Deinstitutionalisation

Vienna's Narrenturm—German for "fools' tower"—was one of the earliest buildings specifically designed for mentally ill people. It was built in 1784.

Deinstitutionalisation (or deinstitutionalization) is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability. In the late 20th century, it led to the closure of many psychiatric hospitals, as patients were increasingly cared for at home or in halfway houses, clinics and regular hospitals.

Deinstitutionalisation works in two ways. The first focuses on reducing the population size of mental institutions by releasing patients, shortening stays, and reducing both admissions and readmission rates. The second focuses on reforming psychiatric care to reduce (or avoid encouraging) feelings of dependency, hopelessness and other behaviors that make it hard for patients to adjust to a life outside of care.[1]

The modern deinstitutionalisation movement was initiated by three factors:

  • A socio-political movement for community mental health services and open hospitals;
  • The advent of psychiatric drugs able to manage psychotic episodes;
  • Financial imperatives (in the US specifically, to shift costs from state to federal budgets)[2]

The movement to reduce institutionalisation was met with wide acceptance in Western countries, though its effects have been the subject of many debates. Some experts, such as E. Fuller Torrey, have argued that deinstitutionalisation was a mistake,[3] while others, such as Thomas Szasz, argue it did not provide enough freedom for patients.[4] Others have argued that it was an improvement on the system that existed before. Psychiatrist Leon Eisenberg has argued that it has generally been beneficial for psychiatric patients, while noting that some were left homeless or without care.[2]

Origins

19th century

The 19th century saw a large expansion in the number and size of asylums in Western industrialised countries. Although initially based on principles of moral treatment, they became overstretched, non-therapeutic, isolated in location, and neglectful of patients.[5]

20th century

By the beginning of the 20th century, increasing admissions had resulted in serious overcrowding, causing many problems for psychiatric institutions. Funding was often cut, especially during periods of economic decline and wartime. Asylums became notorious for poor living conditions, lack of hygiene, overcrowding, ill-treatment, and abuse of patients. Many patients starved to death.[6]

The first community-based alternatives were suggested and tentatively implemented in the 1920s and 1930s, although asylum numbers continued to increase up to the 1950s. The movement for deinstitutionalisation moved to the forefront in various countries during the 1950s and 1960s with the advent of chlorpromazine and other antipsychotic drugs.

The prevailing public arguments, time of onset, and pace of reforms varied by country.[6] In the United States, class action lawsuits and the scrutiny of institutions through disability activism and antipsychiatry helped expose poor conditions and treatment. Sociologists and others argued that such institutions maintained or created dependency, passivity, exclusion, and disability, which caused people to remain institutionalised. Rosenhan's experiment in 1973 "accelerated the movement to reform mental institutions and to deinstitutionalize as many mental patients as possible."[7]

A prevailing argument claimed that community services would be cheaper and that new psychiatric medications made it more feasible to release people into the community.[8] Mental health professionals, public officials, families, advocacy groups, public citizens, and unions held differing views on deinstitutionalisation.[9]

A key text in the development of deinstitutionalisation was Asylums: Essays on the Social Situation of Mental Patients and Other Inmates, a 1961 book by sociologist Erving Goffman.[10][11][12] The book is one of the first sociological examinations of the social situation of mental patients, the hospital.[13] Based on his participant observation field work, the book details Goffman's theory of the "total institution" (principally in the example he gives, as the title of the book indicates, mental institutions) and the process by which it takes efforts to maintain predictable and regular behavior on the part of both "guard" and "captor," suggesting that many of the features of such institutions serve the ritual function of ensuring that both classes of people know their function and social role, in other words of "institutionalizing" them.

Franco Basaglia, a leading Italian psychiatrist who inspired and was the architect of the psychiatric reform in Italy, also defined mental hospital as an oppressive, locked and total institution in which prison-like, punitive rules are applied, in order to gradually eliminate its own contents, and patients, doctors and nurses are all subjected (at different levels) to the same process of institutionalism.[14]

The American Association for the Abolition of Involuntary Mental Hospitalisation (AAAIMH) was an organisation founded in 1970 by Thomas Szasz, George Alexander, and Erving Goffman for the purpose of abolishing involuntary psychiatric intervention, particularly involuntary commitment, against individuals.[15] The founding of the AAAIMH was announced by Szasz in 1971 in the American Journal of Public Health[16] and American Journal of Psychiatry.[17] The association provided legal help to psychiatric patients and published a journal, The Abolitionist.[18] The organization was dissolved in 1980.[18][19]

American psychiatrist Loren Mosher noticed that the psychiatric institution itself gave him master classes in the art of the "total institution": labeling, unnecessary dependency, the induction and perpetuation of powerlessness, the degradation ceremony, authoritarianism, and the primacy of institutional needs over those of the persons it was ostensibly there to serve-the patients.[20]

In New York ARC v. Rockefeller, parents of 5,000 residents at the Willowbrook State School in Staten Island, New York, filed suit over the inhumane living conditions at that institution, where residents were abused and neglected. A 1972 television broadcast from the Willowbrook State School, titled "Willowbrook: The Last Great Disgrace," outraged the general public. However, it took 3 years from the time the lawsuit documents were filed before the consent judgement was signed. In 1975, the consent judgement was signed, and it committed New York state to improve community placement for the now designated "Willowbrook Class." The Willowbrook State School was closed in 1987, and all but about 150 of the former Willowbrook residents were moved to group homes by 1992.[21][22][23][24][25]

In 1973, a federal district court ruled in Souder v. Brennan that patients in mental health institutions must be considered employees and paid the minimum wage required by the Fair Labor Standards Act of 1938 whenever they performed any activity that conferred an economic benefit on an institution. Following this ruling, institutional peonage was outlawed, as evidenced in Pennsylvania's Institutional Peonage Abolishment Act of 1973.

Consequences

There is an increased incarceration for the mental health population due to mental health treatment facilities being closed as a result of the lack of government funding. The solution is to put money back into mental health treatment facilities to decrease the mental health population in jail. Better Mental health services would combat not only mental illness, but homelessness as well. In a survey by the United States Conference of Mayors (2008), 20 percent of cities listed better coordination with mental health service providers as one of the top three items needed to combat homelessness. Incarceration and homelessness are mutual risk factors for each other. Researchers generally estimate that 25-50 percent of the homeless population has a history of incarceration. According to the Substance Abuse and Mental Health Services Administration, 20 to 25 percent of the homeless population in the United States suffers from some sort of severe mental illness (SAMSHA 2018). About a fifth of America’s 1.7 million homeless population suffer from untreated schizophrenia or manic-depressive illness. According to the National Coalition for the Homeless, when you focus in on single adult homeless males, about 16% of them suffer from some form of severe and persistent mental illness. There is general agreement among researchers that the number of mentally ill individuals in jail is substantial, and that many of these individuals are arrested for minor crimes, particularly disorderly conduct or trespassing. There is evidence that a large percentage of jailed individuals may also have been homeless at the time of arrest. Nearly 21 percent were classified as homeless when they were arrested and 40 percent said they had been homeless at some time during the past few years. The researchers concluded that homelessness significantly increases the risk of indictment for violent criminal offenses among mentally disordered offenders (National Coalition for the Homeless 2009).

Community services that developed include supportive housing with full or partial supervision and specialised teams (such as assertive community treatment and early intervention teams). Costs have been reported as generally equivalent to inpatient hospitalisation, even lower in some cases (depending on how well or poorly funded the community alternatives are).[6] Although deinstitutionalisation has been positive for the majority of patients, it also has shortcomings.

Criticism of deinstitutionalisation takes two forms. Some, like E. Fuller Torrey, defend the use of psychiatric institutions and conclude that deinstitutionalisation was a move in the wrong direction. Others, such as Walid Fakhoury and Stefan Priebe argue that it was an unsuccessful move in the right direction, suggesting that modern day society faces the problem of "reinstitutionalisation".[6] Sometimes these groups have similar criticisms. Both argue that many patients became homeless or in prison.[26][6]

New community services are often uncoordinated and unable to meet complex needs. Services in the community sometimes isolate the mentally ill within a new ghetto, where service users meet each other but have little contact with the rest of the public community. Fakhoury and Priebe said that instead of "community psychiatry", reforms established a "psychiatric community".[6]

Families can often play a crucial role in the care of those who would typically be placed in long-term treatment centres. However, many mentally ill people are resistant to such help due to the nature of their conditions. The majority of those who would be under continuous care in long-stay psychiatric hospitals are paranoid and delusional to the point that they refuse help, believing they do not need it, which makes it difficult to treat them.[27]

Violence

Victimisation

Moves to community living and services have led to various concerns and fears, from both the individuals themselves and other members of the community. Over a quarter of individuals accessing community mental health services in a US inner-city area are victims of at least one violent crime per year, a proportion eleven times higher than the inner-city average. The elevated victim rate holds for every category of crime, including rape/sexual assault, other violent assaults, and personal and property theft. Victimisation rates are similar to those with developmental disabilities.[28][29]

Misconceptions

Despite perceptions by the public and media that people with mental disorders released into the community are more likely to be dangerous and violent, a large study indicated that those without substance abuse symptoms are no more likely to commit violence than others without substance abuse symptoms in their neighborhoods, which were usually economically deprived and high in substance abuse and crime. The study also reported that a higher proportion of the patients than of the others in the neighborhoods reported symptoms of substance abuse.[30]

Findings on violence committed by those with mental disorders in the community have been inconsistent and related to numerous factors; a higher rate of more serious offences such as homicide have sometimes been found but, despite high-profile homicide cases, the evidence suggests this has not been increased by deinstitutionalisation.[31][32][33] The aggression and violence that does occur, in either direction, is usually within family settings rather than between strangers.[34]

Worldwide

Asia

Hong Kong

In Hong Kong, a number of residential care services such as halfway houses, long-stay care homes, supported hostels are provided for the discharged patients. In addition, community support services such as rehabilitation day services and mental health care have been launched to facilitate the patients' re-integration into the community.

Japan

In Japan, the number of hospital beds has risen steadily over the last few decades.[6]

Africa

Uganda has one psychiatric hospital.[6]

Australia and Oceania

New Zealand

New Zealand established a reconciliation initiative in 2005 to address the ongoing compensation payouts to ex-patients of state-run mental institutions in the 1970s to 1990s. A number of grievances were heard, including: poor reasons for admissions; unsanitary and overcrowded conditions; lack of communication to patients and family members; physical violence and sexual misconduct and abuse; inadequate mechanisms for dealing with complaints; pressures and difficulties for staff, within an authoritarian hierarchy based on containment; fear and humiliation in the misuse of seclusion; over-use and abuse of ECT, psychiatric medications, and other treatments as punishments, including group therapy, with continued adverse effects; lack of support on discharge; interrupted lives and lost potential; and continued stigma, prejudice, and emotional distress and trauma.

There were some references to instances of helpful aspects or kindnesses despite the system. Participants were offered counselling to help them deal with their experiences, along with advice on their rights, including access to records and legal redress.[35]

Europe

In some countries where deinstitutionalisation has occurred, "re-institutionalisation", or relocation to different institutions, has begun, as evidenced by increases in the number of supported housing facilities, forensic psychiatric beds, and the growing prison population.[36]

Some developing European countries still rely on asylums.

Italy

Italy was the first country to begin the deinstitutionalisation of mental health care and to develop a community-based psychiatric system.[37] The Italian system served as a model of effective service and paved the way for deinstitutionalisation of mental patients.[37] Since the late 1960s, the Italian physician Giorgio Antonucci questioned the basis itself of psychiatry; from 1973 to 1996 Antonucci worked on the dismantling of the psychiatric hospitals Osservanza and Luigi Lolli of Imola and the liberation – and restitution to life – of the people there secluded.[38] In 1978, the Basaglia Law had started Italian psychiatric reform that resulted in the end of the Italian state mental hospital system in 1998.[39]

The reform was focused on the gradual dismantlement of psychiatric hospitals, which required an effective community mental health service.[14]:665 The object of community care was to reverse the long-accepted practice of isolating the mentally ill in large institutions and to promote their integration in a socially stimulating environment, while avoiding subjecting them to excessive social pressures.[14]:664

The work of Giorgio Antonucci, instead of changing the form of commitment from the mental hospital to other forms of coercion, questions the basis of psychiatry, affirming that mental hospitals are the essence of psychiatry and rejecting any possible reform of psychiatry, that must be completely eliminated.[38]

United Kingdom

The water tower of Park Prewett Hospital in Basingstoke, Hampshire. The hospital was redeveloped into a housing estate after its closure in 1997.

In the United Kingdom, the trend towards deinstitutionalisation began in the 1950s. At the time, 0.4% of the population of England were housed in asylums.[40] The government of Harold Macmillan sponsored the Mental Health Act 1959,[41] which removed the distinction between psychiatric hospitals and other types of hospitals. Enoch Powell, the Minister of Health in the early 1960s, criticized psychiatric institutions in his 1961 "Water Tower" speech and called for most of the care to be transferred to general hospitals and the community.[42] The campaigns of Barbara Robb and several scandals involving mistreatment at asylums (notably Ely Hospital) furthered the campaign.[43] The Ely Hospital scandal led to an inquiry led by Brian Abel-Smith and a 1971 white paper that recommended further reform.[44]

The policy of deinstitutionalisation came to be known as Care in the Community at the time it was taken up by the government of Margaret Thatcher. Large-scale closures of the old asylums began in the 1980s. By 2015, none remained.[45]

North America

United States

The former St Elizabeth's Hospital in 2006, closed and boarded up. The hospital had been one of the sites of the Rosenhan experiment in the 1970s.

The United States has experienced two main waves of deinstitutionalisation. The first wave began in the 1950s and targeted people with mental illness.[1] The second wave began roughly 15 years later and focused on individuals who had been diagnosed with a developmental disability.[1] Loren Mosher argues that deinstitutionalisation fully began in the 1970s and was due to financial incentives like SSI and Social Security Disability, rather than after the earlier introduction of psychiatric drugs.[46]

The most important factors that led to deinstitutionalisation were changing public attitudes to mental health and mental hospitals, the introduction of psychiatric drugs and individual states' desires to reduce costs from mental hospitals.[1][2] The federal government offered financial incentives to the states to achieve this goal.[1][2] Stroman pinpoints World War II as the point when attitudes began to change. In 1946, Life magazine published one of the first exposés of the shortcomings of mental illness treatment.[1] Also in 1946, Congress passed the National Mental Health Act of 1946, which created the National Institute of Mental Health (NIMH). NIMH was pivotal in funding research for the developing mental health field.[1]

President John F. Kennedy had a special interest in the issue of mental health because his sister, Rosemary, had incurred brain damage after being lobotomised at the age of 23.[1] His administration sponsored the successful passage of the Community Mental Health Act, one of the most important laws that led to deinstitutionalization. The movement continued to gain momentum during the Civil Rights Movement. The 1965 amendments to Social Security shifted about 50% of the mental health care costs from states to the federal government,[1] motivating state governments to promote deinstitutionalization. The 1970s saw the founding of several advocacy groups, including Liberation of Mental Patients, Project Release, Insane Liberation Front, and the National Alliance on Mental Illness (NAMI).[1]

The 1970s saw some key court rulings that increased the rights of patients, due to lawsuits from these advocacy groups. In 1973, a federal district court ruled in Souder v. Brennan that patients in mental health institutions must be considered employees and paid the minimum wage required by the Fair Labor Standards Act of 1938 whenever they performed any activity that conferred an economic benefit on an institution. Following this ruling, institutional peonage was outlawed. In 1975, the U.S. Supreme Court restricted the rights of states to incarcerate someone who was not violent. This was followed up with a 1978 ruling further restricting states from confining anyone involuntarily for mental illness. In 1975, the United States Court of Appeals for the First Circuit ruled in favour of the Mental Patient's Liberation Front of Rogers v. Okin,[1] establishing the right of a patient to refuse treatment. Later reforms included the Mental Health Parity Act, which required health insurers to give mental health patients equal coverage.

Other factors include scandals. A 1972 television broadcast exposed the abuse and neglect of 5,000 patients at the Willowbrook State School in Staten Island, New York. The Rosenhan's experiment in 1973 caused several psychiatric hospitals to fail to notice fake patients who showed no symptoms once they were institutionalized.[7] The pitfalls of institutionalization were dramatized in an award-winning 1975 film, One Flew Over the Cuckoo's Nest.

In 1955 for every 100,000 US citizens there were 340 psychiatric hospital beds. In 2005 that number had diminished to 17 per 100,000.

South America

In several South American countries,, such as in Argentina, the total number of beds in asylum-type institutions has decreased, replaced by psychiatric inpatient units in general hospitals and other local settings.[6]

See also

General

References

  1. 1 2 3 4 5 6 7 8 9 10 11 Stroman, Duane (2003). The Disability Rights Movement: From Deinstitutionalization to Self-determination. University Press of America.
  2. 1 2 3 4 Eisenberg, Leon; Guttmacher, Laurence (August 2010). "Were we all asleep at the switch? A personal reminiscence of psychiatry from 1940 to 2010". Acta Psychiatrica Scandinavica. 122 (2): 89–102. doi:10.1111/j.1600-0447.2010.01544.x. PMID 20618173.
  3. ↑ Torrey, E. Fuller (Summer 2010). "Documenting the failure of deinstitutionalisation". Psychiatry. 73 (2): 122–4. doi:10.1521/psyc.2010.73.2.122. PMID 20557222.
  4. ↑ Szasz, Thomas (2007). Coercion as cure: a critical history of psychiatry. Transaction Publishers. p. 34. ISBN 978-0-7658-0379-5.
  5. ↑ Wright D (April 1997). "Getting out of the asylum: understanding the confinement of the insane in the nineteenth century". Social History of Medicine. 10 (1): 137–55. doi:10.1093/shm/10.1.137. PMID 11619188.
  6. 1 2 3 4 5 6 7 8 9 Fakhourya, W; Priebe, S (August 2007). "Deinstitutionalisation and reinstitutionalisation: major changes in the provision of mental healthcare". Psychiatry. 6 (8): 313–316. doi:10.1016/j.mppsy.2007.05.008.
  7. 1 2 Kornblum, William (2011). Mitchell, Erin; Jucha, Robert; Chell, John, eds. Sociology in a Changing World (9th ed.). Cengage learning. p. 195. ISBN 978-1-111-30157-6.
  8. ↑ Rochefort, D.A. (Spring 1984). "Origins of the "Third psychiatric revolution": the Community Mental Health Centers Act of 1963". Journal of Health Politics, Policy and Law. 9 (1): 1–30. doi:10.1215/03616878-9-1-1. PMID 6736594. Archived from the original on 2012-07-09. Retrieved 2009-04-30.
  9. ↑ Scherl, D.J.; Macht, L.B. (September 1979). "Deinstitutionalization in the absence of consensus". Hosp Community Psychiatry. 30 (9): 599–604. doi:10.1176/ps.30.9.599. PMID 223959.
  10. ↑ Mac Suibhne, Séamus (7 October 2009). "Asylums: Essays on the Social Situation of Mental Patients and other Inmates". British Medical Journal. 339: b4109. doi:10.1136/bmj.b4109.
  11. ↑ Goffman, Erving (1961). Asylums: essays on the social situation of mental patients and other inmates. Anchor Books.
  12. ↑ "Extracts from Erving Goffman". A Middlesex University resource. Retrieved 8 November 2010.
  13. ↑ Weinstein R. (1982). "Goffman's Asylums and the Social Situation of Mental Patients" (PDF). Orthomolecular Psychiatry. 11 (N 4): 267–274.
  14. 1 2 3 Tansella, M. (November 1986). "Community psychiatry without mental hospitals—the Italian experience: a review". Journal of the Royal Society of Medicine. 79 (11): 664–669. PMC 1290535. PMID 3795212.
  15. ↑ Fischer, Constance; Brodsky, Stanley (1978). Client Participation in Human Services: The Prometheus Principle. Transaction Publishers. p. 114. ISBN 978-0878551316.
  16. ↑ Szasz, Thomas (1971). "To the editor". American Journal of Public Health. 61 (6): 1076. doi:10.2105/AJPH.61.6.1076-a.
  17. ↑ Szasz, Thomas (1 June 1971). "American Association for the Abolition of Involuntary Mental Hospitalization". American Journal of Psychiatry. 127 (12): 1698. doi:10.1176/ajp.127.12.1698. PMID 5565860.
  18. 1 2 Schaler, Jeffrey, ed. (2004). Szasz Under Fire: A Psychiatric Abolitionist Faces His Critics. Open Court Publishing. pp. xiv. ISBN 978-0812695687.
  19. ↑ Aut aut (in Italian). Il Saggiatore. 2011. p. 166. ISBN 978-8865761267.
  20. ↑ Mosher L.R. (March 1999). "Soteria and other alternatives to acute psychiatric hospitalization: a personal and professional review" (PDF). Journal of Nervous and Mental Disease. 187 (3): 142–149. doi:10.1097/00005053-199903000-00003. PMID 10086470. Archived from the original (PDF) on 2012-02-29.
  21. ↑ "Disability History Timeline". Rehabilitation Research & Training Center on Independent Living Management. Temple University. 2002. Archived from the original on 2013-12-20.
  22. ↑ "Sproutflix website description of film titled Willowbrook: The Last Great Disgrace". Archived from the original on 24 July 2012. Retrieved 6 October 2014.
  23. ↑ New York Times article, "Big Day for Ex-Residents Of Center for the Retarded," by Celia W. Duggar, published March 12, 1993
  24. ↑ NYS Office For People With Developmental Disabilities, article title Milestones in OMRDD's History Archived 2011-08-09 at the Wayback Machine.
  25. ↑ Museum of DisABILITY History, article title The New York State Timeline Archived 2012-04-20 at the Wayback Machine.
  26. ↑ Torrey, Dr. E. Fuller. "250,000 Mentally Ill are Homeless. The number is increasing". Mental Illness Policy Org. Retrieved 6 August 2015.
  27. ↑ Torrey, E. Fuller (2008). The insanity offense: how America's failure to treat the seriously mentally ill endangers its citizens (1st ed.). New York: W.W. Norton. ISBN 978-0-393-06658-6.
  28. ↑ Teplin, Linda A; McClelland, Gary M; Abram, Karen M; Weiner, Dana A (August 2005). "Crime Victimisation in Adults With Severe Mental Illness: Comparison With the National Crime Victimisation Survey". Archives of General Psychiatry. 62 (8): 911–21. doi:10.1001/archpsyc.62.8.911. PMC 1389236. PMID 16061769.
  29. ↑ Petersilia, Joan R (2001). "Crime Victims With Developmental Disabilities: A Review Essay". Criminal Justice and Behavior. 28 (6): 655–94. doi:10.1177/009385480102800601.
  30. ↑ Steadman, Henry J; Mulvey, Edward P.; Monahan, John; Robbins, Pamela Clark; Appelbaum, Paul S; Grisso, Thomas; Roth, Loren H; Silver, Eric (May 1998). "Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods". Archives of General Psychiatry. 55 (5): 393–401. doi:10.1001/archpsyc.55.5.393. PMID 9596041.
  31. ↑ Sirotich, F. (2008). "Correlates of Crime and Violence among Persons with Mental Disorder: An Evidence-Based Review". Brief Treatment and Crisis Intervention. 8 (2): 171–94. doi:10.1093/brief-treatment/mhn006.
  32. ↑ Stuart, H. (June 2003). "Violence and mental illness: an overview". World Psychiatry. 2 (2): 121–4. PMC 1525086. PMID 16946914.
  33. ↑ Taylor, P.J.; Gunn, J. (January 1999). "Homicides by people with mental illness: Myth and reality". Br J Psychiatry. 174 (1): 9–14. doi:10.1192/bjp.174.1.9. PMID 10211145.
  34. ↑ Solomon, Phyllis L.; Cavanaugh, Mary M.; Gelles, Richard J. (January 2005). "Family violence among adults with severe mental illness: a neglected area of research". Trauma, Violence, & Abuse. 6 (1): 40–54. doi:10.1177/1524838004272464. PMID 15574672.
  35. ↑ "Report of the Confidential Forum for Former In-Patients of Psychiatric Hospitals". Department of Internal Affairs, New Zealand Government. June 2007.
  36. ↑ Priebe, Stefan; Badesconyi, Alli; Fioritti, Angelo; Hansson, Lars; Kilian, Reinhold; Torres-Gonzales, Francisco; Turner, Trevor; Wiersma, Durk (January 2005). "Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries". British Medical Journal. 330 (7483): 123–6. doi:10.1136/bmj.38296.611215.AE. PMC 544427. PMID 15567803.
  37. 1 2 Russo, Giovanni; Carelli, Francesco (April 2009). "Dismantling asylums: The Italian Job" (PDF). London Journal of Primary Care.
  38. 1 2 "Dacia Maraini intervista Giorgio Antonucci" [Dacia Maraini interviews Giorgio Antonucci]. La Stampa (in Italian). 26 July 1978. Archived from the original on 2013-04-13. Retrieved 2014-05-25.
  39. ↑ Burti L. (2001). "Italian psychiatric reform 20 plus years after". Acta Psychiatrica Scandinavica. Supplementum. 104 (410): 41–46. doi:10.1034/j.1600-0447.2001.1040s2041.x. PMID 11863050.
  40. ↑ A brief history of specialist mental health services, S Lawton-Smith and A McCulloch, Mental Health Foundation, "Archived copy" (PDF). Archived from the original (PDF) on 2015-04-04. Retrieved 2014-12-26.
  41. ↑ Ministry of Health: Mental Health Act 1959 General Policy, Registered Files (95,200 Series), The National Archives, http://discovery.nationalarchives.gov.uk/details/r/C10978
  42. ↑ Powell's Water Tower speech
  43. ↑ Report of the Committee of Inquiry into Allegations of Ill – Treatment of Patients and other irregularities at the Ely Hospital, Cardiff (Government report), Presented to Parliament by the Secretary of State of the Department of Health and Social Security, 11 March 1969
  44. ↑ "Learning difficulties residential home scandals: the inside story and lessons from Longcare and Cornwall". Community Care. 10 January 2007. Retrieved 13 November 2013.
  45. ↑ "Case study 1: Deinstitutionalisation in UK mental health services". The King's Fund. July 2015.
  46. ↑ Mosher, Loren (1999). "Letter Mosher to Goodwin" (PDF). Psychology Today. 32 (5): 8.

Bibliography

  • Borus, J.F. (August 1981). "Sounding Board. Deinstitutionalization of the chronically mentally ill". New England Journal of Medicine. 305 (6): 339–42. doi:10.1056/NEJM198108063050609. PMID 7242636.
  • Pepper, B.; Ryglewicz, H (1985). "The role of the state hospital: a new mandate for a new era". Psychiatric Quarterly. 57 (3–4): 230–57. doi:10.1007/BF01277617. PMID 3842522.
  • Sharfstein, S.S. (August 1979). "Community mental health centers: returning to basics". American Journal of Psychiatry. 136 (8): 1077–9. doi:10.1176/ajp.136.8.1077. PMID 464136.
  • Torrey, E. Fuller; Zdanowicz, Mary (4 August 1998). "Why deinstitutionalization turned deadly". Wall Street Journal.
  • Davis, DeWayne L.; Fox-Grage, Wendy; Gehshan, Shelly (January 2000). "Deinstitutionalization of Persons with Developmental Disabilities: A Technical Assistance Report for Legislators" (PDF). National Conference of State Legislatures.
  • Torrey, E. Fuller (1997). "Deinstitutionalization: A Psychiatric "Titanic"". PBS Frontline.
  • Torrey, E. Fuller (1997). Out of the shadows: confronting America's mental illness crisis. New York: John Wiley. ISBN 978-0-471-16161-5.

Further reading

  • Taylor, S.J.; Searl, S. (1987). "The disabled in America: History, policy and trends". In P. Knoblock. Understanding Exceptional Children and Youth. Boston: Little, Brown. pp. 5–64.
  • Arce, A.A.; Vergare, M.J. (December 1987). "Homelessness, the chronic mentally ill and community mental health centers". Community Mental Health Journal. 23 (4): 242–9. PMID 3440376.
  • Institute of Medicine (US) Committee on Health Care for Homeless People (1988). Homelessness, Health, and Human Needs. Washington, D.C: National Academy Press. p. 97. ISBN 978-0-309-03832-4.
  • Kramer, M. (1969). "Statistics of Mental Disorders in the United States: Current Status, Some Urgent Needs and Suggested Solutions". Journal of the Royal Statistical Society. Series A (General). 132 (3): 353–407. doi:10.2307/2344118. JSTOR 2344118.
  • Lamb, H. Richard; Weinberger, Linda E (April 1998). "Persons With Severe Mental Illness in Jails and Prisons: A Review". Psychiatric Services. 49 (4): 483–492. doi:10.1176/ps.49.4.483. PMID 9550238. Retrieved 13 November 2010.
  • Rochefort, David A. (1993). From Poorhouses to Homelessness: Policy Analysis and Mental Health Care. Westport, Connecticut: Auburn House. ISBN 978-0-86569-237-4.
  • Rudin, E.; McInnes, R.S. (July 1963). "Community Mental Health Services—Five Years of Operation Under the California Law". California Medicine. 99 (1): 9–11. PMC 1515154. PMID 13982995.
  • Sharfstein, Steven S. (May 2000). "Whatever happened to community mental health?". Psychiatric Services. 51 (5): 616–20. doi:10.1176/appi.ps.51.5.616. PMID 10783179. Archived from the original on 2013-04-15.
  • Stavis, Paul F. (April–May 1991). "Homeward Bound: The Developing Legal Right to a Home in the Community". Quality of Care Newsletter (48). New York State Commission on Quality of Care and Advocacy for Persons with Disabilities. Archived from the original on January 11, 2009.
  • Apollonio, D.E.; Malone, R.E. (December 2005). "Marketing to the marginalised: tobacco industry targeting of the homeless and mentally ill" (PDF). Tobacco Control. 14 (6): 409–15. doi:10.1136/tc.2005.011890. PMC 1748120. PMID 16319365.
This article is issued from Wikipedia. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.