A Model of Deinstitutionalization of Psychiatric Care across 161 Nations: 2001–2014

Hudson, Christopher G.

doi:10.1080/00207411.2016.1167489

Cited by 25 publications

(14 citation statements)

References 32 publications

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“…While historically, nursing ethics primarily referred to individual nurses’ personal characteristics including etiquette and manner, the development of professional ethics governing nursing practice shifted the principles informing treatment and care of patients and populations, including those with mental illness (Kangasniemi, Pakkanen, & Korhonen, ). In keeping with emergent mental health public policy and nursing professional ethics, the articulated aims of deinstitutionalization included returning individuals to home communities to restore freedom and autonomy (Hudson, ; Mezzina, ), and reducing or eliminating nursing practices grounded in punishment that were being societally reconceputalized as harmful (Gooding, ). Yet while the advancement of health care ethics has minimized the use of overt punishment in mental health care settings, numerous risk management strategies from the era of institutionalization continue to be utilized by nurses, including containment (i.e., locking doors to hospital units) and seclusion.…”

Section: Current Perspectives On Safety In Psychiatric Carementioning

confidence: 99%

Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice

2017

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The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self‐harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re‐centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re‐evaluating the risk management culture that gives rise to and legitimizes harmful practices.

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Section: Current Perspectives On Safety In Psychiatric Carementioning

confidence: 99%

Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice

2017

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“…Within contemporary social care there is a general consensus that over the past 30 years we have witnessed the deinstitutionalisation of mental health services (Glasby and Tew, 2015;Hudson, 2016). When exploring how participants' lives have changed after deinstitutionalisation, and the implementation of the NHS and Community Care Act (1990), the majority of service users/survivors in this study were living in privately run residential care homes.…”

Section: Residential Care and Hospitalisationmentioning

confidence: 94%

Marketing ‘madness’: conceptualising service user/survivor biographies in a period of deinstitutionalisation (1975–2014)

Macdonald

Charnock

Scutt

2018

Disability & Society

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This article aims to present the lived experiences of psychiatric service users/survivors who have experienced the transition from institutional care in the 1970s and 1980s to community care services in the 1990s and post-2000s. By using a biographical narrative approach the study compares service users' historical experiences with their contemporary experiences of community and residential care. Sixteen biographical narratives were analysed to explore how mental health services have changed over time, from the perspective of service users/survivors, their families and mental health practitioners. The study examines how the closure of NHS mental hospitals in the 1980s, which were replaced in the 1990s with new types of community and residential care services, has changed the lives of service users/survivors. Thus, the article presents these lived biographical experiences which, for the majority of service users/survivors, were defined by the process of transinstitutionalisation rather than de-institutionalisation, within a neoliberal context.• This article presents empirical data on how institutionalisation has changed for service users/survivors in this study since the 1980s.• The article explores the lives of service users/survivors through their biographical stories to conceptualise changing models of care from their perspectives.• The findings discovered that most service users/survivors in this study were still living in an institutional environment where medication played a significant role in their lives.• Therefore, the article asks the question: to what extent has the neoliberalisation of care impacted on the lives of service users/survivors in this study? mad studies; trans-institutionalisation; neoliberalism; residential care; biographical experiences; mental illness

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“…Deinstitutionalization of mental health services began in Canada and other countries in the 1960s-70s with the rapid closure of psychiatric hospitals followed by further reductions in general hospital admissions for mental health in the 1990s (85). In most countries, the motivations for this change included breakthroughs in pharmaceutical treatments (86) combined with an emphasis on human rights and social inclusion of persons with mental illness (87), and the expectation of better outcomes in the community (88). However, legal concerns and fiscal decisions aimed at reducing health care expenditures (85,89) were also important drivers.…”

Section: Trans-institutionalization and The Criminal Justice Systemmentioning

confidence: 99%

The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care

et al. 2020

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The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection

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A Model of Deinstitutionalization of Psychiatric Care across 161 Nations: 2001–2014

Cited by 25 publications

References 32 publications

Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice

Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice

Marketing ‘madness’: conceptualising service user/survivor biographies in a period of deinstitutionalisation (1975–2014)

The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care

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