PSYC 3690 Chapter Notes -Vocational Rehabilitation, Deinstitutionalisation, Mental Health Professional

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Published on 15 Apr 2013
School
University of Guelph
Department
Psychology
Course
PSYC 3690
Page:
of 6
Article #: 29
Title: Mental Hospitals and Deinstitutionalization
Definitions
Aftercare - after hospitalization, a continuing program of treatment and rehabilitation
designed to reinforce the effects of therapy and to help patients adjust to their
environment
Board-and-Care Home - a congregate living facility in the community for persons with
mental illness, provides room, board, minimal staff supervision and sometimes
medication
Deinstitutionalization - the mass exodus of mentally ill persons from living in hospitals to
living in the community
Gravely Disabled - a condition in which a person, as a result of a mental disorder, is
unable to provide for his or her basic personal needs for food, clothing, or shelter
Institutes for Mental Disease - community facilities that are usually, but not always
locked. They provide 24 hour structured care, close medication supervision and at least
27 hours per week of therapeutic activity for every resident
Institutionalism - a syndrome characterized by lack of initiative, apathy, withdrawal,
submissiveness to authority, and excessive dependence on the institution
Background
- before the current era of deinstitutionalization, chronically and severely mentally ill
persons were usually institutionalized for life in large state mental hospitals
- in the 1960s, it was observed that persons who sent long periods in mental hospitals
developed what has come to be known as institutionalism, a syndrome characterized
by a lack of initiative, apathy, withdrawal, submissiveness to authority, and excessive
dependence on the institution
- this treatment can strip away a patientʼs dignity and individuality and foster regression,
the deviant person is locked into a degraded, stigmatized, deviant role
Functions of the State Hospital
- the term “asylum” was in many ways appropriate, these imperfect institutions did
provide asylum and sanctuary from the pressures of the world where most patients
were unable to cope
- they provided medical care, patient monitoring, respite for the patientʼs family, and a
social network for the patient, as well as food, shelter, and needed support for
structure
- the treatment and services that did exist were in one place under one administration
- in the community, the situation is very different - services and treatment are under
various administration jurisdictions and various locations
- the use of the word asylum, which has taken on such a negative connotation, needs
further elaboration
- the fact that the chronically mentally ill have been deinstitutionalized does not mean
they no longer need social support, protection, and relief from external stimuli and the
pressures of life
- they need asylum and sanctuary in the community
Hospital Versus Community
- in the view of some, deinstitutionalized has gone too far in terms of attempting to treat
long-term mentally ill persons in the community
- some long-term mentally ill persons clearly require a highly structured, locked, 24 hour
setting for adequate intermediate or long-term management
- where to treat is a decision that is best based on the clinical needs of the person
- deinstitutionalization has too often confused locus of care and quality of care - where
mentally ill persons are treated has been deemed to be more important than how or
how well they are treated
- the long-term mentally ill are not a homogeneous population, what is appropriate for
some is not appropriate for others
- e.g. persons who are assaultive, lack internal controls, are self destructive may be lost
to the mental health system and are on the streets and in jails
- one consequence has been an alienation of a number of long-term mentally ill persons
from a system that has not met their needs and some mental health professionals
have become disenchanted with their treatment as well
New Generation of Chronically Mentally Ill Persons
- the problem that has proved most vexing and almost totally unforeseen by the
advocates of deinstitutionalization, is the treatment of the new generation of severely
mentally ill persons that has emerged since deinstitutionalization
- the large homeless population with major mental illness has tended to be young
- those who have been hospitalized for long periods have been institutionalized to
passivity - for the most part they have come to do what they are told
- this is not true for the new generation of severely mentally ill persons
- they have not been institutionalized to passivity
- not only have they not spent long years in hospitals, they have probably had difficulty
just getting admitted to an acute hospital and even greater difficulty staying there for
more than a short period on any one admission
- when one is still young and just beginning to deal with lifeʼs demands and trying to
make a way in the world, one struggles to achieve some measures of independence,
to choose and succeed at a vocation, to establish satisfying interpersonal relationships
and attain some degree of intimacy and to acquire some sense of identity
- these efforts often only lead to failure
- before deinstitutionalization, these “new chronic patients” would have been chronically
institutionalized, often starting from the time of their first break down in adolescence or
early adulthood
- they were given a permanent place of asylum from the demand of the world
- since large scale deinstitutionalization began, hospital stays tend to be brief
- the majority of “new” long-term patients are the products of deinstitutionalization
- it is this new generation of chronically and severely mentally ill persons that has
constituted the greatest concerns about deinstitutionalization
- they have posed the most difficult clinical problems in treatment and by swelling the
ranks of the homeless mentally ill and the mentally ill in jail, they have created serious
social problems for the community
Problems in Treatment of the New Long-Term Patients
- many patients fail to take psychotropic because of disturbing side effects, denial of
illness, and other reasons
- admitting mental illness seems to them to be admitting failure - becoming part of the
mental health system seems to many of these persons like joining an army of misfits,
many of these persons also have primary substance abuse disorders and/or medicate
themselves with street drugs
- these problems becomes worse for those whose illness is more severe, and may
result in serious problems such as homelessness
Basic Needs of Chronically and Severely Mentally Ill Persons in the Community
- a comprehensive and integrated system of care needs to be established in the
community
- the following are the components of such a system
- adequate, comprehensive and accessible psychiatric and rehabilitative services need
to be available
- first, there needs to be an adequate number of direct psychiatric services that provide:
(a) outreach contact, (b) psychiatric assessment, (c) crisis intervention, (d)
individualized treatment plans, (e) psychotic medication, (f) psychosocial treatment
- second, there needs to be an adequate number of rehabilitative services that provide
socialization experiences, training in the skills of everyday living, and social and
vocational rehabilitation
- third, both treatment and rehabilitative services need to be provided assertively
- fourth, the difficulty of working with some of these patients should not be
underestimated
- crisis services need to be available and accessible
- an adequate number of professionals and paraprofessionals need to be trained for
community care
- an adequate number and ample range of graded, stepwise, supervised community
housing systems need to be established
- a system of responsibility for the chronically and severely mentally ill living in the
community needs to be established, with the goal of ensuring that each patient has a
therapeutic relationship with one mental health professional or paraprofessional who is
ultimately responsible for their care
- respite care needs to be provided to enhance the familyʼs ability to provide a support
system
- the mentally ill person needs to be linked with a formal community support system
- basic changes need to be made in legal and administrative procedures to ensure
continuing community care for the chronically and severely mentally ill
- involuntary commitment laws need to be made more humane to permit prompt return
to active inpatient treatment for mentally ill persons when acute exacerbations of their
illnesses make their lives in the community chaotic and unbearable

Document Summary

Aftercare - after hospitalization, a continuing program of treatment and rehabilitation designed to reinforce the effects of therapy and to help patients adjust to their environment. Board-and-care home - a congregate living facility in the community for persons with mental illness, provides room, board, minimal staff supervision and sometimes medication. Deinstitutionalization - the mass exodus of mentally ill persons from living in hospitals to living in the community. Gravely disabled - a condition in which a person, as a result of a mental disorder, is unable to provide for his or her basic personal needs for food, clothing, or shelter. Institutes for mental disease - community facilities that are usually, but not always locked. They provide 24 hour structured care, close medication supervision and at least. 27 hours per week of therapeutic activity for every resident. Institutionalism - a syndrome characterized by lack of initiative, apathy, withdrawal, submissiveness to authority, and excessive dependence on the institution.