Institutionalization revisited – with and without walls

Priebe, Stefan

doi:10.1111/j.1600-0047.2004.00386.x

Cited by 40 publications

(26 citation statements)

References 7 publications

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“…reinstitutionalization. 2 Various factors are responsible for this. Some outcome studies of discharged patients reported worse clinical profiles for them following discharge.…”

Section: 29mentioning

confidence: 99%

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Long stay patients in a psychiatric hospital in Lagos, Nigeria

Taiwo¹,

Ladapo²,

Aina³

et al. 2008

Afr. J. Psych

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IntroductionIn psychiatric practice, some mentally ill patients spend their life in continuous or prolonged hospitalization; that is, as long stay patients. 1,2 This is due among other reasons to severe mental illness with poor symptom control, substance dependence, homelessness and abandonment by the patients' relatives. 3,4 Furthermore, in developing countries such as Nigeria, the situation is slightly different. The issue of long-stay patients is intertwined with the historical development of orthodox psychiatric care. In the early 20th century, asylums were established in selected towns and cities in the country by the then colonial powers. These were to serve as places of confinement or long-stay for psychiatrically ill offenders. 5,6 Over the years, these asylums were converted to fully-fledged psychiatric hospitals; with most of the long-stay offender inmates remaining in these facilities till date. 6 Another major source of long-stay patients is from the population of vagrant, psychotic individuals in the country. From time to time, the Nigerian print media focuses on this situation. 7,8 Some of these vagrant patients have over the years found their way to hospital, with a prolonged stay, by being brought to the centre by government health officials or most times by concerned members of the public. 9 Finally, in the study centre, the additional source of long-stay patients include some abandoned mentally ill returnee Nigerian soldiers from both the Second World War as well as the Nigerian civil war of 1967-1970. However, the cost of prolonged hospitalization care for these patients is borne by the hospital management. In the face of recently introduced government health reform and the dwindling number of available beds for acutely ill patients, a cross sectional study was carried out on long-stay patients at the 100 years old psychiatric hospital Yaba, Lagos, Nigeria with a view to discharging most of them. Method: Necessary consent was obtained from the Hospital Research and Ethical Committee. All the long-stay patients were evaluated with a specially designed proforma to elicit socio-demographic, clinical and long-stay variables. Further more, each of them had clinical assessment to make diagnosis in accordance with ICD -10 and finally, the subjects were also assessed with the Brief Psychiatric Rating Scale (BPRS). Results: Fifty-one (51) subjects; that is, occupying 10.7% of the hospital functional beds fulfilled the criteria of long-stay. They included 36 (70.6%) males and 15(24.4%) females. The mean age was 47.3±16.5 years with age range of 18-92 years. The average length of stay was 11.4±15.0 years and range of 0.5 to 57 years; with significant gender difference (males higher than females) (t =3.51, p<0.02). The vast majority of the subjects were diagnosed with schizophrenia (84.3%), followed by mental retardation with seizure disorder (5.9%). One-third (33.3%) of the subjects had co-morbid physical pathologies most especially epilepsies, hypertension, Koch's disease, HIV/AIDS. Despite being on hig...

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“…reinstitutionalization. 2 Various factors are responsible for this. Some outcome studies of discharged patients reported worse clinical profiles for them following discharge.…”

Section: 29mentioning

confidence: 99%

“…1,2 This is due among other reasons to severe mental illness with poor symptom control, substance dependence, homelessness and abandonment by the patients' relatives. 3,4 Furthermore, in developing countries such as Nigeria, the situation is slightly different.…”

Section: Introductionmentioning

confidence: 99%

Long stay patients in a psychiatric hospital in Lagos, Nigeria

Taiwo¹,

Ladapo²,

Aina³

et al. 2008

Afr. J. Psych

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“…This phenomenon is considered to be a new form of social exclusion: "exclusion without walls". 16 The links between disease characteristics, poverty and social vulnerability may contribute towards impaired living conditions and quality of life among individuals with such disorders. The social behavior of individuals with such disorders may increase the social disorganization, perception of fear and crime levels in these communities, thus generating negative attitudes among their residents.…”

Section: Introductionmentioning

confidence: 99%

Condições de vida de portadores de transtornos psicóticos vivendo em cortiços em Santos, SP

et al. 2011

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OBJECTIVE:To describe the living conditions and sociability among people with severe mental disorders living in slums. METHODOLOGICAL PROCEDURES:A qualitative study was carried out among adults living in slums in the central region of Santos, Southeastern Brazil, conducted in 2004. Ethnographic observations were made in four slum properties, and in-depth semi-structured interviews were conducted with eight women who were living with individuals with psychotic disorders. The analysis method used was qualitative, based on anthropology. ANALYSIS OF RESULTS:The slum properties presented specific characteristics regarding sociability. The diffi culties with psychotic patients came from breakage of the minimal rules. In one of the slum properties, one resident acted as a caregiver for the patients and kept closely in touch with the healthcare services. Despite day-to-day contact with such patients, the participants did not have any information about such disorders and believed that the patients were mad, nervous or mentally weak. They believed that such individuals should live in places other than the slum property. CONCLUSIONS:The population living in these slum properties did not deal with the individuals with psychotic disorders any differently from the general population, because of lack of knowledge, discrimination and stigmatization. The living conditions were poor for everyone, without any difference for the residents with psychotic disorders, except for those living in the collective residence with a greater number of patients, which was organized around them and was economically dependent on their benefi ts.

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“…The populating of mental health teams solely with professionals may represent misguided professional expansionism 72 and the imposition of substantial costs without commensurate benefits. 47 Mental health support or recovery workers can perform fundamental caring duties and spend dedicated time with service users and/ or their care givers and are cost-effective.…”

Section: Professional and Non-professional Affiliated Staffmentioning

confidence: 99%