Mental hospital reform in Asia: the case of Yuli Veterans Hospital, Taiwan

Abstract

BackgroundYuli Veterans Hospital (YVH) has been the largest mental hospital for the patients with chronic and severe mental illness in Taiwan for the past 50 years. While this hospital used to be a symbol of hopelessness among patients and their families and an unspoken shame among Taiwan psychiatry and mental health circles it now represents an example of how an old, custodial hospital can be transformed into a very different institution. In this case study we will describe the features of this transformation, which, over the past 20 years, has aimed to help extended stay inpatients with severe mental illness to integrate into the local community of Yuli even though it is not their original home.MethodsUsing historical documents and oral narratives from Yuli inhabitants, workers and patients of YVH, we will offer a case study of the Yuli model.ResultsThere are four main components of the Yuli model: holistic medical support, vocational rehabilitation, case management, and the residential program. The four components help patients recover two essential features of their lives: vocational life and ordinary daily routines. As the process of recovery evolves, patients gradually regain inner stability, dignity, self-confidence, and a sense of control. The four components are critical to rebuild the structure and order of life of the patients and are indispensable and interdependent parts of one service package. They operate simultaneously to benefit the patients to the greatest degree possible.DiscussionThere are many challenges to the further development and financial viability of the model of services developed at YVH. There are also important questions concerning the replicability of the Yuli model in other sociocultural and service system contexts.ConclusionThis case study reveals the possibility of transforming a custodial mental hospital into a hospital providing high quality care. Hospital and community are not in opposition. They are part of a continuum of care for the patients. We reinterpret and redefine the boundary and function of hospital and community, and thereby create a new service model, the Yuli Model, to help patients to reintegrate into the community. The Yuli model, which particularly focuses on the needs of people with long-standing illness and prolonged hospital stay, illustrates one approach to linking hospital and community in a creative and constructive manner.

Continuing Accommodation and Support Needs of Long-Term Patients with Severe Mental Illness in the Era of Community Care

“…The Yu-Li psychiatric rehabilitation model reports positive outcomes for former long-stay patients living in community residential services in a township in Taiwan [45]. The model includes vocational rehabilitation, case management and maintenance of holistic medical support [45]. It is based on the principles of a therapeutic community and normalisation, and incorporates a continuum of residential care options including nursing homes and less restrictive community rehabilitation settings [45].…”

“…In the absence of a welfare network and limited public funding for vocational rehabilitation services, there may be greater scope for entrepreneurial initiatives such as social enterprises [43,44]. The Yu-Li psychiatric rehabilitation model reports positive outcomes for former long-stay patients living in community residential services in a township in Taiwan [45]. The model includes vocational rehabilitation, case management and maintenance of holistic medical support [45].…”

“…The model includes vocational rehabilitation, case management and maintenance of holistic medical support [45]. It is based on the principles of a therapeutic community and normalisation, and incorporates a continuum of residential care options including nursing homes and less restrictive community rehabilitation settings [45].…”

Impact of Mental Health First Aid on Confidence Related to Mental Health Literacy: A National Study With a Focus on Race-Ethnicity

“…Other countries have focused on the impact of MHFA among various racial and ethnic subgroups (11,12). This focus is also warranted in the United States, given the nation’s racial and ethnic diversity.…”

Psychiatric diagnoses during institutionalization: an investigation of 1334 psychiatric patients hospitalized in an Italian asylum during the 20th Century

“…Th e prevailing public arguments, time of onset, and pace of reforms have varied by country [7]. Before the changes in regulations in the second part of the last century, patients often spent their entire life as inpatients, and psychiatric hospitals were organized as small communities with no real contact with the outside world [8]. Th e secret aim of internment was punishment in the medieval period and exclusion from those who were socially considered "normals" in later periods.…”