Deinstitutionalised patients, homelessness and imprisonment: Systematic review

Winkler, Petr; Barrett, Barbara; McCrone, Paul; Csémy, Ladislav; Janoušková, Miroslava; Höschl, Cyril

doi:10.1192/bjp.bp.114.161943

Cited by 58 publications

(55 citation statements)

References 83 publications

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“…These objections to community care have been examined in a recent study which reviewed the consequences of reducing the number of beds for long‐term psychiatric patients. The authors of this review focused upon cohort studies of people with severe mental disorders who were discharged from psychiatric hospitals following an admission of one year or longer, and in whom data were analyzed at the individual level.…”

Section: Possible Adverse Effects Of Deinstitutionalizationmentioning

confidence: 99%

Community mental health care worldwide: current status and further developments

2016

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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.

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Section: Possible Adverse Effects Of Deinstitutionalizationmentioning

confidence: 99%

Community mental health care worldwide: current status and further developments

2016

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“…With respect to criminality and homelessness, we demonstrated in our recent systematic review that there is only weak evidence to support the association between deinstitutionalization, homelessness, and criminality (Winkler et al, 2016). The evidence is stronger with regard to problems of 'revolving-door' patients and difficulties of life within the community.…”

Section: Discussionmentioning

confidence: 95%

“…Coordination and cooperation of extramural services, case management and appropriately supervised housing seem to be necessary components of successful deinstitutionalization (Freedman & Moran, 1984, Craig et al, 1984, Lamb, 1993. Criminality and homelessness, and other societal problems related to mental disorders might be primarily associated with low level of efficacious investments into mental health rather than with deinstitutionalization itself (Winkler et al 2016). To our mind, the most recent Department of Health report on mental health services in England (Farmer & Dyer, 2016) supports this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

Long-term hospitalizations for schizophrenia in the Czech Republic 1998–2012

Winkler

Mladá

Krupchanka

et al. 2016

Schizophrenia Research

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Deinstitutionalization has not been pursued in the post-communist Europe until recently. The population of psychiatric patients institutionalized in the regional mental hospitals is, however, largely understudied. The aim of this study is to assess discharges of long-term inpatients with schizophrenia from Czech psychiatric hospitals and to analyse re-hospitalizations within this group. The nationwide register of all-cause inpatient hospitalizations was merged with the nationwide register of all-cause deaths on an individual level basis. Descriptive statistics, survival analysis and logistic regression were performed. 3,601 patients with schizophrenia previously hospitalized for more than a year were discharged from Czech mental hospitals between 1998 and 2012. This included 260 patients hospitalized for more than 20 years. Nearly one fifth (n=707) of the long-term patients died during the hospitalization; and discharges of 19.36 % (n=697) were only administrative in their nature. Out of 2,197 truly discharged patients, 14.88 % (n=327) were re-hospitalized within two weeks after the discharge. The highest odds of rehospitalization were associated with being discharged against medical advice (OR 5.27, p<0.001). These data are important for the ongoing mental health care reforms in the Czech Republic and other countries in the Central and Eastern Europe.

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“…Both countries differ significantly in terms of the average number of beds per institution. While the CR with its 502 beds places the highest of all EU countries (Winkler et al 2013), SR's 182 beds per institution correspond to the EU average (193 beds per institution in EU 15 and 218 in EU 27) (WHO 2011 quoted by Winkler et al 2013). In terms of human resources in mental health care, the CR has more psychiatrists, but both countries are below the average of the EU 15.…”

Section: Key Indicators Of Mental Health Care In the Czech Republic Amentioning

confidence: 97%

“…The upward trend in the number of psychiatrists corresponds to the increasing number of contacts with outpatient facilities (Potůček & Scheffler 2008: 33) 1 Regarding the WHO data, used in this article, they should be interpreted with caution. WHO statistics do not show a significant difference in the quality of psychiatric beds in the monitored countries (Winkler et al 2013). It is also necessary to take into account the varying reliability of the information that the states provide (Muijen 2008quoted by Winkler et al 2013.…”

Section: Transformation In the Czech Republic And Slovak Republicmentioning

confidence: 99%

The Development of Mental Health Policies in the Czech Republic and Slovak Republic since 1989

Dobiášová

Tušková

Hanušová

et al. 2016

Central European Journal of Public Policy

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The article aims to describe the key events in the development of mental health care policies after 1990 in the two countries and identify the main reasons for stagnation or incremental changes to the institutional setting in the field of mental health care. The process of mental health care reform is explained using the framework of historical institutionalism. The explanation shows that the lack of political interest in combination with the tradition of institutional care resulted in poor availability of psychiatric care, outdated network of inpatient facilities and critical lack of community care facilities in both countries. Even though Slovak Republic adopted national programme at the governmental level, it still struggles with its implementation. The ongoing reform attempt in the Czech Republic may bring some change, thanks to a new approach towards strategic governance of the mental health care system and the mechanism of layering that the promoters of the reform use.

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Deinstitutionalised patients, homelessness and imprisonment: Systematic review

Abstract: Our results contradict the findings of ecological studies which indicated a strong correlation between the decreasing number of psychiatric beds and an increasing number of people with mental health problems who were homeless or in prison.

Cited by 58 publications

References 83 publications

Community mental health care worldwide: current status and further developments

Community mental health care worldwide: current status and further developments

Long-term hospitalizations for schizophrenia in the Czech Republic 1998–2012

The Development of Mental Health Policies in the Czech Republic and Slovak Republic since 1989

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