Deinstitutionalization: An Appraisal of Reform

Mechanic, David; Rochefort, David A.

doi:10.1146/annurev.so.16.080190.001505

Cited by 244 publications

(98 citation statements)

References 40 publications

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“…These resources could be used more effec tively by correcting the fragmentation, duplication, and disorganization of the services system and establishing clear priorities focused on the seriously and persistently mentally ill (13a, 35). Building an integrated system requires new financing and organizational strategies, such as continuous team case management arrangements, the development of strong local mental health authorities, and mental health HMOs organized around capitation arrange ments (24)(25)(26).…”

Section: Resultsmentioning

confidence: 99%

“…Deinstitutionalization became more feasible with the broad expansion of social programs in the middle 1960s, which enhanced housing opportunities, medical care, and disability subsistence (22, 23). Large-scale reduction of the number of public mental hospital beds only became possible with these developments, and the rate of deinstitutionaliza tion between 1966 and 1980 was almost five times that of the previous decade (9,26).…”

mentioning

confidence: 99%

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Recent Developments in Mental Health: Perspectives and Services

Mechanic

1991

Annu. Rev. Public Health

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Recent Developments in Mental Health: Perspectives and Services

Mechanic

1991

Annu. Rev. Public Health

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“…Since the deinstitutionalization movement began in the 1960s (Mechanic & Rochefort, 1990), it has been increasingly recognized that in addition to being more costeffective than inpatient care, residential care is also a more humane alternative for caring for people who are not able to live autonomously (Susser, Goldfinger, & White, 1990). Residential care protects and monitors clients who are not stable in an outpatient therapeutic relationship, and simultaneously engages these clients in therapeutic activities and self-help.…”

Section: Definitions and Benefits Of Residential Carementioning

confidence: 99%

Innovative Therapeutic Care for Homeless, Mentally Ill Clients: Intrapsychic Humanism in a Residential Setting

Tyson

Carroll

2001

Families in Society: The Journal of Contemporary Social Service

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IN THE MOST RECENT STEP in the trend towards deinstitutionalization of severely mentally ill clients, the Supreme Court's landmark decision on June 22, 1999, ruled that "isolating people with disabilities in big state institutions when there is no medical reason for their confinement is a form of discrimination that violates Federal disabilities law" (New York Times, 1999). The occasion for the decision was a lawsuit brought by two Atlanta women against the state of Georgia, claiming that they were being held in an inpatient setting when they could benefit from residential care, and that their rights under the 1990 Americans with Disabilities Act (ADA) were being violated by the excessive confinement. In addition, as the Times reported, a determined, vocal grassroots movement on behalf of the rights of persons with disabilities has arisen nationwide to support the rights of clients with severe mental illness to live in the community in the least restrictive environments possible (Chamberlin, 1990;Harp, 1990;Tower, 1994). These groups are also active in demanding funding from states to develop residential care. Although there are cutbacks in resources for other forms of mental health care, increased funding is available through The U.S. Department of Housing and Urban Development and other federal and state sources for residential programs for homeless mentally ill clients. For these and a number of other reasons, residential care is seen as critical to the future of mental health services. Social workers are especially suited to direct residential care programs, because the programs use psychosocial rather than medical means of healing (Sullivan, 1992).This paper applies the unique, original psychology, intrapsychic humanism, to offer guidelines that social workers can use for residential program planning and management. The conceptual framework used as the base for the research presented here is the postpositivist heuristic paradigm, with an emphasis on the value of research for advancing human rights (Heineman (Pieper), 1981,

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“…Mental health care providers 669 Mechanic and Rochefort 1990;Raftery 1992). The chronically mentally ill will never be fully cured, hence long term planning and support services are essential (Michels and Marzuk 1993).…”

Section: Introductionmentioning

confidence: 99%

An explication of treatment ideology among mental health care providers

Scheid

1994

Sociology Health & Illness

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This paper presents an exploratory analysis of the treatment ideologies of mental health care providers who work with the chronic:ally 'mentally ill.' Treatment ideology is understood as the complex set of beliefs providers hold about the aetiology of mental illness, the role of the client and the provider, and the efficacy of various treatments or interventions. A case study of a large, urban mental health care organisation providing care to the chronically 'mentally ill' was conducted in 1992. The author attended a series of staff retreats, administered a questionnaire, and completed in-depth interviews with 22 providers. A typology reflecting two dimensions that juxtapose altemative treatment preferences was developed to represent the range of treatment ideologies uncovered. The first dimension reflects differing conceptions of the role of the provider (supportive or facilitative) anci the second dimension reflects differing treatment goals (adjustment or autonomy). This typology was then theoretically extended to include a custodial role for the provider and a treatment goal oriented toward social control of clients. Further study of providers in differing organisation settings is needed to determine the salience of these typologies.Research must also investigate the development and consequences of treatment ideologies, with critical attention fcx:used on the consistency (or inconsistency) of treatment ideologies within a given system, the professional and organisational sources of differing preferences for treatment, and the effect of various belief sets on health care services and outcomes.

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Deinstitutionalization: An Appraisal of Reform

Cited by 244 publications

References 40 publications

Recent Developments in Mental Health: Perspectives and Services

Recent Developments in Mental Health: Perspectives and Services

Innovative Therapeutic Care for Homeless, Mentally Ill Clients: Intrapsychic Humanism in a Residential Setting

An explication of treatment ideology among mental health care providers

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