What is the difference between institutionalization and deinstitutionalization?
INSTITUTIONALIZATION AND DEINSTITUTIONALIZATION. Deinstitutionalization, the mass exodus of mentally ill persons from state hospitals into the community, was accomplished in the United States during the seventh and eighth decades of the twentieth century.
When does institutionalization occur for mental illness?
This institutionalization often began after a first acute mental breakdown in adolescence or early adulthood. Sometimes these patients went into remission in the hospital and were discharged, but at the point of their next psychotic episode were rehospitalized, often never to return to the community.
How does deinstitutionalization affect long-term mental illness?
With deinstitutionalization, these researchers observed that many persons with long-term, severe mental illness who were liable to institutionalism seemed to develop dependence on any other way of life that provided minimal social stimulation and allowed them to be socially inactive.
Is institutionalism a symptom of schizophrenic schizophrenia?
Other investigators, however, observed that institutionalism may not be entirely the outcome of living in dehumanizing institutions; at least in part, it may be characteristic of the schizophrenic process itself.
What is problematic about the use of the term abnormal quizlet?
What is problematic about the use of the term abnormal? Multiple definitions of abnormality fail to distinguish between desirable and undesirable behavior.
What is the largest failed social experiment in the 20th century America?
The magnitude of deinstitutionalization of the severely mentally ill qualifies it as one of the largest social experiments in American history. In 1955, there were 558,239 severely mentally ill patients in the nation's public psychiatric hospitals.
What is a deficit for the social work profession when it comes to responding to natural disasters?
What is a deficit for the social work profession when it comes to responding to natural disasters? The profession has undertaken minimal research on outcomes of disaster relief interventions.
How was mental health treated in the 1970s?
In the treatment of mental disorders, the 1970s was a decade of increasing refinement and specificity of existing treatments. There was increasing focus on the negative effects of various treatments, such as deinstitutionalization, and a stronger scientific basis for some treatments emerged.
Has deinstitutionalization improved the quality of mental health?
Background: The process of deinstitutionalization (community-based care) has been shown to be associated with better quality of life for those with longer-term mental health problems compared to long stay hospitals.
How can social work profession manage disaster risk?
Social workers also have unique disaster mandates: to support vulnerable groups such as people with disabilities, children and elderly people; to help agencies and organizations achieve effec- tive responses; to provide therapeutic interventions to survivors; and to organize recovery programs that improve the ...
What is disaster management in social work?
Disaster social work is the practice of social work during natural disasters. This field specializes in strengthening individuals and communities in the wake of a natural disaster.
What do social workers do during a disaster?
Social work disaster services include helping people qualify for aid for home reconstruction and for replacement of other material losses. Volunteer programs managed by social workers also provide skills and personnel for rebuilding and for management of temporary shelters.
What are the alternatives to deinstitutionalization?
For deinstitutionalization to be successful, there must be adequately funded community alternatives—other than jail, prison, homelessness, or early death—for individuals diagnosed as mentally ill.
Why did institutional care cost rise?
Meanwhile, the cost of institutional care began to rise dramatically. In part, this too was due to the efforts of civil rights attorneys and federal courts. Eventually, large class actions such as Wyatt v. Stickney resulted in court-mandated improvements in institutional care, which dramatically increased staffing requirements and costs.
What was the impact of the deinstitutionalization of the 1960s and 1970s?
In many ways, the decades since the massive deinstitutionalization of the 1960s and 1970s have been devoted to repairing the flaws of that era. Community support systems and supportive housing were gradually increased —although demand vastly outstrips supply in every state. The growth of the family movement and consumer empowerment movement brought new advocacy to the needs of those attempting to manage and recover from severe mental illness.
What is the term for the high prevalence of mental illness in local jails and state prisons?
The high prevalence of mental illness in local jails and state prisons eventually became known as the “criminalization” of mental illness. Yet when deinstitutionalization is done thoughtfully, the results are impressive.
What was the main cause of the creation of the Joint Commission on Mental Illness and Health in 1955?
By the 1950s, several factors had combined to alter this approach to serious mental illness. First, institutional abuses became widely publicized, resulting in the creation of the Joint Commission on Mental Illness and Health in 1955. Six years later, this commission was to produce recommendations for a community mental health system in a book titled Action for Mental Health (1961).
What were the reasons for admission to the state hospitals?
Through the first half of the 20th century, state hospitals provided care, housing, employment (usually unpaid), and social control of people deemed unable to meet life’s daily demands. Mental illness, alcoholism, mental retardation, advanced age, or chronic somatic illness, or a combination of these factors, were all reasons for admission.
What was the mental health system in the mid-20th century?
As recently as the mid-20th century, the U.S. public mental health system consisted largely of the state hospitals. These hospitals, originally constructed for the humane asylum and “moral treatment” of those deemed mentally ill, had evolved into overcrowded, understaffed, and inadequate responses to the general welfare burden of society.
What are the flaws and triumphs of deinstitutionalization?
The first is that public policy implemented without consultation with those directly affected—patients and their families in this case—can lead to major folly.
Why did institutional care cost rise?
Meanwhile, the cost of institutional care began to rise dramatically. In part, this too was due to the efforts of civil rights attorneys and federal courts. Eventually, large class actions such as Wyatt v. Stickney resulted in court-mandated improvements in institutional care, which dramatically increased staffing requirements and costs.
What was the impact of the deinstitutionalization of the 1960s and 1970s?
In many ways, the decades since the massive deinstitutionalization of the 1960s and 1970s have been devoted to repairing the flaws of that era. Community support systems and supportive housing were gradually increased —although demand vastly outstrips supply in every state. The growth of the family movement and consumer empowerment movement brought new advocacy to the needs of those attempting to manage and recover from severe mental illness.
What was the main cause of the creation of the Joint Commission on Mental Illness and Health in 1955?
By the 1950s, several factors had combined to alter this approach to serious mental illness. First, institutional abuses became widely publicized, resulting in the creation of the Joint Commission on Mental Illness and Health in 1955. Six years later, this commission was to produce recommendations for a community mental health system in a book titled Action for Mental Health (1961).
What were the reasons for admission to state hospitals?
Through the first half of the 20th century, state hospitals provided care, housing, employment (usually unpaid), and social control of people deemed unable to meet life’s daily demands. Mental illness, alcoholism, mental retardation, advanced age, or chronic somatic illness, or a combination of these factors, were all reasons for admission. The census nationally peaked at 553,000 in 1955 and is today less than 10% of that number.
When was the Mental Retardation Facilities and Community Mental Health Centers Construction Act passed?
Eventually, these pressures resulted in the passage of the Mental Retardation Facilities and Community Mental Health Centers Construction Act in 1963. The bill was passed with optimism and fanfare and promised that high-quality mental health services in the community would be less expensive and more effective than hospital care. However, these promises were never kept.
How many patients did the Pilgrim Psychiatric Center have in 1955?
The evolution from small pastoral asylum to large, multiburdened institution—Pilgrim Psychiatric Center in New York had more than 14,000 patients in 1955— was less the result of a conscious, articulated social policy than a drift in policy by a relatively young nation struggling with immigration, urbanization, poverty, disability, and industrialization.
Why are social workers not concerned about diversity?
Social workers are not concerned about the diversity of family forms because they are committed to helping all families, and diverse family forms do not change intervention strategies.
What is attuning to clients?
attuning to what the clients want and refraining from making assumptions or labeling.
What is the role of class in learning?
Class plays a significant role in providing support for people with learning differences.
Is treatment of children a private matter?
Treatment of children is both a private and public matter.
Is oppositional defiant disorder a neurodevelopmental disorder?
ADHD and oppositional defiant disorder are considered neurodevelopmental disorders; which other diagnosis is in the same category in the DSM-5?
Why did the deinstitutionalization of hospitals begin?
Deinstitutionalization as a policy for state hospitals began in the period of the civil rights movement when many groups were being incorporated into mainstream society. Three forces drove the movement of people with severe mental illness from hospitals into the community: the belief that mental hospitals were cruel and inhumane; the hope that new antipsychotic medications offered a cure; and the desire to save money [8]. It has not worked out as well as expected on any of the three fronts. People with severe mental illness can still be found in deplorable environments, medications have not successfully improved function in all patients even when they improve symptoms, and the institutional closings have deluged underfunded community services with new populations they were ill-equipped to handle.
Why do private hospitals have difficulty using the court system to commit people with SMI to the hospital?
But private hospitals have difficulty using the court system to commit people with SMI to the hospital because of the cost of transportation to the court, which is usually off-site, use of personnel, and the lack of reimbursement for psychiatrists who testify in court.
Why are people with mental illness placed in jails?
Factors such as high arrest rates for drug offenders, lack of affordable housing, and underfunded community treatments might better explain the high rate of arrests of people with severe mental illness [21]. Emergency rooms are crowded with the acutely ill patients with long psychiatric histories but no plausible dispositions. Patients who are violent, have criminal histories, are chronically suicidal, have history of damage to property, or are dependent on drugs cannot be easily placed. They are often discharged back to the streets where they started.
What is the role of state hospitals in mental health?
They must function as entry points to the mental health system for most people with severe mental illness who otherwise will wind up in a jail or prison. State hospitals are also necessary for involuntary commitment. As a nation, we are working through a series of tragedies involving weapons in the hands of people with severe mental illness—in Colorado, where James Holmes killed or wounded 70 people, Arizona, where Jared Loughner killed or wounded 19 people, and Connecticut, where Adam Lanza killed 28 including children as young as 6 years old. All are thought to have had severe mental illness at the time of their crimes. After we finish the debate about the availability of guns, particularly to those with mental illness, we will certainly have to address the mental health system and lack of services, especially for those in need of treatment but unwilling or unable to seek it. With proper services, including involuntary commitment, many who have the potential for violence can be treated. Just where will those services be initiated, and what will be needed?
What was the purpose of asylum in ancient Greece?
In ancient Greece and Rome, asylum was a place where those who were persecuted could seek sanctuary and refuge. Those persons included debtors, criminals, mistreated slaves, and inhabitants of other states [1]. Is there a group of American citizens more deserving of safety and refuge than people with severe mental illness (SMI) ...
Which Supreme Court case stated that mental illness was a disability and covered under the Americans with Disabilities Act?
The 1999 U.S. Supreme Court decision in Olmstead v. L.C. stated that mental illness was a disability and covered under the Americans with Disabilities Act.
Who coined the term "dying with one's rights on"?
The term “dying with one’s rights on” was coined by Darold Treffert in 1973 to describe how the laws have gone too far in protecting the rights of individuals at the expense of their safety and well-being [14]. Reduced beds in state facilities.
Why did deinstitutionalization help people?
It gave people the same rights as anyone else who was sick. As we began to see mental illness as more of a sickness than a disorder that deserved to have people locked away, deinstitutionalization provided access to their individual rights that were often stripped away in the United States.
What are the health issues that caregivers manage for individuals who went through deinstitutionalization?
The three most common health issues that caregivers manage for individuals who went through the deinstitutionalization are diabetes, hypertension, and arthritis.
What are the human arguments for deinstitutionalization?
The human arguments for deinstitutionalization are always the most compelling, whether you lean more toward the pros or the cons of this subject. What we do know is that when an individual is given the correct level of support in their home and community, then they are much more likely to thrive in that environment.
How many people are deinstitutionalized?
It reduced the amount of care that people received. As a result of the emphasis on deinstitutionalization in the United States, there are an estimated 2.2 million people who have a severe mental illness diagnosis that aren’t receiving any form of psychiatric treatment.
What are the health issues that prevent a normal integration into community life?
These health issues may involve physical, mental, or developmental disabilities that prevent a “normal” integration into community life. Institutions create a regimented culture that processes people into groups, discouraging individuality, while imposing mass treatment options by hiring staff to become caregivers.
What happens when you live in an institutional space?
When people live in an institutional space, there is rarely any privacy and never any personal space. These individuals are forced to live with people that they do not choose and may not like. Some facilities might even ban the development of personal relationships or the pursuit of individual hobbies.
Is there an institutional bias in Medicaid?
Even though the expense profile of deinstitutionalization is the same in most states, the variability in care quality can create wide gaps of support. There is an institutional bias that still exists in the U.S. regarding the provision of Medicaid benefits for individuals who have a complex condition.
The Origins of Deinstitutionalization
Deinstitutionalization in Practice
- One of the most important lessons to be drawn from the experience with deinstitutionalization was almost totally unforeseen by its advocates. The most difficult problem is not the fate of those patients discharged into the community after many years of hospitalization. Rather, the problem that has proved most vexing and that has presented the most ...
Existential Problems in The Community
- A young person just beginning to deal with life's demands struggles to achieve some measure of independence, to choose and succeed at a vocation, to establish satisfying interpersonal relationships and attain some degree of intimacy, and to acquire some sense of identity. Lacking the abilities to withstand stress and to form meaningful interpersonal relationships, the mentall…
Problems in Treatment
- As recently as 1950, there were no psychoactive drugs to bring long-term, severely mentally ill persons out of their world of autistic fantasy and help them return to the community. Even today, many patients fail to take psychoactive medications because of disturbing side effects, denial of illness, or, in some cases, the desire to avoid the depression and anxiety that result when they se…
Functions of The State Hospital
- Valid concerns about the shortcomings and antitherapeutic aspects of state hospitals in the United States often overshadowed the fact that the state hospitals fulfilled some crucial functions for persons with long-term, severe mental illness. The term asylumwas in many ways appropriate: these imperfect institutions did provide asylum and sanctuary from the pressures of the world w…
Ingredients of A System of Community Care
- Has community care in the United States been better than institutionalized care for persons with long-term, severe mental illness? The answer appears to be both yes and no. With deinstitutionalization, for instance, some long-term dysfunctional and mentally disordered individuals gradually, over a period of years, succeed in their strivings for independence, a vocati…
Independence
- For many long-term mentally ill persons, nothing is more difficult to attain and sustain than independence. The issue of supervised versus unsupervised housing provides an example. Professionals would like to see their patients living in their own apartments and managing on their own, perhaps with some outpatient support. But, as described in the 1992 American Psychiatric …
Freedom
- What about the issue of freedom? Persons with long-term, severe mental illness enjoy much more liberty than when they were institutionalized; in most cases, as was discussed earlier, this is appropriate. But that freedom may well be damaging to some patients if they are given more than they can handle. Many of those on the streets and in the jails suffer from the lack of structure an…
Conclusion
- Further deinstitutionalization must be preceded by careful planning and the establishment of community services. In fact, community services set up in the United States have in most cases been swamped by the number of patients coming out of the hospitals or who are already in the community and in need of care. Clearly, deinstitutionalization should be implemented only to th…
Bibliography
- American Psychiatric Association. 1992. Treating the Homeless Mentally Ill: A Task Force Report of the American Psychiatric Association,ed. H. Richard Lamb, Leona L. Bachrach, and Frederic I. Kass. Washington, D.C.: Author. Bachrach, Leona L. 1984. "Asylum and Chronically Ill Psychiatric Patients." American Journal of Psychiatry141(8): 975–978. Baum, Alice S., and Burnes, Donald …
Historical Progression of Hospitalization of Persons with Mental Illness
- Through the first half of the 20th century, state hospitals provided care, housing, employment (usually unpaid), and social control of people deemed unable to meet life’s daily demands. Mental illness, alcoholism, mental retardation, advanced age, or chronic somatic illness, or a combination of these factors, were all reasons for admission. The census nationally peaked at 553,000 in 195…
Deinstitutionalization
- There was insufficient provision for the comprehensive needs of both discharged patients and future generations of people with serious mental illnesses. These needs— housing, social support, employment—were largely neglected in the early decades of deinstitutionalization. Treatment services were expanded but were often focused on those with less se...
Implications For The Future
- There are many lessons to be drawn from the flaws and triumphs of deinstitutionalization. The first is that public policy implemented without consultation with those directly affected—patients and their families in this case—can lead to major folly. A second lesson is the danger of overpromising. Policymakers overestimated the impact of medication alone, ignoring the need f…
Historical Progression of Hospitalization of Persons with Mental Illness
- Through the first half of the 20th century, state hospitals provided care, housing, employment (usually unpaid), and social control of people deemed unable to meet life’s daily demands. Mental illness, alcoholism, mental retardation, advanced age, or chronic somatic illness, or a combination of these factors, were all reasons for admission. The census nationally peaked at 553,000 in 195…
Deinstitutionalization
- There was insufficient provision for the comprehensive needs of both discharged patients and future generations of people with serious mental illnesses. These needs— housing, social support, employment—were largely neglected in the early decades of deinstitutionalization. Treatment services were expanded but were often focused on those with less se...
Implications For The Future
- There are many lessons to be drawn from the flaws and triumphs of deinstitutionalization. The first is that public policy implemented without consultation with those directly affected—patients and their families in this case—can lead to major folly. A second lesson is the danger of overpromising. Policymakers overestimated the impact of medication alone, ignoring the need f…