Ethical implications of deinstitutionalization and moves of the institutionalized elderly.

Abstract

We focus on the ethical issues faced by psychologists working as members of an interdisciplinary team in a psychiatric hospital in light of the current trend and policy to deinstitutionalize. The major ethical dilemma results from psychologists' awareness of the effects of long-term institutionalization and moves on the elderly, as well as some of the documented adverse consequences of deinstitutionalization. We review the current policy on deinstitutionalization and the literature on the effects of deinstitutionalization and relocation on the elderly. We also address the role of the psychologist in a hospital setting that may have goals and values that conflict with those of the therapists. Possible ways to resolve this conflict of interest are explored.

Process of Deinstitutionalization of Aging Individuals With Severe and Disabling Mental Disorders: A Review

“…Present in the general population, the impact of this double stigmatization would be just as pronounced at the professional level. Thus, some works recall that within the psychiatric field, health professionals adopt a pessimistic and nihilistic stance induced by the idea that this population is “incurable” ( 22 , 42 ), “unaware of its environment” ( 55 , 59 ) and by long-term hospitalization ( 55 ). Outside the psychiatric field, these individuals are also negatively perceived by certain medical specialties fearing that they will have to manage complex situations correlated to the diagnoses, bed availability/problems and the difficulty of reorienting this population ( 14 , 22 , 46 ).…”

“…One of the remedies to institutionalization of APSDMHD-H is based on the development of community-based services ( 1 , 7 , 9 , 24 , 72 , 73 ). There is however a limited supply of community care and a lack of alternatives to hospitalization ( 30 , 32 , 34 , 42 , 46 , 55 , 60 ). Similarly, it would appear that existing services are considered difficult to access and present problems of use ( 32 , 50 , 54 , 74 ), by being, in particular, poorly defined and poorly identified ( 46 , 52 ).…”

“…Where structures are identified, they appear to focus primarily on continuity and coordination of care ( 46 ). They may then abandon the psychosocial dimension associated with the deinstitutionalization process ( 10 , 18 , 25 , 32 , 55 , 57 ). There is also evidence that the needs of individuals with psychiatric support in terms of recreation, culture or social connection are poorly addressed ( 10 , 26 , 37 , 42 , 75 , 77 ).…”

“…There is also evidence that the needs of individuals with psychiatric support in terms of recreation, culture or social connection are poorly addressed ( 10 , 26 , 37 , 42 , 75 , 77 ). Some publications also denounce the mechanism of ghettoization of PSDMHD in poor and disadvantaged neighborhoods ( 55 , 56 ).…”

“…The first factor is based on the preconceived idea that aging can lead to premature loss of autonomy in individuals suffering from psychosis ( 30 , 34 , 42 , 52 ). Another factor is based on the fact that the association of psychiatric, cognitive and somatic pathologies implies a strong coordination of care that is difficult to achieve within a community-based approach ( 28 , 30 , 33 , 34 , 55 , 86 ). A third factor seems to be related to the lack of effective therapies for APSDMHD, given that most of the care offered to this population remains focused on medication ( 18 , 26 , 53 , 82 , 87 ).…”