of their families for different reasons, many of them closely related to poverty is still too often accepted. Some current programs in Europe described in the article can contribute to better implementation of the current policies and recommendations globally, however there is a parallel movement towards emphasizing the need and value of institutional care and the lack of alternatives in many cases, that should also be taken into consideration. More research, evidence and data is needed to defend the arguments for deinstitutionalization. Copyright © 2017 Elsevier Ltd. All rights reserved.
Fernando Sfair Kinker
Full Text Available The objective of this paper is to make a reflection on the contradictions and the alleged rehabilitative potential of labor-therapeutic practices, starting from the experience developed by the Work Center of the Mental Health Program of the Municipality of Santos from 1989 to 1996, from the beginning of the intervention in the psychiatric hospital to the implementation of territorial and community services. The labor-therapeutic practice is characterized here as a disciplinary technology of deviation control, operating in line with the psychiatric paradigm. On the other hand, work projects that combine mental health and solidarity economy are considered devices that multiply opportunities, expand social networks and transform the concrete conditions of life, contributing to deconstruct the psychiatric paradigm and the sociability of merchandise. The ideas herein presented are part of a doctoral thesis that used the experience report of the Work Center implementation as a method, articulating the theoretical perspective of deinstitutionalization and the discussion of complexity, presenting new emancipatory possibilities of dealing with the issue of labor in the mental health field.
Full Text Available The process of deinstitutionalization in Brazil has being concretizing the guidelines of overcoming and substitution of the attention centered model in psychiatric hospitals, for community health services, focused on Psychosocial Rehabilitation as a practical – theoretical reference of this construction. The therapeutic home services are alternatives of residence to those who have being institutionalized for years as they have no family or social reference to leave the psychiatric hospital. The objective of this paper consists on knowing how the daily life and the way of living of residents of therapeutic settings have being reconstructed and if the actions are focused on social inclusion. It is a qualitative research, realized by semi- structured interview made with residents of three Therapeutic Residences in a town at the Triangulo Mineiro county, thematic content data was used as analysis. The results pointed the existence of a reconstructed daily life, however the complete social inclusion is absent, which minimizes the potentiality of fully living the norms of Psychosocial Rehabilitation.
As with the rest of biomedicine, psychiatry has, since the Second World War, developed under the strong influence of the transnational accumulation of a whole series of practices and knowledge. Anthropology has taught us to pay attention to the transactions between local-level actors and those operating at the global level in the construction of this new world of medicine. This article examines the role played by the recommendations of the WHO Expert Committee of Mental Health in the reform of the French mental health system during the 1950s. Rooted in the experience of practitioners and administrators participating in the process of reforming local psychiatric systems, the recommendations of the WHO Expert Committee developed a new vision of regulating psychiatry, based on professionalism and an idea of a normativity of the doctor-patient relation. This article shows how, by mobilizing the WHO reports' recommendations, French administrators and doctors succeeded in creating a typically French object: "the psychiatric sector", founded on elaborating a new mandate for the psychiatric profession. The article thus questions the deinstitutionalization model as an explanation of transformations of the structure of the French psychiatry system in the post-war period.
In 1978, Italy passed a law establishing the abolition of the mental hospital. Up to that time, the traditional asylums were still governed by the 1904 law that positioned psychiatry within the criminal justice system by assigning it the function of custodia (control, custody) rather than of cura (care). In the 1960s and 1970s, Italian psychiatrist Franco Basaglia initiated a movement of de-institutionalization of the mentally ill that revolutionized psychiatric care in Italy. It also had a deep impact on restructuring the psychiatric system in other European and Latin American countries. In this article, I discuss the different psychiatric practices and imaginaries that resulted from the movement of democratic psychiatry and Basaglia's visions for a community-based and diagnosis-free care of the mentally ill. I ethnographically trace what I call the "Basaglia effect" in today's psychiatric practices, and focus on ethnopsychiatry as a counter clinic that emerged from Basaglia's legacy. I reflect on the frictions between care and cure that ethnopsychiatry re-articulates and works with in the context of contemporary migrations to Europe.
Avieli, Hila; Smeloy, Yael; Band-Winterstein, Tova
Increasing numbers of aging parents are finding themselves in the role of caregiver for their mentally ill adult child due to global deinstitutionalization policy. The aim of this article is to explore preparations for the end of life in light of the life review process among old parents of abusive children with mental disorder. Data collection was performed through in-depth semi-structured interviews with 20 parents, followed by phenomenological analysis. Five different types of departure scripts emerged: a pragmatic departure script, a burned-out departure script, a dead-end departure script, an optimistic departure script, and a violent departure script. The parents in this study tended to interpret events in their past to fit their perception of the current relationship with their child, thus connecting past, present, and future into one coherent picture. Years of extended care have led to a unique aging process which does not allow separation from the child or the development of a sense of closure that characterizes the aging process. This calls for better insights and deeper understanding in regard to intervention with such families. Copyright © 2015. Published by Elsevier Inc.
Baloush-Kleinman, Vered; Schneidman, Michael
Deinstitutionalization and community mental health services have become the focus of mental health care in the United States, Italy and England, and now in Israel. Tirat Carmel MHC developed an intervention model of organizational change implemented in a rehabilitation hostel. It is an interim service based on graduated transition from maintenance care to a transitional Half-way House, followed by a Transitional Living Skills Center oriented for independent community living. Of 205 rehabilitees who resided in the hostel since the beginning of the project, 138 were discharged to community residential settings: 67 patients were discharged to reinforced community hostels; 27 to sheltered housing and 23 to independent residential quarters; 7 patients were discharged to comprehensive hostels, 3 to old-age homes and 11 returned home to their families. In terms of employment, 79 were placed in sheltered employment facilities, 24 work in the open market and 3 returned to school; 22 work in therapeutic occupational settings and 10 patients discharged to comprehensive hostels and old-age homes are engaged in sheltered employment programs in those settings. The system flexibility model and the rehabilitation processes anchored in normalization supported the relocation of hospitalized psychiatric patients to community-based settings and enabled the rehabilitees to cope with readjustment to community life.
Vorarlberg--Austria's most western province with a population of about 325,000--has always implemented forms of social policy in which the principles of subsidiarity and solidarity play an important role. This is reflected in the structure of the organizations traditionally providing social services as well as in the more recent programmes the government has developed for social policy. This paper discusses two cases in point: the private associations for home care (Krankenpflegerverbände)--which now exist in 65 Vorarlberg communities and cover 85% of the population in the province--offering nursing services at home to members or to persons who are willing to join the organization when they need care, and the new organizational model, called Gesunder Lebensraum Vorarlberg (GLV), which is successfully operating in a few pilot communities. GLV has spawned umbrella organizations, run by volunteers, and offering a variety of social services relevant to the elderly, for example visiting services or neighbourhood help in case of emergencies. The volunteers get organizational help from a profit-making firm financed by the government. The Vorarlberg models can be interpreted as a step towards demedicalization and deinstitutionalization of health care for the elderly. Nevertheless, they also show the problems that arise when professionals and volunteers must cooperate. The models may lead to savings for the governments involved, although details are still subject to future empirical investigations.
Globally, health management information systems (HMIS) have been hailed as important tools for health reform (1). However, their implementation has become a major challenge for researchers and practitioners because of the significant proportion of failure of implementation efforts (2; 3). Researchers have attributed this significant failure of HMIS implementation, in part, to the complexity of meeting with and satisfying multiple (poorly understood) logics in the implementation process. This paper focuses on exploring the multiple logics, including how they may conflict and affect the HMIS implementation process. Particularly, I draw on an institutional logics perspective to analyze empirical findings from an action research project, which involved HMIS implementation in a state government Ministry of Health in (Northern) Nigeria. The analysis highlights the important HMIS institutional logics, where they conflict and how they are resolved. I argue for an expanded understanding of HMIS implementation that recognizes various institutional logics that participants bring to the implementation process, and how these are inscribed in the decision making process in ways that may be conflicting, and increasing the risk of failure. Furthermore, I propose that the resolution of conflicting logics can be conceptualized as involving deinstitutionalization, changeover resolution or dialectical resolution mechanisms. I conclude by suggesting that HMIS implementation can be improved by implementation strategies that are made based on an understanding of these conflicting logics.
Belén Fernández Suárez
Full Text Available Spain is one of the countries with the lowest social spending within the EU-15, and its welfare state has developed later and with less intensity. At the end of the 20th century, Spain became an immigration country, reaching 5.7 million immigrants in 2011. This article explores how the definition of migrant ‘integration’ is based more on a concept of universal rights and social cohesion by the main actors (political parties, trade unions, third sector organizations and immigrant associations than on a notion of a cultural type. We will also analyze how the influence of European policies and restrictive liberalism have led to the implementation of programmes which aim to make civic integration compulsory for the renewal of residence and work permits. The empirical evidence for this article stems from 60 qualitative interviews with social actors in migrant integration policies during 2010 and 2011. The impact of the economic crisis on the foreign population, especially regarding its position in the labor market, will also be considered, explaining the reduction of specific and general policies targeting the migrant population. This cut in social spending has involved a deinstitutionalization of this particular policy field.
Rønning, Solrun Brenk; Bjørkly, Stål
One of the prioritizations in the World Health Organization's (WHO) Mental Health Action Plan 2013-2020 is the provision of community mental health and social care services, such as supported housing. The ongoing process of such deinstitutionalization has raised issues concerning the impact on users' quality of life. The purpose of this study was to explore how residents in supported housing experience receiving professional help and how they perceived their relationships with nurses. The second aim was to investigate the relevance of Giorgi's method of analysis and self psychology in analyzing these experiences. Four residents were interviewed individually. The interviews were based on a semi-structured interview guide and analyzed by Giorgi's method of analysis. Relations were interpreted within self psychology. The residents reported that they not only felt safe in the community but also felt a greater awareness of wanting to appear normal. They seemed to have an easier daily life and felt that the personnel met their selfobject needs when routines allowed for it. Professional awareness of empathic attunement and selfobject roles might enhance residents' self-cohesiveness. The interviews were analyzed by Giorgi's method of analysis, and the use of clinical concepts from self psychology was chosen to achieve a more dynamic understanding of the participants' relational experiences and needs in supported housing.
LeMay, M.; Alvarez, N.
Head CT studies of patients with Alzheimer's disease (AD) show global atrophic changes. Tissue loss is especially prominent in the temporal lobes, with widening of the temporal horns of the lateral ventricles and, usually, widening of the temporal sulci. Some recent studies have found a familial form of AD to be mapped to chromosome 21. Down syndrome (DS) results from the inheritance of three chromosomes 21, and it has been shown that after the age of 35 the brains of patients with DS commonly show neuropathological changes similar to those in patients with AD. CT studies of 25 patients with DS (ages 29-64 years) were examined for tissue loss in the temporal regions, and this was compared to the findings commonly seen in patients with AD. The widths of CSF spaces varied considerably in patients with DS, but after the age of 50 most of them showed significant widening of the temporal horns. In some patients the horns were large enough to suggest obstructive hydrocephalus. Because of a new trend toward deinstitutionalization of patients with DS, radiologists will be seeing more studies on these patients and should familiarize themselves with the unique ways in which they manifest the aging process. (orig.)
Quinlan, Michael; Bohle, Philip
The practice of outsourcing or subcontracting of work has grown rapidly in most countries over the past two decades. Outsourcing, de-institutionalization, and a range of other practices have also resulted in a growth of home-based work. Home-based workers, even when not part of a subcontracting process, operate in an isolated situation remote from their employer and other workers. Do such work arrangements expose workers to greater risk of injury, illness, or assault? The authors reviewed international studies of the occupational health and safety (OHS) effects of subcontracting and home-based work undertaken over the past 20 years. Of the 25 studies analyzed, 92 percent found poorer OHS outcomes. The studies were examined for clues about the reasons for these negative outcomes. The authors also identified similarities and differences between subcontracting and home-based work. Despite the evidence of poor OHS outcomes, research into outsourcing has stalled in recent years. With notable exceptions, governments have taken little account of findings on these work arrangements in their laws and policies, in part because neoliberal ideas dominate national and global policy agendas. The authors examine policy challenges and regulatory responses and make suggestions for future research and policy interventions.
Novotná, Gabriela; Dobbins, Maureen; Henderson, Joanna
The effective and timely integration of the best available research evidence into healthcare practice has considerable potential to improve the quality of provided care. Knowledge translation (KT) approaches aim to develop, implement, and evaluate strategies to address the research-practice gap. However, most KT research has been directed toward implementation strategies that apply cognitive, behavioral, and, to a lesser extent, organizational theories. In this paper, we discuss the potential of institutional theory to inform KT-related research. Despite significant research, there is still much to learn about how to achieve KT within healthcare systems and practices. Institutional theory, focusing on the processes by which new ideas and concepts become accepted within their institutional environments, holds promise for advancing KT efforts and research. To propose new directions for future KT research, we present some of the main concepts of institutional theory and discuss their application to KT research by outlining how institutionalization of new practices can lead to their ongoing use in organizations. In addition, we discuss the circumstances under which institutionalized practices dissipate and give way to new insights and ideas that can lead to new, more effective practices. KT research informed by institutional theory can provide important insights into how knowledge becomes implemented, routinized, and accepted as institutionalized practices. Future KT research should employ both quantitative and qualitative research designs to examine the specifics of sustainability, institutionalization, and deinstitutionalization of practices to enhance our understanding of these complex constructs.
Yu V Yatsutsenko
Full Text Available The contemporary social reality is marked by a considerable change of religious views and practices: the religion itself becomes a worldview option; the religious individuals are more autonomous from the religious institutions; individuals get an opportunity to construct and approve different beliefs; the religious identity transmission mechanisms weaken; the privatized religious ethics is legitimized outside the religious institutions. Danièle Hervieu-Léger’s theory presents one of the ways for the sociological conceptualization of the problems mentioned. The concept ‘bricolage’ is used by Hervieu-Léger as a technical explanation of the religious life deinstitutionalization. We define the bricolage as an individual practice that overcomes system-imposed modes and means of production, as an activity based on a random set of available elements. Hervieu-Léger notes that the main feature of the contemporary religiosity is the bricolage freedom, i.e. the freedom to construct an individual religious ethics. However, such a mode of social control does not necessarily lead to religious negligence or radical individualism. French sociologist believes that the generational transfers of religious identity are weakening and the in-out decisions in religious communities are becoming easier. According to Hervieu-Léger, such a movement itself becomes the main behavioral motif for contemporary religious agents for it is responsible not only for the individual religious pursuit, but for the collective construction and exchange of the religious experience.
Hale, Kathryn Law
Drawing on clinical data from 15 months of on-site participant observation in the only public psychiatric hospital in the state of Puebla, Mexico, this article advances our understanding of globalization in relation to psychiatry. I challenge the construction of psychiatry as only treating the individual patient and provide grounded doctor-patient-family member interaction in a Mexican psychiatric clinic in order to review what happens when doctors cannot interact with patients as atomized individuals even though in theory they are trained to think of patients that way. Challenged by severe structural constraints and bolstered by lessons from other nations' efforts at deinstitutionalization, psychiatrists in Puebla push to keep patients out of the inpatient wards and in their respective communities. To this end, psychiatrists call upon co-present kin who are identified both as the customer and part of the caretaking system outside the clinic. This modification to the visit structure changes the dynamic and content of clinical visits while doctors seamlessly respond to unspoken beliefs and values that are central to local life, ultimately showing that efforts to define a "global psychiatry" informed by global policy will fail because it cannot exist in a uniform way-interpersonal interaction and personal experience matters.
Renée de la Torre
-protestant; a proportional augment of those who are not members of any religion; a reinstating of native, neo-indigenous or ethnic religious streams that tend to break away from popular Catholic practice; and, finally, a marked tendency to de-institutionalization and subjectivization of beliefs and values. This tendency traverses and diversifies cult practices and ways of acting and believing inside Catholicism. We hereby analyze several sources that deliver empirical data on a national scale, with the purpose of informing on these tendencies towards religious change, namely, INEGI's 1950-2000 census results on the plurality of religious confessions; the results of a study on Catholics in Mexico, which was carried out to contemplate diversity inside Catholicism; an analysis of compared results provided by 1990-2000 World Values Survey data; and, finally, information extracted from a longitudinal study in Guadalajara city. All of these data will help us assess current tendencies towards de-institutionalization and subjectivization of Mexicans.
Full Text Available Solrun Brenk Rønning, Stål Bjørkly Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway Abstract: One of the prioritizations in the World Health Organization’s (WHO Mental Health Action Plan 2013–2020 is the provision of community mental health and social care services, such as supported housing. The ongoing process of such deinstitutionalization has raised issues concerning the impact on users’ quality of life. The purpose of this study was to explore how residents in supported housing experience receiving professional help and how they perceived their relationships with nurses. The second aim was to investigate the relevance of Giorgi’s method of analysis and self psychology in analyzing these experiences. Four residents were interviewed individually. The interviews were based on a semi-structured interview guide and analyzed by Giorgi’s method of analysis. Relations were interpreted within self psychology. The residents reported that they not only felt safe in the community but also felt a greater awareness of wanting to appear normal. They seemed to have an easier daily life and felt that the personnel met their selfobject needs when routines allowed for it. Professional awareness of empathic attunement and selfobject roles might enhance residents’ self-cohesiveness. The interviews were analyzed by Giorgi’s method of analysis, and the use of clinical concepts from self psychology was chosen to achieve a more dynamic understanding of the participants’ relational experiences and needs in supported housing. Keywords: mental health, nursing relationship, self psychology, supported housing, experiences
Williams, Arthur Robin
Last year marks the first year of implementation for both the Patient Protection and Affordable Care Act and the Mental Health Parity and Addiction Equity Act in the United States. As a result, healthcare reform is moving in the direction of integrating care for physical and mental illness, nudging clinicians to consider medical and psychiatric comorbidity as the expectation rather than the exception. Understanding the intersections of physical and mental illness with autonomy and self-determination in a system realigning its values so fundamentally therefore becomes a top priority for clinicians. Yet Bioethics has missed opportunities to help guide clinicians through one of medicine's most ethically rich and challenging fields. Bioethics' distancing from mental illness is perhaps best explained by two overarching themes: 1) An intrinsic opposition between approaches to personhood rooted in Bioethics' early efforts to protect the competent individual from abuses in the research setting; and 2) Structural forces, such as deinstitutionalization, the Patient Rights Movement, and managed care. These two themes help explain Bioethics' relationship to mental health ethics and may also guide opportunities for rapprochement. The potential role for Bioethics may have the greatest implications for international human rights if bioethicists can re-energize an understanding of autonomy as not only free from abusive intrusions but also with rights to treatment and other fundamental necessities for restoring freedom of choice and self-determination. Bioethics thus has a great opportunity amid healthcare reform to strengthen the important role of the virtuous and humanistic care provider. © 2015 John Wiley & Sons Ltd.
Full Text Available Este artículo sostiene la idea de que el reconocimiento del matrimonio homosexual –frente a otro tipo de iniciativas–, conseguido por el movimiento LGTB español en ese país, constituye una reforma no reformista. Es decir, antes que una reivindicación conservadora, que actualiza los sentidos naturalizados en el matrimonio al imponerlos a nuevos sujetos (homosexuales, constituye un mecanismo hacia su des-institucionalización. Se trataría de una reivindicación que al tiempo que afirma la plena ciudadanía de los grupos GLTB, es decir, su reconocimiento social, deconstruye el matrimonio a través de un doble movimiento. Primero, la comprensión de esta institución como cultural y socialmente construida y por tanto, sujeta a sucesivas modificaciones a lo largo de su historia. Dos, siendo el matrimonio homosexual una contradicción en sí mismo; esto es, desde la red de sentidos y prácticas que integra, este reconocimiento conlleva el desbordamiento mismo de dicha institución.This article posits the idea that the recognition of homosexual marriage (compared to other types of initiatives which have been achieved by the Spanish LGTB movement is a non-reformist reform. That is to say rather than a conservative assertion, which modifies the naturalized character of marriage by imposing it on new subjects (homosexuals, it is a deinstitutionalization mechanism. This means that while affirming the full citizenship of the GLTB groups, in other words their social recognition, it also deconstructs marriage in two ways. Firstly, through the understanding of this institution as culturally and socially constructed and therefore subject to subsequent modifications throughout its history. Secondly, homosexual marriage being a contradiction in itself (from the point of view of an integrated network of meanings and practices reveals the ‘overflow’ of that same institution.
Yuliya A. Lysenko
Full Text Available The article considers the main results of political modernization in the Central Asian national outskirts of the Russian Empire taken place in the late 19th – early 20th centuries. The concept “Central Asian national outskirts” includes Stepnoy and Turkistan Governorate Generals, the two administrative-territorial entities founded in the 1860s as a result of a complete joining of the Kazakh camping grounds of the Junior, Middle and Elder zhuzhes; after the Kokand and Khivinsk khanates inhabited by nomads ( the Kirghiz, the Kara-Kalpaks as well as the settled population (the Uzbeks were conquered. The analysis of the sources and materials conducted by the authors asserts that the political modernization of the Central Asian national outskirts proposed by the Russian Empire was carried out in line with the fundamental characteristics of West European civilization and the basis of its political culture. Thus the system of local government was established and the democratic electoral system was introduced by means of expanding the voter’s base, with the region’s population participating in social and political life. The principles of bourgeois ideology based on such concepts as “equality”, “freedom”, “self-determination” were also formed. However, the political modernization of the Central Asian national outskirts should not be considered as complete. Up to 1917 the political sphere of the region’s population was characterized by the predominance of traditional mores, values and laws, whereas clan ideology, tribalism and Muslim ethno-consciousness were characteristic of the social sphere. All these factors affected the process of adapting to western political culture. The institutionalization of the new structures did not go along with the de-institutionalization of the traditional ones, and so resulted in the combination and coexistence of the traditional and modern structures.
Full Text Available Los problemas de salud mental aumentan su incidencia en todo el mundo mientras la psiquiatría atraviesa una crisis que afecta a su propia identidad y a la delimitación del objeto de su trabajo. Después de más de medio siglo de una política desinstitucionalizadora y comunitaria, la globalización neoliberal está llevando a cambios que socavan la atención pública en salud mental, en especial de los trastornos que demandan mayor atención social. Cambios en la responsabilidad del Estado y cambios en el tipo de demanda y en la forma de entender la enfermedad y su tratamiento. Al tiempo, frente a la medicalización de la sociedad que mediatiza la expresión de las necesidades en salud, empiezan a surgir movimientos de usuarios que reclaman autonomía, plena ciudadanía, empoderamiento, recuperación y "abogacía".There has been an increased incidence of mental health problems around the world while psychiatry is experiencing a crisis that concerns its own identity and the definition of the scope of its work. After more than half a century of deinstitutionalized community policies, neoliberal globalization is leading to changes that undermine public attention on mental health, particularly of the disorders that require greater social attention. There have been changes in the responsibility of the state and changes in the type of demand and in the way of understanding disease and its treatment. At the time, compared to the medicalization of society that mediates the expression of needs in health, user movements are beginning to emerge demanding autonomy, full citizenship, empowerment, recovery and advocacy.
Full Text Available Alejandra Caqueo-Urízar,1,* Mar Rus-Calafell,2,* Alfonso Urzúa,3 Jorge Escudero,1 José Gutiérrez-Maldonado4 1Departamento de Filosofía y Psicología, Universidad de Tarapacá, Arica, Chile; 2Department of Social Psychiatry, Institute of Psychiatry, King’s College London, London, UK; 3Alfonso Urzúa Morales, Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile; 4Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad de Barcelona, Barcelona, Spain *These authors have contributed equally to this work Abstract: Family interventions for schizophrenia have been amply demonstrated to be effective and are recommended by most of the international clinical guidelines. However, their implementation in the clinical setting as well as in treatment protocols of patients with psychosis has not been fully achieved yet. With the increasing deinstitutionalization of patients, family has begun to assume the role of care performed by psychiatric hospitals, with a high emotional cost for caregivers as well as the recognition of burden experiences. Families have been the substitute in the face of the scarcity of therapeutic, occupational, and residential resources. For this reason, the viability of patients’ care by their families has become a challenge. This article aims to discuss the most important aspects of family interventions, their impact on families, and the most important challenges that need to be overcome in order to achieve well-being and recovery in both patients and caregivers. Keywords: family intervention, schizophrenia, caregivers, quality of life, therapy
Gostin, Lawrence O
Despite countless promises for a better life by national commissions, governments and the international community, there has evolved a vicious cycle of neglect, abandonment, indignity, cruel and inhuman treatment, and punishment of persons with mental illness. This shameful history of benign, and sometimes malignant, neglect of persons with mental illness is well understood, with the deep stigma and unredressed discrimination, the deplorable living conditions, and the physical and social barriers preventing their integration and full participation in society. The maltreatment of this vulnerable population has been reinforced by the hurtful stereotypes of incompetency and dangerousness. The belief that persons with mental illness are uniformly dangerous is an equally harmful myth. It provides policy makers with an ostensible justification to exercise control over persons with mental illness, even if they have not committed a violent offence. However, research demonstrates that the class of persons with most mental illnesses is no more dangerous than other populations, and that the vast majority of violence is committed by persons without mental illness. This article will show how this vulnerable population has been unconscionably treated. First, the gross violations of human rights that have occurred, and continue to occur, in 'old' psychiatric institutions will be examined. The deinstitutionalization movement, however, resulted in new places of confinement for this population, such as jails, prisons and homeless shelters. The second part of this paper will explore the new realities of criminal confinement of persons with mental illness. As we will see, incarceration of this vulnerable population in the criminal justice system has caused enormous suffering. If Dostoyevsky was correct that the 'degree of civilization... can be judged by entering its prisons', then by that measure, we are a deeply uncivilized society.
Full Text Available Italian psychiatry has gained International attention after its radical reform of 1978, which established the progressive closure of mental hospitals and the establishment of community services throughout the country. However it is technically inappropriate to talk about Italian psychiatry as the devolution process has transferred to the regions all competences about policy, planning and evaluating health services. This explains the variety of “community psychiatries” that can be found along the peninsula and the reasons of interest that can arise from their comparison. The development of community psychiatry in Emilia‐Romagna, a region of 4 million inhabitants in Northern Italy, has proceeded through two partially overlapping phases of deinstitutionalization (1978‐1997 and development of integrated mental health departments (1990‐2008. The analysis of raw data about allocation of resources and professional capital development give way to tentative comparisons with the current Portuguese situation of implementation of a similar reform. In 2006 the regional Council launched a three year project aimed at rethinking the welfare system and the integration of social and health services, considering the dramatic social and demographic changes occurring in the region. This project has implied also a three year process of redrafting mental health policy finalised in the Emilia‐Romagna Mental Health Action Plan 2009‐2011 approved by the council in March 2009. It basically follows two strategies: integration of health and social services and further qualification of health services. The former is pursued through a reshaping of the planning and commissioning bodies of both health and social services, previously separated and now merging. They are taking responsibility on many issues related to mental health care, such as prevention, mental health promotion, supported employment, supported housing, subsidies, self‐help. The improvement of
Estíbaliz Amaro Martín
Full Text Available Deinstitutionalization processes in recent times have led to a new age in relations between family and mental health professionals. Care professionals were replaced, after the psychiatric reform, for care carried out by the family without the knowledge, information and skills to assume these functions. This is the situation of many families of patients with schizophrenia.Disabling features of schizophrenia usually cause depends on their families, who take care with the consequent impact on their lives. Psychosocial interventions assessing their work and want to build an alliance with them by giving them skills and coping mechanisms to reduce adverse family atmosphere, anticipate and solve problems and reduce the expressions of anger and guilt keeping appropiate expectations. However, these actions must be enforced by providing main caregivers with the skills that enable them to gain control, this is the main target of psychoeducational programs.Today there are many people in favour of such interventions in the early stages of schizophrenia. However, it is no clear how far development of these programs is supported by evidence of effectiveness. So it has proposed a psychosocial and psychoeducational program aimed at main caregivers of patients with schizophrenia in early stages. This program will be led by a psychiatric nurse in collaboration with other professionals in the interdisciplinary team; psychiatrist, clinical psychologist and social worker. It has developed clinical trial with a control group who will receive the gide for families, caregivers and people affected, "Cómo afrontar la esquizofrenia," and an experimental group will receive, in addition to the guide, the group intervention sessions.
In 1990, political, economic and social changes in Lithuania introduced the possibility to develop for the first time in nations's history an effective and modern system of child mental health services. During the period between 1990 and 1995 a new model of services was developed in the Department of Social pediatrics and child psychiatry of Vilnius University. The model included development of child and adolescent psychiatric services, as well as early intervention services for infants and preschool children with developmental disabilities. The emphasis, following recommendations of WHO and existing international standards, was made on deinstitutionalization and development of family-oriented and community-based services, which have been ignored by previous system. In the first half of 90's of 20th century, new training programs for professionals were introduced, more than 50 methods of assessment, treatment and rehabilitation, new for Lithuanian clinical practice, were implemented, and a new model of services, including primary, secondary and tertiary level of prevention, was introduced in demonstration sites. However, during next phase of development, in 1997-2001, serious obstacles for replicating new approaches across the country, have been identified, which threatened successful implementation of the new model of services into everyday clinical practice. Analysis of obstacles, which are blocking development of new approaches in the field of child mental health, is presented in the article. The main obstacles, identified during analysis of socioeconomic context, planning and utilization of resources, running of the system of services and evaluation of outcomes, are as follows: lack of intersectorial cooperation between health, education and social welfare systems; strong tradition of discrimination of psychosocial interventions in funding schemes of health services; societal attitudes, which tend to discriminate and stigmatize marginal groups, including
Full Text Available O processo de transformações no campo da saúde mental e das reformas psiquiátricas mantém estreitas relações com as questões práticas e teóricas surgidas a partir da experiência de Franco Basaglia. O presente texto propõe-se a refletir sobre sua trajetória, destacando os principias conceitos e referências teóricas por ele operados, e procurando demarcar o caráter singular de suas contribuições em relação ao projeto atual de desinstitucionalização em psiquiatria. Basaglia opera uma ruptura ao exercer um profundo questionamento sobre o saber e as instituições psiquiátricas, o que possibilita um novo quadro epistemológico e, conseqüentemente, cultural e assistencial no lidar com a loucura. Partindo da constatação de que esta obra é muito pouco conhecida, este texto procura revisitar o pensamento de Basaglia, sublinhando a originalidade de suas contribuições e atentando para a necessidade de seu melhor conhecimento por parte daqueles que se dedicam ao campo da saúde mental e das instituições sociais.The process of change in the mental health field and psychiatric reforms bear a close relationship to practical and theoretical issues stemming from Franco Basaglia's experience. This article is intended as a reflection on Basaglia's career, stressing the main concepts and theoretical references he worked with and seeking to trace the unique nature of his contributions to the current project for de-institutionalizing psychiatry. Basaglia produces a break by profoundly challenging psychiatric knowledge and institutions, thus allowing for a new epistemological framework (a framework that was thus also new in relation to culture and mental health care in dealing with insanity. Based on the observation that Basaglia's work is little known, this article attempts to revisit his thinking, highlighting the unique nature of his contributions and stressing the need for a better understanding of his work by those who are devoted
Full Text Available The discussion on the spirit possession phenomenon is related in this study to the more general question of the role of religious institutions as part in the development process of a people living in a limited geographical area of a wider national society. It is assumed that religion, like culture in general, has its specific institutional forms as result of the historical development of a society, but at the same time religion is a force shaping that history. People's cultural resources influence their social and economic development and form a potential creative element in it'. Some of the questions to be asked are: "How are specific religious practices related to the dynamics of change in the societies in question? What is the social and religious context in which the spirit possession phenomenon occurs in them? What social and economic relations get their expression in them? To what extent is spirit possession in this case a means of exerting values and creatively overcoming a crisis or conflict which the changing social and economic relations impose on the people? The established spirit possession cults are here seen as the institutional forms of religious experience. At the same time it becomes evident that there is institutionalization in process as well as deinstitutionalization of spirit possession where it occurs outside established institutional forms. Institution is taken as a socially shared form of behaviour the significance of which is commonly recognized by those who share it. By the term spirit possession cult is meant a ritual form of spirit possession of a group which is loosely organized and without strict membership. The context of the study is four ethnic groups in Eastern Tanzania, near the coast of the Indian Ocean. The general theme of the project is The Role of Culture in the Restructuring of Tanzanian Rural Areas. The restructuring refers to a villagisation programme carried out in the whole country. People are being
Luís Gustavo Vechi
Full Text Available Este trabalho apresenta um retrospecto histórico sobre o discurso científico a respeito da loucura no Brasil, com destaque para a evolução das noções de doença mental e de iatrogenia. O discurso manicomial, eminentemente psiquiátrico, introduziu o gerenciamento científico da loucura, a partir do final do século XIX. De meados do século XX ao final da década de 80, o discurso da saúde mental, organizado pela Psiquiatria e por outras disciplinas, como a Psicanálise, a Sociologia e a Antropologia, sob a perspectiva biopsicossocial de compreensão do homem, representou uma nova tentativa de validar o gerenciamento científico da loucura. A partir do final da década de 80, foi introduzido o discurso da desinstitucionalização que, em vez de propor uma nova validação do discurso científico no gerenciamento da loucura, indicou a necessidade de sua (desconstrução: uma radical operação epistemológica de modificação de suas concepções, como a de doença mental.This paper presents a historical retrospective on the scientific discourse about madness in Brazil, emphasizing the evolution of the notions of mental disease and of iatrogeny. The manicomial discourse, produced by Psychiatry, has introduced the scientific management of madness since the end of the 19th century. From the middle of the 20th century until the end of 1980, the discourse of mental health, organized by Psychiatry and by other disciplines, such as Psychoanalysis, Sociology and Anthropology, using a biopsychossocial understanding of man, represented a new attempt to reinforce the scientific management of madness. At the end of 1980, the deinstitutionalization discourse was introduced and, instead of proposing a new validation for the scientific discourse on madness, it indicated the necessity of its (deconstruction: a radical epistemological operation to modify some of its main notions, such as the notion of the mental disease.
Full Text Available Este artigo aborda a autonomia e cidadania no processo de reabilitação psicossocial. A revisão bibliográfica aborda conceitos de desinstitucionalização e reabilitação de autores da tradição basagliana, assim como autores americanos e ingleses que discutem a questão da reabilitação/trabalho/saúde mental. Os resultados apontam que enquanto os primeiros adotam um estilo de trabalho mais flexível, em que o sentido de produção de vida supera a vida produtiva, os autores ingleses e americanos apresentam modelos em que o objetivo é a normalização dos pacientes psiquiátricos através dos confrontos com o mercado de trabalho. Observa-se que ambos os modelos trazem consigo variáveis determinantes - o estigma, as expectativas, a intolerância -, que denunciam formas de exclusão social do trabalho para segmentos marginalizados da população. Conclui-se que um dos maiores obstáculos diz respeito à inserção no mercado de trabalho formal, em razão da competitividade e da necessidade do estabelecimento de uma nova perspectiva na relação doença mental e sociedade.This article approaches autonomy and citizenship in the psychosocial rehabilitation process. The bibliographical review approaches concepts such as de-institutionalization and rehabilitation used by authors following the tradition of Basaglia, as well as American and British authors discussing the question rehabilitation/work/mental health. The results show that while the first are adopting a more flexible style, in which production of life is more important that productive life, American and British authors present models whose objective is the normalization of psychiatric patients by confronting them with the labor market. Both models bring along determinant variables - stigma, expectations, intolerance - denouncing forms of social exclusion from work for marginalized segments of the population. It is concluded that one of the biggest obstacles for rehabilitation is the
Visibilidad e invisibilidad de los cuidados en enfermería en una colonia neuropsiquiátrica argentina: una mirada etnográfica Visibilidade e invisibilidade do trabalho da enfermagem em uma colônia Argentina neuro-psiquiátrica: uma perspectiva etnográfica Visibility and invisibility of nursing work in an Argentine neuro-psychiatric colony: an ethnographic perspective
Full Text Available El presente trabajo recoge las reflexiones sobre la identidad y la labor desarrollada por el personal de Enfermería de una institución neuropsiquiátrica, dedicada a la atención de la persona con discapacidad mental, a raíz de los cambios que, desde 2004, se vienen implementando en esa Institución. Inspirados en los procesos de desinstitucionalización, iniciados en Europa por Basaglia, Laing, Cooper y Szasz entre otros, y en nuestro medio por Hugo Cohen, esta transformación da por tierra con muchos años de práctica de un modelo custodial, que perpetraba la función asilar, más que la rehabilitación para la integración a la vida cotidiana. Los cambios instrumentados y los ajustes que el personal de Enfermería debió hacer generaron una serie de reflexiones y cuestionamientos sobre la identidad del colectivo y la invisibilidad de su quehacer.Este artigo apresenta reflexões sobre a identidade e sobre o trabalho da equipe de enfermagem de uma instituição neuropsiquiátrica, dedicados ao cuidado de pessoas com deficiência mental, como resultado de mudanças implementadas na instituição desde 2004. Inspirado no movimento de desinstitucionalização iniciado na Europa por Basaglia, Laing, Cooper, Szasz, e em nosso ambiente por Hugo Cohen, essas transformações seria deixar de lado o modelo tradicional privativa de liberdade, em favor de um modelo psico-social que busca a integração na vida comunitária. As mudanças implementadas e ajustes gerados entre a equipe de enfermagem de uma variedade de reflexões e questionamentos sobre sua identidade coletiva e da invisibilidade do seu trabalho.This paper presents reflections on identity and on the work of the nursing staff of a neuropsychiatric institution, dedicated to the care of people with mental disability, as the result of changes implemented in the institution since 2004. Inspired by the deinstitutionalization movement initiated in Europe by Basaglia, Laing, Cooper, Szasz, and
Meil Landwerlin, Gerardo
Full Text Available According to family resources theory, the empowerment of women caused by the different dimensions of family change during the last decades (deinstitutionalization of the family, female work, higher education, etc has brought about a greater say in the process of negotiation of gender roles inside the family and the couple life. This impowerment of women should have implied also a lower degree of partner violence against women in “modern” family life settings. Based on a survey on violence against women carried out in 1999 in Spain among 20.000 women, the paper analyses using logistic regressions models if different dimensions of family change (female work, cohabitation, among others are associated with lower risks of partner violence against women. Results from such type of analyses show that there is little support to suppose that family change and the corresponding empowerment of women which it implies will bring about a lower risk of partner violence against women.
Según la teoría de los recursos, la ganancia de recursos de poder por parte de las mujeres derivada de las distintas dimensiones del cambio familiar (desintitucionalización de la familia, incorporación de la mujer al mercado de trabajo, mayor nivel educativo, etc. ha comportado un mayor poder de negociación del contenido de los roles familiares y domésticos. Esta ganancia en recursos de poder debería haberse traducido en una menor violencia conyugal contra las mujeres que viven en uniones “modernas”. A partir de la macroencuesta sobre violencia de género realizada por el Instituto de la Mujer en 1999 se analiza si las distintas dimensiones del cambio familiar están asociadas con un menor riesgo de maltrato. Los resultados obtenidos mediante ajustes de regresión logística indican que el cambio familiar y el correspondiente aumento de poder de negociación de las mujeres no se ha traducido automáticamente en una reducción del riesgo de maltrato.
Sueli de Carvalho Villela
Full Text Available Este trabalho descreve os aspectos político-sociais que envolveram a reforma da assistência psiquiátrica, enfocando o processo de desinstitucionalização e a importância da enfermagem além de constituinte da equipe interdisciplinar. Objetiva analisar o processo de assistência de enfermagem ao doente mental em serviços externos ao hospital. Constitui-se de revisão bibliográfica em periódicos nacionais no período de 1999 a 2001. As autoras discutem sobre o comprometimento dos trabalhadores na área de saúde mental, com a "desconstrução"/construção a cerca do cuidado, fazendo-se necessária uma abordagem humanizada por meio do relacionamento interpessoal de pacientes, enfermeiros e as equipes responsáveis pela assistência ao doente mental.Este trabajo describe los aspectos político-sociales que involucraron la reforma de la asistencia psiquiátrica, enfocando el proceso de desinstitucionalización y la importancia de la enfermería además de constituyente del equipo interdisciplinar. Objetiva analizar el proceso de asistencia de enfermería al enfermo mental en servicios externos al hospital. Se constituye de revisión bibliográfica en periódicos nacionales en el período de 1999 a 2001. Las autoras discuten sobre el compromiso de los trabajadores en el área de salud mental, con la "desconstrucción"/construcción acerca del cuidado, haciéndose necesario un abordaje humanizado por medio de la relación interpersonal de pacientes, enfermeros y los equipos responsables por la asistencia al enfermo mental.This study describes the sociopolitical aspects that involved the psychiatric assistance reform, focusing the deinstitutionalization process and the importance of nursing beyond a component of the interdisciplinary team. It aims to analyze the process of nursing assistance to the mentally sick in services outside the hospital. It is a bibliographical review of national periodicals from 1999 to 2001. The authors discuss
Care of abandoned children in India is discussed in terms of reasons for abandonment, the physical condition of the children, and legal categories. The options available currently are the cottage system, sponsorship programs, foster care, or adoption. Child-care and rehabilitation that may be necessary is specified as is the importance of maintaining records. The gaps in child-care are exposed. The role of nongovernmental organization (NGOs) and new legislation in closing the gaps is presented. Abandonment is usually a direct result of poverty, but it can also be caused by mental or physical handicaps or illegitimacy. The numbers of abandoned children may reach 2 million. 40-60% of abandoned infants die during monsoons and summers. The legal categories are privately abandoned, children on remand, or court-committed children. The cottage system emphasizes deinstitutionalization, but there remains a great demand for care. Sponsorship aims to strengthen the family unit to prevent abandonment. Foster care provides an alternative family substitute, but is known only theoretically. Childcare may involve instant hospitalization, care is an institution, or foster care with a suitable family. Nursery care requires discipline in hygiene, sanitation, maintenance of individual medical records, and a general cheerful atmosphere. Records are important for the child in later life and for adoption. Rehabilitation is a sociolegal process which must be done properly or it can jeopardize a child's future security. Despite the Supreme Court guidelines of 1984, there is no uniform system of adoption practices, and the child's interests are overlooked when adoptions are promoted. NGOs play an important role in making social welfare programs work. However their efforts are of limited help without government support and legislation. There is a lack of proper legislation which is outside the control of political and religious interests; e.g., Hindu law only permits adoption of one child of
Euzilene da Silva Rodrigues
(Southeastern Brazil has currently been enabled mainly by Matrix Support. This paper presents the results of a research endeavor aimed at analyzing this ongoing interlocution in the aforementioned city. It was assumed in the study that the achievements of this dialog can positively impact community life and benefit both the professionals' practice and users. This is a qualitative study and data were collected through semi-structured interviews carried out with fourteen health professionals of various categories who worked at a Centro de Atenção Psicossocial (CAPS - Psychosocial Care Center and at a Family Health Unit. Results show that the so-called interlocution takes different forms in the territory, with important dialogs but also great challenges. However, rich possibilities can be envisioned and perceived as indications that we must believe and make investments in the potentiality of the constitution of a substitutive net between the CAPS and primary care services as a way of guaranteeing integrality to users with mental disorders. This articulation was first outlined in Vitoria with the systematization of Matrix Support. The belief in this dialog has brought with it de-institutionalization and the transformation of the production of care in the territory.
Full Text Available Abstract Background The aim of this paper is to assess the mental health system in Brazil in relation to the human resources and the services available to the population. Methods The World Health Organization Assessment Instrument for Mental Health Systems (WHO AIMS was recently applied in Brazil. This paper will analyse data on the following sections of the WHO-AIMS: a mental health services; and b human resources. In addition, two more national datasets will be used to complete the information provided by the WHO questionnaire: a the Executive Bureau of the Department of Health (Datasus; and b the National Register of Health Institutions (CNS. Results There are 6003 psychiatrists, 18,763 psychologists, 1985 social workers, 3119 nurses and 3589 occupational therapists working for the Unified Health System (SUS. At primary care level, there are 104,789 doctors, 184, 437 nurses and nurse technicians and 210,887 health agents. The number of psychiatrists is roughly 5 per 100,000 inhabitants in the Southeast region, and the Northeast region has less than 1 psychiatrist per 100,000 inhabitants. The number of psychiatric nurses is insufficient in all geographical areas, and psychologists outnumber other mental health professionals in all regions of the country. The rate of beds in psychiatric hospitals in the country is 27.17 beds per 100,000 inhabitants. The rate of patients in psychiatric hospitals is 119 per 100,000 inhabitants. The average length of stay in mental hospitals is 65.29 days. In June 2006, there were 848 Community Psychosocial Centers (CAPS registered in Brazil, a ratio of 0.9 CAPS per 200,000 inhabitants, unequally distributed in the different geographical areas: the Northeast and the North regions having lower figures than the South and Southeast regions. Conclusion The country has opted for innovative services and programs, such as the expansion of Psychosocial Community Centers and the Return Home program to deinstitutionalize
Ações de saúde mental no Programa Saúde da Família: confluências e dissonâncias das práticas com os princípios das reformas psiquiátrica e sanitária Mental health care in the Family Health Program: consensus and dissent in practices and principles under the psychiatric reform and health reform in Brazil
Full Text Available Em um grande número de Reformas Psiquiátricas que se sedimentam sobre os pressupostos básicos da não-institucionalização dos pacientes psiquiátricos e da consolidação de bases territoriais do cuidado em saúde mental, a ênfase é atribuída a uma rede de cuidados que contemple a rede de atenção primária. No Brasil, a Reforma Psiquiátrica Brasileira nasce no bojo da Reforma Sanitária, guardando em comum princípios que reorientariam o modelo de atenção. Neste artigo, discutiremos as articulações entre esses dois movimentos por intermédio das práticas concretas do cuidado de saúde mental no Programa Saúde da Família (PSF, tomando como base um estudo etnográfico com quatro equipes de saúde da família, em que priorizamos a narrativa dos trabalhadores de saúde. Analisaremos, dessas práticas, discrepâncias entre o proposto normativo e o instituído, fatores dificultadores e conquistas da operacionalização das ações e limites da confrontação e potencialidades da transversalidade de campos epistemológicos particulares como a clínica ampliada da saúde mental e do PSF. Moveremos nossa discussão com base em conceitos como modelo psicossocial do cuidado, integralidade da atenção, participação social, territorialidade, ações coletivas, entre outros.In many psychiatric reforms based on the principles of deinstitutionalization of psychiatric patients and the consolidation of territorial systems for mental health care, the emphasis is on a mental health care system that includes the primary care network. In Brazil, the Psychiatric Reform emerged within the country's overall Health Reform, with which it shares common principles for reorienting the model of care. The current article discusses the links between these two movements through actual mental health care practices within the Family Health Program (FHP, based on an ethnographic study with four family health teams, in which the authors prioritize health workers
Full Text Available En un contexto en donde los marcos colectivos que estructuran la identidad social e individual de la población se fueron desistitucionalizando, nos vemos obligados a repensarlos en el marco de los nuevos procesos de socialización, donde el trabajo, mirado de manera tradicional, deja de ser el eje central de referencia. Aparecen nuevos espacios que dan lugar a esta construcción que se expresa en términos identitarios, en los cuales la política social, a través del poder simbólico que posee derivado de la capacidad que tiene el Estado de establecer clasificaciones, define identidades sociales al condicionar las prácticas cotidianas de los actores y actrices sociales. Las mujeres subjetivan su paso por los programas sociales, dándole un significado particular. En este sentido el trabajo presenta una tipología elaborada a partir de la lejanía o la proximidad en la que pueden encontrarse las mujeres, "beneficiarias" de programas de empleo, respecto a la posibilidad de construir su propia autonomía. Esta se propone aportar al momento de interpelar las acciones sociales desde una perspectiva de género, en tanto habilitantes, en mayor o en menor medida, de cambios en los repertorios subjetivos de las mujeres y de una forma diferente o no de hacer las cosas y de verse a si mismas y a su futuro. La metodología utilizada para la elaboración de esta tipología basada en la exploración de las representaciones e imaginarios femeninos explícitos e implícitos, fue de tipo cualitativo, esta metodología tiene la peculiaridad de captar la perspectiva interna de los actores y actrices sociales por medio de la utilización de un lenguaje de conceptos (Glasser y Strauss, 1967; Denzin y Lincoln, 1994.In a context where the collective frameworks that structure people's social and individual identities have been deinstitutionalizing, we are compelled to rethink them within the framework of the new processes of socialization, in which labor, as
Reforma psiquiátrica brasileira: conhecimentos dos profissionais de saúde do serviço de atendimento móvel de urgência Reforma psiquiátrica brasileña: conocimientos de los profesionales de salud del servicio móvil de urgencia Brazilian psychiatric reform: knowledges of health professional of mobile service of urgency
tratamiento psicosocial, sus líneas de referencia a la necesidad de hospitalización para los pacientes psiquiátricos. El modelo centrado en los hospitales y diseñado por la psiquiatría clásica exclusiva sigue vivo en las ideas de estos profesionales como una referencia a la atención de urgencias psiquiátricas.Objective is to identify the knowledge of health professionals of Service of Mobile Emergency of Natal on the Brazilian Psychiatric Reform. Information was collected through semi-structured interviews with 24 health professionals stationed at the institution. The interviews were transcribed and submitted to the technique of thematic analysis revealed three categories of analysis: admission of the subject in crisis as social and family demands; Psychiatric Reform: legislation and reality in the SAMU-Natal, and the Brazilian Psychiatric Reform as a promoter of deinstitutionalization. The professionals showed misleading and reductionist understandings of the Brazilian Psychiatric Reform and, mostly, did not give credence to the current model of mental health care in guided psychosocial treatment, his lines referring to the need for hospitalization of psychiatric patients. In this sense, we realize that the hospital-centered model designed by classical psychiatry is still alive in the ideas of these professionals as a reference to the psychiatric emergency care.
whom should be either a psychologist or a psychiatrist". We all know that psychologists play a very important role in mental health care, but the medical training of psychiatrists will surely enable them to make very complex medical decisions such as the decision to confine a patient into hospital. Some other aspects to be mentioned about this law are that no reference is made to outpatient services, although they are of utmost importance in everyday practice, and that there is a bureaucratization of hospitalization. Such decision is no longer made by a professional, as a means to achieve the best treatment possible, but by a judge, who is expected to know what is best for the patient. However, there are basic contents in this law which are definitely positive: it defends patients' rights; it promotes interdisciplinary team work; it recommends deinstitutionalization, community services and, if necessary, inpatient services in general hospitals. However, there are many doubts as regards the way this will be put into practice. In most countries psychiatry is also threatened by a shortage of psychiatrists. In Argentina, the number of medical students who choose this branch of medicine as their specialty has declined the past twenty years, while the number of prospective psychologists has soared in the meantime. These are some of the reasons why many believe that psychiatry is being discredited. In this scenario, where there are both internal and external risks for psychiatry, our main professional interest is based on improving our patients' quality of life, which obviously includes their mental health. In order to achieve the best results we should avoid militant attitudes and the ideologization of reality, and be as creative as possible looking for the best way to do so.
As representações sociais dos profissionais de saúde mental acerca do modelo de atenção e as possibilidades de inclusão social Social inclusion practices: professionals' social representations about the mental health assistance model
the study are the professionals' social representations on social inclusion practices that are performed by the substitutive mental health services. The guiding concepts of this study are Psychosocial Rehabilitation and the Italian de-institutionalization. The data, collected by means of semi-structured interviews, were submitted to discourse analysis, from which it was possible to recognize empirical categories. One of them is the mental health assistance model, which is studied in this article. The analysis of the categories was carried out according to the view of Social Representation. Among the results, it was possible to observe that the discourses revealed concepts that represent the traditional psychiatric assistance model. These representations can be overcome through a higher clarity of CAPS' institutional project and discussions within the interdisciplinary teams.
Fernando Ferreira Pinto de Freitas
sectors of Brazilian society, we intend not only to respond to the economic/administrative irrationality created by "hospital-centrism", but especially to meet the needs of patients, health professionals, and society in general in moving away from a psychiatric care model dominated by the reference patterns of psychiatry and to de-institutionalize mental health. The results of this study criticize the biomedical model and open the door to a care model engaged in "psychosocial rehabilitation". The critical analysis based upon the data from the investigation done at the Psychiatric Center should be applicable to other psychiatric hospitals in Brazil's public and private sectors.
Nakatani, Yoji; Hasuzawa, Suguru
This article describes the background and recent changes in French forensic mental health. The literature suggests that three law reforms have been crucial to changes in the mental health system. First, the Penal Code of 1992 redefined the provisions of criminal responsibility and introduced the category of diminished responsibility. Second, a controversial law for preventive detention (rétention de sûretê) was enacted in 2008, according to which criminals with severe personality disorders are subject to incarceration even after the completion of their prison sentences if they are still considered to pose a danger to the public. Third, the revision of mental health laws in 2011 altered the forms of involuntary psychiatric treatments, stipulating a judge's authority to decide treatment. In parallel with these legal reforms, the psychiatric treatment system for offenders with mental disorders has been reconstructed. The number of difficult patient units (unités pour malades difficiles) has increased from four to ten across the nation in order to meet the needs of patients transferred from general psychiatric institutions for the reason of being unmanageable. In the penitentiary system, new facilities have been established to cope with the growing number of inmates with mental disorders. As background to these changes, it is pointed out that the current psychiatric system has undergone deinstitutionalization and become less tolerant of aggressive behavior in patients. In the broader context, public sensitivity towards severe crime, as shown by the sensation triggered by serious crimes conducted by pedophiles, seems to urge tough policies. In the 2000 s, several homicides committed by psychiatric patients had a great impact on the public, which led President Sarkozy to issue a statement calling for stronger security in psychiatric institutions. The harsh attitude of courts towards psychiatric practices is illustrated by a 2012 ruling; after a patient escaped from
Full Text Available El art��culo propone una agenda de "cuestiones educativas" orientada a la reconstitución del lazo entre educación y democracia después de las reformas implementadas en los años 90. Construye previamente un estado de situación caracterizado por la presencia de tres procesos: a. un proceso de des-institucionalización escolar que se expresa tanto en la dificultad de la escuela para sostener un marco normativo sancionado socialmente, como en la crisis de identidad por la que atraviesan las instituciones; b. un proceso de fragmentación del sistema educativo que se diferencia de la tradicional segmentación de los sistemas; c. el agotamiento del instrumental teórico-conceptual con el que tradicionalmente nos hemos propuesto organizar y dar sentido a los fenómenos de la realidad. En este marco el artículo propone: 1. discutir los limites de la modernidad educativa en países periféricos como el nuestro y, en este marco, los de la pedagogía moderna para superar las problemáticas de discriminación y exclusión educativa; 2. rediscutir el concepto de ciudadanía y el papel de la escuela en la formación ciudadana; 3. repensar y discutir el papel del conocimiento y la investigación en la modificación de las practicas políticas y pedagógicas.This article proposes an agenda on "educational matters" which is meant for binding afair education to democracy after the reforms carried out in the 90's. First it describes the current state which is characterized by three processes: a. a school deinstitutionalization process which is expressed both in terms of the difficulty to keep a socially-sanctioned normative framework, and the identity crisis the institutions currently go through; b. a fragmentation process of the educational system which is different from the traditional segmentation of the systems; c. the wearing out of the theoretical and conceptual instruments on which we have been traditionally supposed to rely for organizing and
Full Text Available SUMMARY Trying to live independently: social rented housing with support for vulnerable target groups In October 2010, the Flemish Ministers for Welfare and for Housing launched a joint call for experimental projects to improve cooperation between social care services and social rented housing providers. The selected projects were also encouraged to explore legal barriers. The “Proefwonen” project aimed to provide a solution to several difficulties that can stand in the way of successful cooperation between welfare and social renting services: (1 waiting lists for social housing services, which can prevent the smooth transition of a person with intellectual and/or psychological problems into a residential setting and an independent life with support in situations where the right timing is crucial; (2 there are few options for “trying out” independent living and taking a step back if necessary, two conditions for de-institutionalization; and (3 social rented housing providers have to work with vulnerable clients, but do not have the means to support them. In some cases, this may even lead to eviction.The “Proefwonen” project aims to facilitate access to social renting for two vulnerable groups - people with mild to moderate intellectual disabilities/learning difficulties and/or people with mental health issues - by providing a solution to the difficulties described above, which prevent many of these service users from living independently.Through closer collaboration and regular meetings between providers of housing and social services, the project aims to facilitate the transition and prevent evictions. The objective is to achieve structural cooperation and to lay a basis for mutual trust. Consensus and careful deliberation between the partners are essential to work towards community care and deinstitutionalization.In the project, social care service users can apply for social rented housing in combination with mobile support. The
Caracterização epidemiológica dos usuários do Centro de Atenção Psicossocial Casa Aberta Caracterización epidemiológica de los usuarios del Centro de Atención Psicosocial "Casa Aberta" Epidemiological characterization of the users of Casa Aberta, a psychosocial attention center
Cátula da Luz Pelisoli
un alto nivel de no adhesión y un bajo promedio de consultas por paciente; la raíz más relevante es la demanda espontánea; y la psiquiatría logra la mayor búsqueda de los usuarios. CONCLUSIÓN: Concluye que hay la necesidad de modificaciones operacionales, tales como la formación de grupos terapéuticos, la creación de un protocolo estándar para que los profesionales sigan y la realización de nuevas investigaciones o la replicación de este estudio.INTRODUCTION: After the deinstitutionalization of psychiatry, substitute services have become the main resource for people in need of mental health care. Thus, categorizing the clients of such services is of major importance. OBJECTIVE: The goal of this study is to outline an epidemiological profile of the population of users of a psychosocial attention center in the state of Rio Grande do Sul, Brazil. RESULTS: The most prevalent diagnostic categories were mood disorders, stress-related neurotic disorders and somatoform disorders. There is a low compliance to treatment prescriptions and a low rate of medical visits for each patient. The most relevant source of referral is the spontaneous demand by clients, and psychiatry is the service with the highest demand. FINDINGS: Operational changes were shown to be required, such as the creation of therapy groups and of a standard protocol to be followed by caregivers, the reassignment of psychiatric patients, and the conduction of further research. The replication of this study may be useful as well.