Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-26T06:37:54.214Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  11 October 2011

Alain D. Lesage
Get access Rights & Permissions [Opens in a new window]

Summary

Objectives – 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.

Riassunto

Scopo – Secondo la matrice di valutazione recentemente proposta da Tansella e Thornicroft, la disciplina del la psichiatria sociale ed epidemiologica si è concentrata maggiormente a livello di singolo/paziente dei servizi di cura della salute mentale. Inoltre, fenomeni quali la deistituzionalizzazione sono stati esaminati piuttosto come fatti clinici che sociali. Nel tentativo di approfondire la nostra conoscenza della deistituzionalizzazione, si prendono in esame in primo luogo le funzioni palesi e latenti degli ospedali psichiatrici ed in particolare modo le questioni del loro ridimensionamento/chiusura, nonché del loro ruolo. Metodi – Segue una discussione relativa alle modalità con cui tali funzioni devono essere soddisfatte da qualsiasi sistema generale per comunità, che abbia come scopo la cura della salute mentale di pazienti affetti da gravi patologie mentali. Al fine di riconsiderare il ridimensionamento/chiusura degli ospedali psichiatrici in quanto fatto sociale per il campo della psichiatria sociale e l'epidemiologia psichiatrica, si premette, inoltre, che il processo di deistituzionalizzazione viene oggi condotto dalle stesse forze presenti al momento della nascita del movimento. Risultati – Vengono esaminati quattro serie di studi recenti aventi come oggetto principale, unitamente ad altri aspetti, il ridimensionamento o la chiusura degli ospedali psichiatrici, allo scopo d'illustrare i metodi impiegati, i risultati ottenuti, nonché gli aspetti trascurati da questi studi. Conclusioni – Infine, vengono avanzate delle conclusioni sulle modalità con cui riempire talune cellule inutilizzate della matrice.

Keywords

social psychiatrydeinstitutionalisationhealth services researchmethodologypsichiatria socialedeistituzionalizzazionericerca sui servizi sanitarimetodologia.
Type
Invited Paper
Information
Epidemiology and Psychiatric Sciences , Volume 9 , Issue 3 , September 2000 , pp. 163 - 170
Copyright
Copyright © Cambridge University Press 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Basaglia, F. & Tranchina, P. (Ed.) (1979). Autobiografia di un Movimento: 1961-1979: dal Manicomio alia Riforma Sanitaria. Unione province italiane, Regione Toscana, Amministrazione provincialedi Arezzo: Arezzo, pp. 146–147.Google Scholar
Bonin, J.P., Lesage, A.D., Ricard, N., Demers, M., Morissette, R. & Benoit, D. (1998). Empowering the staff in long-stay wards. Canadian Journal of Psychiatry 43(10), 1054.Google ScholarPubMed
Côté, C. & Larouche, D. (2000). Radiographie d'une Mort Fine. Dimension Sociale de la Maladie au Québec. Les Éditions JCL: Chicoutimi.Google Scholar
Goering, P.N. & Streiner, D.L. (1996). Reconcilable differences: the marriage of qualitative and quantitative methods. Canadian Journal of Psychiatry 41(8), 491–497.CrossRefGoogle ScholarPubMed
Goldman, H., Morrissey, J. & Ridgely, S. (1994). Evaluating the Robert Wood Johnson Foundation Program on chronic mental illness. MilIBank Quarterly 72, 37–48.CrossRefGoogle Scholar
Guba, E. G. & Lincoln, Y.S. (1989). Fourth Generation Evaluation. Sage: Newbury Park.Google Scholar
Henderson, C. & Thornicroft, G. (1997). L'étet de la désinstitutionnalisation en Grande Bretagne. Santé Mentale au Quebec 22, 88–114.CrossRefGoogle Scholar
Hinings, R. & Greenwood, R. (1988). The Dynamics of Strategic Change. Blackwell: Oxford.Google Scholar
Johnson, S., Salvador-Carula, L. & the EPCAT Group. (1998). Description and classification of mental health services: a European perspective. European Psychiatry 13, 333–341.CrossRefGoogle ScholarPubMed
Kamis-Gould, E., Snyder, F., Hadley, T.R. & Casey, T. (1999). The impact of closing a state psychiatric hospital on the county mental health system and its clients. Psychiatric Services 50(10), 1297–1302.CrossRefGoogle ScholarPubMed
Kirmayer, L.J. & Young, A. (1999). Culture and context in the evolutionary concept of mental disorder. Journal of Abnormal Psychology 108(3), 446–452.CrossRefGoogle ScholarPubMed
Knapp, M. (1997). Economics and mental health: a concise European history of demand and supply. In Making Rational Mental Health Services (ed. Tansella, M.). Epidemiologia e Psichiatria Sociale Monograph Supplement No. 1, pp. 157–166.CrossRefGoogle Scholar
Leff, J., Trieman, N. & Gooch, C. (1996). Team for the assessment of psychiatric services (TAPS) project 33: prospective follow-up study of long-stay patients discharged from two psychiatric hospitals. American Journal of Psychiatry 47, 62–67.Google Scholar
Lesage, A.D., Contandriopoulos, A.P. & Reinharz, D. (1999). La Désinstitutionnalisation dans un Grand Hôpital Psychiatrique Québécois depuis 1989: Analyse des Besoins de Soins, des Coûts et des Aspects Organisationnels. Centre de recherche Fernand-Seguin, Hôpital Louis-H. Lafontaine. Rapport final déposé au Programme conjoint en santé mentale du Conseil Québécois de la Recherche Sociale (CQRS) et du Fonds de la Recherche en Santé du Québec (FRSQ).Google Scholar
Lesage, A.D., Contandriopoulos, A.P. & Reinharz, D. (2000). A look at psychiatric deinstitutionalization:†lessons for health care programs. Canadian Journal of Psychiatry (submitted for publication).Google Scholar
McGrew, J.H. (Ed.) (1999). Special section: multiple perspectives on the closing of a state hospital. Journal of Behavioral Health Services and Research 26, 236–328.CrossRefGoogle Scholar
O'Driscoll, C. (1993). The TAPS project. Mental hospital closure a literature review of outcome studies and evaluative techniques. British Journal of Psychiatry 162, Suppl.19, 7–17.CrossRefGoogle Scholar
Rothbard, A.B., Schinnar, A.B., Hadley, T.P., Foley, K.A. & Kuno, E. (1998). Cost comparison of state hospital in community based care for seriously mentally ill adults. American Journal of Psychiatry 155, 523–529.CrossRefGoogle ScholarPubMed
Tansella, M. & Thornicroft, G. (1998). A conceptual framework for mental health services. Psychological Medicine 28, 503–508.CrossRefGoogle ScholarPubMed
Thornicroft, G., Baker, T., Hollaway, F., Johnson, S., Leese, M., McCrone, P., Szmukler, G., Teller, R. & Wykes, T. (1999). Community mental health teams:fevidence or belief? British Journal of Psychiatry 175, 508–513.CrossRefGoogle ScholarPubMed
Tomlinson, D. (1991). Utopia, Community Care and the Retreat from the Asylums. Open University Press: Milton Keynes.Google Scholar
Waldrop, M.M. (1992). Complexity: The Emerging Science at the Edge of Order and Chaos. Simon & Schuster: New York.Google Scholar
Wing, J.K., Brown, G.W. (1970). Institutionalism and Schizophrenia. Cambridge University Press: Cambridge.CrossRefGoogle Scholar
Wykes, T. & Wing, J.K. (1982). A ward in a house: accommodation for «new» long-stay patients. Ada Psychiatrica Scandinavica 65, 315–330.CrossRefGoogle Scholar