Life after the mental hospital: the way of life of deinstitutionalized psychiatric patients

Process of Deinstitutionalization of Aging Individuals With Severe and Disabling Mental Disorders: A Review

BACKGROUND

For more than 60 years, psychiatric services has gradually gone from an asylum model to a community model. This change has led to the emergence of a deinstitutionalization movement. This movement seems to have left behind long-term hospitalized aging individuals with severe and disabling mental disorders. The objective of this article is to conduct a review on the challenges and issues associated with the process of deinstitutionalization among hospitalized aging individuals with severe and disabling mental disorders.

METHODS

Using PRISMA statement, the research methodology was carried out in English and French in 16 databases with a combination of 3 lists of keywords. The selection process was then followed by a thematic analysis which aimed at categorizing by theme and classifying the writings selected.

RESULTS

A total of 83 articles published between 1978 and 2019 were selected and organized into six categories: (a) a forgotten population in research and health policies, (b) an economic presentation of the deinstitutionalization process, (c) an improvement in quality of life and global functioning for deinstitutionalized patients (d) from stigmatization to the rejection of elderly psychiatric inpatients from deinstutionalization process, (e) a difficult community-based care offer and a difficult epistemological identification, (f) from the lack of community services to the phenomenon of transinstitutionalization. The current state of scientific research, institutional policies and clinical practices associated with the deinstitutionalization process of SVPTSIH are then commented.

CONCLUSIONS

Recommendations are proposed to researchers and professionals concerned with the support of long-term hospitalized aging individuals with severe and disabling mental disorders.

Subjective well-being and community integration among clients of assertive community treatment

Three aspects of community integration (i.e., physical, social, and psychological integration) were examined in relation to subjective well-being (SWB) in a sample of 92 persons with psychiatric disabilities receiving services from assertive community treatment (ACT) teams. Although two of the integration variables, namely physical and psychological integration, were related to SWB at the bivariate level, these relationships were not maintained following sequential multiple regression analysis. Findings support previously established relationships between SWB and psychiatric symptoms and between SWB and self-esteem. Results also emphasize the importance of client perceptions of social support that may be attributable, in part, to ACT services.

Measuring the impact of housing on people with schizophrenia

Review of the available literature, from various countries, on housing options indicates that, for people with a mental illness, boarding houses are the least desirable type of community accommodation and that living in their own home is the most desirable type of accommodation. The present research project provides a more in-depth examination of people with schizophrenia and the impact of living in their own home compared to living in a boarding house. In this Australian study there were 3231 subjects, 3033 who were living in their own homes and 201 living in boarding house accommodation. The study used two instruments from the Mental Health Classification and Service Cost Project, specifically the Health of the Nation Outcomes Scale, which is a measure of current symptoms, and a shortened version of the Life Skills Profile, which measures global level of functioning. Results indicated that while there were no differences in the level of psychiatric symptoms experienced, people living in boarding houses had less access to social support, meaningful activities and work; they also had a significantly lower level of global functioning. These findings contradict the conventional wisdom that people with schizophrenia resort to living in boarding houses because of their level of disability and highlights an area of potential intervention for community health services.

Storytelling of co-operative team meetings in acute psychiatric care

BACKGROUND

One of the goals of co-operative psychiatric nursing and co-operative team meetings is to improve patients' and significant others' participation and thus, to enhance patients' resources outside the hospital. The objective of this paper is to describe the different expert interventions that either enabled or prevented patient and his/her significant others participation in co-operative team meetings in acute psychiatric wards.

METHODS

The data consisted of 11 videotaped team meetings. The participants were voluntary patients, significant others and experts in health and social care. A narrative approach focused on the storytelling of all members in the meetings. The method of modified dialogue analysis was used to identify the ideas of the stories.

FINDINGS

The same topic of discussion was shared in active participation. The experts asked open-ended questions, the patient and his/her significant others' were free to express their viewpoints and the experts' interpretation was based on their stories. The experts presented the reasons for their questions, and the contents of the questions were verbalized. In passive participation, the experts questions were based on their own point of view, and the patient and his significant others merely answered these questions. If the expert opinion appeared too dominating at the co-operative team meeting, the patient's and his/her significant others' participation was in jeopardy.

CONCLUSIONS

The physician either dominates the storytelling or gives space for free expressions of various viewpoints during the co-operative team meetings.

Subjective quality of life in the evaluation of programs for people with serious and persistent mental illness

Despite the widespread application of the concept of quality of life in mental health evaluation, it has been observed that subjective quality of life measures do not reliably capture changes expected to result from intervention efforts. Moreover, because the domains selected to assess subjective life quality are typically generated by investigators or health professionals, the validity of subjective quality of life measures has also been questioned. Although it represents a conceptual shift from investigator-generated domains to client-elicited domains, it is suggested that a client-elicited approach to measuring subjective quality of life may provide fruitful avenues for resolving some of the conceptual and practical issues associated with understanding and measuring the impact of community-based programs on clients with serious mental illness. Accordingly, while acknowledging the utility of assessing the objective circumstances of people's lives, this paper suggests that client-elicited subjective quality of life domains have the potential to resolve the failure of existing measures to register meaningful change. Unlike previous general reviews of quality of life that have emphasized measurement issues, the present review considers some of the fundamental barriers to our ability to adequately understand and document the experiences of people adjusting to community living with a psychiatric disability.

Patient initiatives during the assessment and planning of psychiatric nursing in a hospital environment

The qualitative study reported in this paper aims to describe the planning and assessment of psychiatric nursing in a hospital environment. The theoretical framework consists of the three types of psychiatric nursing outlined in a developmental model of nursing: confirmatory, educational and catalytic. Confirmatory psychiatric nursing is based on a hierarchical and authoritarian model. Educational psychiatric nursing is based on a professionally driven and behavioural model. Catalytic psychiatric nursing is systematic, theoretical, and research-based. Catalytic psychiatric nursing may vary, depending on the patient's needs, from confirmatory and educational to situationally determined nursing. However, it always enables patient initiatives. The purpose of this paper is to describe patient initiatives during the assessment and planning of patient care by an interdisciplinary mental health team in a psychiatric hospital environment, and the assessment and planning as described by nurses working in a hospital environment. The data, which were collected in two psychiatric hospitals by videotaping interdisciplinary teamwork situations and recording interviews of nurses afterwards, consisted of 384 pages of written text. A total of 640 sentences were identified in the text as reflecting the assessment of care by the interdisciplinary team and by the nurses working in the hospital environment. Deductive content analysis techniques were used to analyse the written data. The results showed that nursing was described by the nurses to be catalytic in 13% of the cases, while the same nurses assessed psychiatric nursing to be most commonly educational (40%) or confirmatory (47%).