Sociology Index

DEINSTITUTIONALIZATION

Deinstitutionalization is reduction in the size of populations held in institutions of involuntary confinement, primarily mental hospitals and prisons. Deinstitutionalization movement began in the 1970s and was very successful in reducing the size of mental hospitals. Community mental health programs and community corrections developed in response to the desire for deinstitutionalization, but community corrections has come to be seen as an aspect of net widening.

Some Perspectives on Deinstitutionalization - H. Richard Lamb, M.D. and Leona L. Bachrach, Ph.D. 

The authors discuss what can be learned from our experience with deinstitutionalization. The deinstitutionalization of mentally ill persons has three components: the release of these individuals from hospitals into the community, their diversion from hospital admission, and the development of alternative community services.

There have been unintended consequences of deinstitutionalization, a new generation of uninstitutionalized persons who have severe mental illness, who are homeless, or who have been criminalized and who present significant challenges to service systems. Among the lessons learned from deinstitutionalization are that successful deinstitutionalization involves more than simply changing the locus of care.

Radical deinstitutionalization: Rousseau versus Freud - Mayerhoff, David
Abstract: Background & aims: This paper considers the policy of radical deinstitutionalization of the chronic, treatment-refractory mentally ill from the perspective of two theories concerning the nature of man and civilization. 
Method: Two apparently opposing points of view are reviewed, that of J. J. Rousseau and that of S. Freud. Results & conclusions: An extrapolation from these points of view suggests that neither would espouse a categorical view of deinstitutionalization in the context of current societal conditions.

The Satellite System: A Model for Deinstitutionalization. - Boyan, Craig 
Abstract: The paper presents the community-based satellite system as a residential and program model to effect deinstitutionalization of mentally retarded young adults in urban centers worldwide. The system is reported to consist of a large, central educational facility surrounded by a series of small houses and apartment units (satellites). Benefits of this environment are discussed.

Testing the limits of deinstitutionalization - RL Okin 
San Francisco General Hospital, California 94110, USA. 
OBJECTIVE: From 1978 to 1993, under favorable administrative and political conditions and protected by a court-ordered consent decree, a comprehensive community-based mental health system was established in western Massachusetts that entirely replaced Northampton State Hospital.

Deinstitutionalization, another way: The Italian mental health reform 
OTA DE LEONARDIS, Associate Professor of Sociology, DIANA MAURI, CNR Project Research Fellow and FRANCO ROTELLI, Director - University of Salerno Department of Sociology, University of Milan Mental Health Services Trieste The article describes the Italian experience of deinstitutionalization in psychiatry, a reform which has attracted international recognition as being the only instance of an industrial society eliminating detention in a mental hospital from its range of mental health agencies and services. 
The first part of the article highlights the differences between the Italian experience and psychiatric reforms in Europe and the US, where deinstitutionalization has been reduced to dehospitalization.
The second part describes the operation, very different in content and method from the above quoted experiences, of the Italian form of deinstitutionalization.
The fourth part examines the reform law arising from the deinstitutionalization process and the characteristics of its implementation, in order to show how this process continues through implementation. 
In the light of these considerations, deinstitutionalization is no longer perceived as an aspect of the "welfare crisis", but rather as a significant pointer to new post-welfare social policies.

Criminal Offending in Schizophrenia Over a 25-Year Period Marked by Deinstitutionalization and Increasing Prevalence of Comorbid Substance Use Disorders 
Cameron Wallace, Ph.D., Paul E. Mullen, Philip Burgess, Ph.D. 
OBJECTIVE: This study examined the pattern of criminal convictions in persons with schizophrenia over a 25-year period marked by both radical deinstitutionalization and increasing rates of substance abuse problems among persons with schizophrenia in the community.

Deinstitutionalization of psychiatric patients, a critical review of outcome studies
P Braun, G Kochansky, R Shapiro, S Greenberg, JE Gudeman, S Johnson and MF Shore 
The authors performed a critical review of experimental studies on the outcomes for psychiatric patients of 1) alternatives to hospital admission, 2) modifications of conventional hospitalization, and 3) alternatives to continued long-term hospitalization. The internal validity of many of the studies was compromised by shortcomings in design and performance and generalizability limited by selection of patient populations. Satisfactory deinstitutionalization appears to depend on the availability of appropriate programs for care in the community.

Deinstitutionalization of Status Offenders: Individual Outcome and System Effects 
Irving A. Spergel, Frederic G. Reamer, James P. Lynch 
In recent years there have been widespread attempts to remove juvenile status offenders from secure detention and correctional facilities. These efforts have been in response to claims that status offenders do not represent a significant danger to the community and that incarceration of them is unwarranted. This article summarizes findings from the evaluation of a statewide program, designed as part of a national deinstitutionalization strategy, that provided alternatives to secure detention for status offenders between the time of arrest and court appearance. Data are provided concerning status offenders' careers and the ability of the deinstitutionalization strategy to divert youths from the juvenile justice and social service systems.

Deinstitutionalization and the ‘long-term mentally ill’: a Swedish case study 
ERIK FORSBERG and BENGT STARRIN 
We discuss deinstitutionalization and the question of how ‘long-term mentally ill’ persons adjust to life outside institutions.

The Leros PIKPA Asylum Deinstitutionalization and Rehabilitation Project 
A follow-up study on care staff fears and attitudes 
John Tsiantis, Stavroula P. Diareme, Gerasimos Kolaitis, Department of Child Psychiatry, Athens University Medical School
This is a three-year follow-up study on the results from the Deinstitutionalization Project of the Leros PIKPA asylum regarding job-related fears of care staff of the institution as well as their attitudes towards people with learning disabilities.

Race and the Impact of Juvenile Deinstitutionalization 
M. A. Bortner, Mary L. Sunderland, Russ Winn 
In a study of 32,000 referrals to juvenile court, the effects of a program to deinstitutionalize status offenders on detention decisions, intake screening, and final dispositions were examined. Although the results of a general comparison of preprogram and postprogram court actions showed relatively little change in court policies, the data did indicate a slight general trend toward less use of secure detention, a greater use of informal hearings, and a lower rate of juveniles placed on probation or in institutions.

Deinstitutionalization's Throwaways: The Development of a Juvenile Prison in Massachusetts 
Ronald E. Vogel, Edward A. Thibault 
With its deinstitutionalization of juvenile offenders in the early 1970s, the Department of Youth Services in the state of Massachusetts developed the reputation of being extremely progressive. However, the label progressive does not characterize all forms of juvenile correction under the new system. In the midst of deinstitutionalization, a small maximum-security prison was developed for juvenile offenders who could not be treated in any of the community-based programs designed to replace the training schools.

Deinstitutionalization for Older Adults With Severe Mental Retardation: Results From Australia 
Louise Young and Adrian F. Ashman
University of Queensland, Fred and Eleanor Schonell Special Education Research Center
Abstract: A deinstitutionalization research project in which residents from the largest institution in Queensland, Australia, were relocated after a government decision to close the center was described.

Longitudinal Study of Deinstitutionalization and the Exercise of Choice 
Roger J. Stancliffe, and Brian H. Abery
Abstract: Day-to-day choices available to former institution residents with severe/profound developmental disabilities (movers) were assessed before and after deinstitutionalization and compared with peers who remained in the same institutions (stayers). Data were gathered annually for both groups for 3 years after baseline. Personal characteristics of the two groups did not differ significantly at baseline, except that stayers exhibited more challenging behavior. This was controlled by using baseline challenging behavior as a covariate in group comparisons. Overall, movers exercised significantly more choice, although groups did not differ at baseline. Effects of deinstitutionalization did not differ with level of disability. However, the absolute level of choice available to both movers and stayers was very low.

Deinstitutionalization of Minors with Mental Retardation. Abstract X: Research & Resources on Special Education.
Abstract: The brief paper summarizes the final report of a federally funded project titled, "Ramps Are Not Enough: The Movement of Children with Mental Retardation from Institutional to Community-Based Care." The follow-up study of former residents (N=178) of New Hampshire's Laconia State School included an examination of residential and educational consequences of deinstitutionalization, four in-depth case studies, and an effort to trace the chronological relationship between federal and state policy and budgetary changes and the community living experiences of subjects.

Deinstitutionalization has been reduced to dehospitalization.