Does community care reduce the need for psychiatric beds for schizophrenic patients?

Dencker, S. J.; Dencker, Karina

doi:10.1111/j.1600-0447.1994.tb05870.x

Cited by 17 publications

(12 citation statements)

References 25 publications

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“…[1][2][3] Far less consensus exists about the quality of care delivered in such settings. 4,5 Our own research has shown that recently discharged patients are at higher risk of experiencing unmet need during the transition to the community than either their counterparts who remain in institutions, or those who have been established in the community for some time. 6 In addition, it has long been recognized that, as greater numbers of patients are removed from mental hospitals, the objective burden experienced by families of such patients increases.…”

Section: Factors Influencing Informal Care-givingmentioning

confidence: 99%

Factors influencing informal care-giving

Holmes

Deb

1998

J. Mental Health Policy Econ.

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Background: As downsizing of institutional care continues, patients discharged are likely to have more severe mental illnesses, and to have experienced longer tenures within institutions than patients who have been discharged in the past. As greater numbers of patients are removed from mental hospitals, the objective burden experienced by informal care‐givers may increase, particularly if formal care levels are inadequate. Aims of the Study: This paper documents who assumes informal care‐giver roles, and the form such care‐giving takes for patients discharged from a state hospital. Specifically, this paper identifies (i) what factors affect a person’s decision to assume a care‐giver role, including the participation of other network members in care‐giving, (ii) what factors influence whether care‐giving is provided in time or in direct purchase of care and (iii) how the patient’s treatment location affects the decision of the network member to assume any care‐giving role. Data and Analytical Methods: Data for this paper are taken from a longitudinal study of the closure of a state mental hospital in central Indiana. Seventy‐seven patients were asked to identify their community networks. Ninety‐eight network members were surveyed about the informal care, both in time or through direct expenditures, they provided to these patients one year after discharge. Care‐giving relationships were estimated using a multivariate probit model. Such a model estimates the extent to which the decision to provide care in either form depends on the care‐giving activities assumed by other network members associated with a given patient, as well as the characteristics of individual patients and network members. Results: Forty‐one per cent of network members provided some level of informal care, with 13.3% providing some care in time, and 35.7% providing some care through direct expenditures. A positive relationship was found between participation in informal care‐giving and the perception by the network member that patient needs were not being met by professionals. The decision to provide informal care was also found to be sensitive to the level of informal and formal care received by the patient. Care‐giving in expense was found to be positively related to the care‐giving decisions of other informal care‐givers, but care‐giving in time was not. Network members were more likely to provide care in time for patients who had been recently discharged to the community than for patients who remained in institutional settings. Conclusion: These results suggest the transfer of persons with severe mental illnesses from state hospitals to the community may shift the care burden between formal and informal providers. If this is the case, discharge criteria should include such factors as the community resources available to the patient. Implications for Health Care Provision and Use: The responsiveness of network members to perceived unmet need bespeaks the importance of informal care when the continuity of formal care cannot be assured....

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Section: Factors Influencing Informal Care-givingmentioning

confidence: 99%

Factors influencing informal care-giving

Holmes

Deb

1998

J. Mental Health Policy Econ.

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“…It has been claimed that such deinstitutionalization ends previously enforced seclusion, enhances human dignity and allows individual privacy (Milner & Hassall 1990, Wray 1995. Dencker & Dencker (1994) suggest that in many instances the deinstitutionalization of chronic schizophrenic patients has resulted in their relatives taking over the burden from the hospital, or the patient living in poverty, without employment, and suffering from medical as well as secondary social complications. Dencker & Dencker (1995) propose that a possible reason for this is the current attempt at health budget reduction.…”

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confidence: 99%

Victimization of people with enduring mental illness in the community

Kelly

McKenna²

1997

Psychiatric Ment Health Nurs

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The deinstitutionalization of care for the mentally ill has been in vogue for about fifty years. Broadly speaking, this transition can be seen to exhibit the following main trends: a dramatic decline in the inpatient population of psychiatric hospitals, coupled with a corresponding increase in community facilities such as psychiatric units in general hospitals, day hospitals, and day centres. It has been claimed that deinstitutionalization ends previously enforced seclusion, enhances human dignity and allows individual privacy. The deinstitutionalization movement has inevitably led both to large numbers of former long-stay patients being cared for in the community and to significant numbers of individuals developing enduring mental illness in the community without ever having had a long inpatient tenure. The findings of recent studies (Gould 1992, Brockington et al. 1993) suggest that there is a positive public attitude towards the mentally ill. However, Kelly (1997), while carrying out Quality of Life research, found that over half of the community-based long-term mentally ill he surveyed reported that they had experienced harassment/victimization. This paper is not a report on the Quality of Life research but a discussion on the theme of victimization that has emerged from the study. The extent of the problem is discussed as are the implications for mental health professionals.

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“…Schizophrenia might be seen as an illness where prevalence is less likely to be affected by changing social patterns. However, both first and total admissions with a diagnosis of schizophrenia have been decreasing throughout the 1970s and 1980s (Dencker & Dencker 1994). This has lead some researchers to suggest that the figures imply a reduced incidence of the disease in Western countries, which in turn may be significant in an understanding of the causes of the disease (Eagles & Whalley 1985.…”

Section: Schizophreniamentioning

confidence: 99%

“…Certainly men are more often admitted for substance abuse and are greater users of drugs and alcohol (Department of Health 1989). Young men also have a higher suicide rate than young women (Bunting 1993), although the risk of suicide amongst female schizophrenic patients may be higher than that amongst males, particularly over the whole first year after discharge from hospital (Goldacre & Seagroatt 1993, Dencker & Dencker 1994.…”

Section: ~~ ~mentioning

confidence: 99%

The rationing of psychiatric beds: changing trends in sex-ratios in admission to psychiatric hospital

Payne

2007

Health &Amp; Social Care in the Community

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Admissions to psychiatric hospital for women have outnumbered those of men throughout most of this century. This paper presents data suggesting that recently there has been a shift in this overrepresentation. From the early 1980s there has been a downward trend in the extent to which women outnumber men in admissions to psychiatric in-patient treatment. This shift towards a greater representation of men in admission data has led to the position where, by 1986, in some age groups -particularly amongst young adults -men now outnumber women in admissions to psychiatric hospital. Possible explanations for this trend include a reduction in the availability of psychiatric beds together with an increasing emphasis on community care during the 1980s. Community care may be used more often in response to the treatment needs of women rather than men, or psychiatric beds may be seen as a scarce resource and more frequently reserved for men rather than for women. The paper explores changing patterns of both total admissions and first admissions from the 1960s. The rates of admission by sex and diagnostic group suggest possible explanations. In particular differences in the trend in admissions for each sex for schizophrenia require further analysis. The conclusion is that figures that indicate an increased tendency to hospitalize young men for psychotic illness in comparison with earlier years and in comparison with female risks of admission, may reflect changing patterns of disease, changes in patterns of treatment which are sexspecific, or more widespread changes in the lives of young men. However, the picture is complex and further research is needed.

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Does community care reduce the need for psychiatric beds for schizophrenic patients?

Cited by 17 publications

References 25 publications

Factors influencing informal care-giving

Factors influencing informal care-giving

Victimization of people with enduring mental illness in the community

The rationing of psychiatric beds: changing trends in sex-ratios in admission to psychiatric hospital

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