Planning mental health services: II. Current Canadian initiatives

Forty years of deinstitutionalization of psychiatric services in Canada: an empirical assessment

OBJECTIVE

To empirically analyze the implementation of the policy of deinstitutionalization of psychiatric services over a 40-year period.

METHOD

We assessed the policy of deinstitutionalization in terms of the following components: 1) population-based psychiatric beds, days of care in psychiatric hospitals (PHs); 2) days of care in psychiatric units in general hospitals (GHs); and 3) per capita expenditures on psychiatric services.

RESULTS

There was a rapid closure of beds in PHs in the 1970s and 1980s, but this was associated with an increasing rate of days of care in psychiatric units in GHs (that is, transinstitutionalization). It was not until the 1990s that the overall days of inpatient care began to decrease. Per capita expenditures on community-based psychiatric services increased throughout this period.

CONCLUSIONS

Standardized rates reveal tremendous variation among the provinces in the timing and intensity of deinstitutionalization.

[Deinstitutionalization in psychiatry: revising our principles of community psychiatry or failure of deinstitutionalization!]

OBJECTIVE

To update community psychiatry principles within the context of increased outpatient services.

METHOD

Analysis of the evolution of some community models in Italy, France, Holland, and the United States.

RESULTS

Deinstitutionalization was aimed to protect patients from the harmful effects of mental hospitals but failed to result in social integration for many of them. Success and failure of community practice shed a new light on the diversity and constancy of patients' needs.

CONCLUSIONS

Quality-of-life improvement and services integration should be guided by planning and selection of the required services.

The National Mental Health Policy: implications for public psychiatric services in Australia

The Health Ministers of all Australian States, Territories and the Commonwealth endorsed a National Mental Health Policy in April 1992. This Policy is intended to set a clear direction for the future development of mental health services within Australia. The Policy recognises the high prevalence of mental health problems and mental disorders in the Australian community and the impact of these on consumers, carers, families and society as a whole. It also clearly accepts the need to address the problems confronting the promotion of mental health and the provision of mental health services.

Planning mental health services: I. Background and key issues

Planning mental health services is a complex task requiring an understanding of background developments and key issues related to mental health services. In Canada, the deinstitutionalization of patients attempted to shift the locus of care from provincial psychiatric hospitals to general hospital psychiatric units. This resulted in the isolation of provincial psychiatric hospitals, general hospital psychiatric units and community mental health programs, with little overall accountability for the services provided--three solitudes. To move toward the creation of responsible, integrated systems a number of issues must be addressed: target population(s); the roles of provincial psychiatric and general hospitals; community support services; continuity of care; co-morbidity; consumerism; and methods of integration. In the development of a comprehensive mental health plan, each issue should be recognized and decisions made which are in keeping with current knowledge. A companion report will survey Canadian initiatives in mental health planning and discuss approaches to many of the issues identified.