The Impact of Closing a State Psychiatric Hospital on the County Mental Health System and Its Clients

Kamis-Gould, Edna; Snyder, Fredrick; Hadley, Trevor R.; Casey, Timothy

doi:10.1176/ps.50.10.1297

Cited by 13 publications

(8 citation statements)

References 24 publications

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“…Apesar de as diferenças, a filosofia da reforma psiquiátri-ca tem sido fundamentada nos princípios básicos dos cuidados na comunidade: desinstitucionalização e diminuição dos leitos hospitalares, desenvolvimento de programas e serviços alternativos, integração com serviços comunitários e demais serviços de saúde e acesso à medicação 17,18 . Trabalhos realizados em vários países têm indicado que os pacientes desospitalizados podem ser mantidos na comunidade [19][20][21] , demonstrando melhora nas habilidades de vida diária e na interação social 3,[22][23][24] , no nível global de funcionamento 21,22,25 e na qualidade de vida [20][21][22][23][24][25][26][27][29][30][31]40 . Em tratamentos de base comunitária, a autonomia e o desempenho geral dos pacientes podem ser melhorados,…”

Section: A Assistência Psiquiátrica Na Atualidadeunclassified

Reforma psiquiátrica e serviços residenciais terapêuticos

Vidal

Bandeira

Gontijo

2008

J. bras. psiquiatr.

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Palavras-chavePsiquiatria, desinstitucionalização, reforma psiquiátrica, moradias assistidas. resumo objetivo: Apresentar os principais aspectos da reforma psiquiátrica ocorrida em diversos países e no Brasil, destacar a política de reinserção social dos pacientes e descrever os procedimentos da desospitalização ocorridos em Barbacena, Minas Gerais, com ênfase nas residências terapêuticas e nas intervenções de reabilitação psicossocial. método: Pesquisa bibliográfica realizada nas fontes eletrônicas Medline e Lilacs (1990Lilacs ( a 2006, com os seguintes descritores: deinstitutionalization, psychiatric reform, community-based treatment, psychosocial rehabilitation. Descrição do processo de implantação das residências terapêu-ticas (RT) por meio de consulta aos documentos da Prefeitura de Barbacena e de observação direta das residências. resultados: A maioria dos trabalhos selecionados indicou que pacientes desospitalizados apresentam melhora na autonomia, na interação social, no nível global de funcionamento e na qualidade de vida. A desospitalização implica a existência de serviços comunitários com diversos níveis de atenção e requer a presença de profissionais qualificados e programas de reabilitação efetivos. Em Barbacena, o processo de desospitalização teve início em 2000. Atualmente existem 24 RTs no município. Conclusão: Apesar das dificuldades na sua implantação, os tratamentos de base comunitária tornaram-se o modelo dominante de cuidados psiquiátricos. Para os pacientes desospitalizados, as RTs têm importante papel no processo de reinserção social.

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Section: A Assistência Psiquiátrica Na Atualidadeunclassified

Reforma psiquiátrica e serviços residenciais terapêuticos

Vidal

Bandeira

Gontijo

2008

J. bras. psiquiatr.

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“…Indeed, if we look at all the other forces that have been outlined here, continued deinstitutionalisation cannot be attributed to economic considerations alone, but also to clinical, scientific, and humanistic factors which together render the trend ineluctable. Table III shows the domains of the mental health services evaluation matrix covered by four recent series of studies conducted in the UK (TAPS studies regarding the closure of two London psychiatric hospitals), the US (Central State Hospital study and studies by Kamis-Gould et al (1999) and Rothbard et al (1998) concerning the closure of the Philadelphia State Hospital), and Canada (study of the downsizing of a large psychiatric hospital in Montreal). Most of the papers stemming from the TA-PS project, especially those published in the British Journal of Psychiatry, have focussed on the patient level, on the dimensions of outcome and, to a lesser extent, process.…”

Section: Functions Of Psychiatric Hospitals and Dynamics Of Deinstitumentioning

confidence: 99%

“…Processes were documented primarily by way of detailed information on service utilisation, including hospitalisation and costs of care. (Leff et al, 1996) CSH: Central State Hospital study (McGrew, 1999) Mtl: Study of Montreal's largest psychiatric hospital (Lesage et al, 1999) PSH: Philadelphia State Hospital study (Rothbard et al, 1998 andKamis-Gould et al, 1999) Epidemiologia e Psichiatria Sociale, 9, 3, 2000 The key findings of this study involving over one thousand patients included the following: 78% of patients were discharged to supervised residential settings; less than 1% became homeless; symptoms generally changed very little; living in community-supervised residential settings allowed more autonomy; and the social networks of discharged patients grew. The overall cost for all discharged patients was slightly higher on average than if they had remained in the hospital.…”

Section: Four Recent Series Of Deinstitutionalisation Studiesmentioning

confidence: 99%

“…The TAPS project in London and more recently conducted US studies of the closure of psychiatric hospitals in Pennsylvania and Indiana (Kamis-Gould et al, 1999;Rothbard et al, 1998;McGrew, 1999) introduced cost analysis into the picture to examine both inputs and processes at the patient level. The McGrew et al study went one step further and incorporated the perspectives of multiple stakeholders.…”

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confidence: 99%

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Evaluating the closure or downsizing of psychiatric hospitals: social or clinical event?

Lesage

2000

Epidemiol Psichiatr Soc

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SummaryObjectives – The evaluation matrix recently proposed by Tansella and Thornicroft suggests that the field of social and epidemiological psychiatry has focussed more on the individual/patient level of mental health care services than the system level. Moreover, phenomena such as deinstitutionalisation have been examined more as clinical events than as social ones. The aims here are to deepen our understanding of deinstitutionalisation, particularly as regards the downsizing/closure and role of psychiatric hospitals. Methods – I begin by reviewing the manifest and latent functions of psychiatric hospitals. This is followed by a discussion of how these functions must be met by any comprehensive community-oriented system of mental health care for severely mentally ill patients. Also, in order to reframe the downsizing/closure of psychiatric hospitals as a social event for the field of social psychiatry and psychiatric epidemiology, I posit that the process of deinstitutionalisation is driven today by the same forces that were present at the outset of the movement. Results – I review four recent series of studies addressing primarily the outcomes, but also other aspects, of the downsizing/closure of psychiatric hospitals, with a view to illustrating the methods used, the results obtained and the blind angles missed in this research. Conclusions – Lessons are drawn on how to fill certain vacant cells of the matrix.

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“…If there are sufficient community alternatives, the demand for acute care psychiatric beds should be lower. At least one study showed that the closure of a state psychiatric hospital and the subsequent reallocation of funds resulted in the growth of community services that better met the needs of the community (Kamis-Gould, Snyder, & Casey, 1999). …”

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confidence: 99%

Key stakeholder perceptions regarding acute care psychiatry in distressed publicly funded mental health care markets

Frueh¹,

Grubaugh²,

Sasso³

et al. 2012

Bulletin of the Menninger Clinic

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The role of acute care inpatient psychiatry, public and private, has changed dramatically since the 1960s, especially as recent market forces affecting the private sector have had ripple effects on publicly funded mental health care. Key stakeholders’ experiences, perceptions, and opinions regarding the role of acute care psychiatry in distressed markets of publicly funded mental health care were examined. A qualitative research study was conducted using semi-structured thematic interviews with 52 senior mental health system administrators, clinical directors and managers, and nonclinical policy specialists. Participants were selected from markets in six regions of the United States that experienced recent significant closures of acute care psychiatric beds. Qualitative data analyses yielded findings that clustered around three sets of higher order themes: structure of care, service delivery barriers, and outcomes. Structure of care suggests that acute care psychiatry is seen as part of a continuum of services; service delivery barriers inhibit effective delivery of services and are perceived to include economic, regulatory, and political factors; outcomes include fragmentation of mental health care services across the continuum, the shift of mental health care to the criminal justice system, and market-specific issues affecting mental health care. Findings delineate key stakeholders’ perceptions regarding the role acute care psychiatry plays in the continuum of care for publicly funded mental health and suggest that public mental health care is inefficacious. Results carry implications for policy makers regarding strategies/policies to improve optimal utilization of scarce resources for mental health care, including greater focus on psychotherapy.

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The Impact of Closing a State Psychiatric Hospital on the County Mental Health System and Its Clients

Cited by 13 publications

References 24 publications

Reforma psiquiátrica e serviços residenciais terapêuticos

Reforma psiquiátrica e serviços residenciais terapêuticos

Evaluating the closure or downsizing of psychiatric hospitals: social or clinical event?

Key stakeholder perceptions regarding acute care psychiatry in distressed publicly funded mental health care markets

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