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Mental Hospitials

Transition from Mental Hospital to Community

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Abstract

Making the transition from the hospital to a community setting can be extremely challenging for patients with acute mental health conditions. Transitional services have been created to help patients overcome difficulties associated with this transition. Nurses frequently play an integral role in the success of these services. By providing patients with individualized support during such transitions, nurses act as clinical liaisons and directly contribute to an increase in positive patient and system-level outcomes. This article describes a transitional service called the Bridge Program, designed to help adolescents make a successful transition from the hospital to the community. An overview of the Bridge Program is provided, and the results of an evaluation of this program are presented. Results suggest that the Bridge Program contributes to a decrease in the length of hospital stays and improves continuity of care for patients and their families.

See Also: Hospital-to-community transitions. A bridge program for adolescent mental health patients.

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Managing Mentally III, Nuisance Offenders: The Consequences of Restricted Civil Commitment and Decentralized Funding

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High rates of mental illness among the growing, visible, urban homeless population provoke public pressure to "do something" to eliminate this "public nuisance." Conviction and jailing on misdemeanor charges provides only temporary incarceration in alneady overcrowded local jails, while, since the 1970s, restrictive commitment standards have limited the availability of civil commitment to hospitalize non-violent mentally ill people.

To encourage development of community-based mental health services and reduce the fiscal domination of state mental hospitals, some states have decentralized funding of mental health services. Under decentralization county officials make commitment decisions and distribute funds to state hospitals and community programs, on a fee-for-service basis.

Many political compromises were required to pass this decentralizing legislation in Ohio. One such compromise has the state retaining financial responsibility only for those state hospital patients committed through criminal processes. The resulting structure of financing and decision making may encourage some local officials to use criminal commitment procedures to manage nuisance offenders.

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Administrative Discharge Procedures for Involuntary Civilly-Committed Mental Patients:An Alternative

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Historically, state practices governing institutionalization of mental patients have escaped serious challenge. Sparked, however, by a rising societal concern for individual rights' and an increasing recognition of the pervasiveness of mental illness,2 litigators and commentators are now demanding a more critical examination of the treatment of mental patients. In accord with these realizations, this note will focus on involuntary, civilly-committed patients in state mental hospials and will examine both highly protective systems recently enacted by some states as well as failures of discharge procedures in others. An alternative system, providing a second level of administrative review, with some improvements on judicial review, will be recommended for those states which currently maintain inadequate procedures and which realistically cannot or will not bear the cost of more protective systems.

IMPORTANCE OF ADEQUATE DISCHARGE PROCEDURES

Most litigation involving the rights of involuntary civil patients focuses on the lack of due process in commitment procedures and on deprivations and abuses occurring within institutions.' Discharge procedures

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Understanding psychiatric institutionalization: a conceptual review

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Abstract

Background: Since Goffman’s seminal work on psychiatric institutions, deinstitutionalization has become a leading term in the psychiatric debate. It described the process of closure or downsizing of large psychiatric hospitals and the establishment of alternative services in the community. Yet, there is a lack of clarity on what exactly the concept of institutionalization means in present-day psychiatry. This review aims to identify the meaning of psychiatric institutionalization since the early 1960s to present-day.

Method: A conceptual review of institutionalization in psychiatry was conducted. Thematic analysis was used to synthesize the findings.

Results: Four main themes were identified in conceptualizing institutionalization: bricks and mortar of care institutions; policy and legal frameworks regulating care; clinical responsibility and paternalism in clinician-patient relationships; and patients’ adaptive behavior to institutionalized care.

Conclusions: The concept of institutionalization in psychiatry reflects four distinct themes. All themes have some relevance for the contemporary debate on how ..

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Deinstitutionalization and Its Discontents:

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INTRODUCTION

Mental illness is real. 10 percent of children and 25 percent of adults in America struggle with serious emotional and mental disorders which cause significant daily functional impairment.

Mental illness is pervasive. 4 of the 10 leading causes of disability in the United States are mental disorders. Children, adolescents and adults from all classes, backgrounds, faiths, and walks of life suffer. Mental illness is ruinous. 31 percent of homeless adults have a combination of mental illness and addiction disorder. Adults living with serious mental illness die 25 years earlier than other Americans. Over 90 percent of those who die by suicide have a mental disorder. 24 percent of state prisoners and 21 percent of jail prisoners have mental illnesses. 70 percent of youth in the juvenile justice system have at least one mental disorder. Over 50 percent of students with a mental disorder drop out of high school...

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Discharged From A Mental Health Admission Ward: Is It Safe To Go Home? A Review On The Negative Outcomes Of Psychiatric Hospitalization

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Abstract

Before psychiatry emerged as a medical discipline, hospitalizing individuals with mental disorders was more of a social stigmatizing act than a therapeutic act. After the birth of the mental health disciplines, psychiatric hospitalization was legitimized and has proven to be indispensable, preventing suicides and helping individuals in need. However, despite more than a century passing since this legitimization occurred, psychiatric hospitalization remains a controversial issue. There is the question of possible negative outcomes after a psychiatric admission ceases to take its protective effect, and even of whether the psychiatric admission itself is related to a negative setback after discharge. This review aims to summarize some of the most important negative outcomes after discharge from a psychiatric institution. These experiences were organized into two groups: those after a brief psychiatric hospitalization, and those after a long-stay admission. The author further suggests possible ways to minimize these..

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Human Rights Group: Mexican Mental Hospitals Performing Lobotomies Without Consent

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Ten years ago a human rights group released a scathing, ground-breaking report on abusive, decrepit conditions in Mexican institutions for the mentally and physically disabled, moving the country to promise change and to take the lead in writing international agreements to protect the disabled.

But in a new report released Tuesday, the group, Disability Rights International, working with a Mexican human rights organization, said a yearlong investigation revealed “atrocious and abusive conditions” that included lobotomies performed without consent, children missing from orphanages, widespread filth and squalor and a lack of medical care.

At one institution here in the capital, which a reporter visited with investigators from the groups, men walked around half-naked, feces littered a yard, bed sheets were missing, the smell of urine permeated a day room, bathroom faucets malfunctioned and patients lay sprawled on several patches of grass....

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Mental Health Disorders And Sexually Transmitted Diseases In A Privately Insured Population.

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Abstract

OBJECTIVES:

To consider whether patients who use mental health services in privately insured settings are also more likely to have received sexually transmitted disease (STD) or human immunodeficiency virus (HIV) diagnoses and whether this relationship extends to patients with milder mental health disorders.

METHODS:

Using frequency tables stratified by age and sex, a logistic regression model, and difference of means tests, we examined the relationship between mental health claims and STDs in a sample of 289 604 privately insured people across the United States.

RESULTS:

Patients with mental health claims were more than twice as likely as other patients to have an STD claim in the same year after controlling for confounding factors (odds ratio, 2.33; 95% confidence interval, 2.11-2.58). This relationship held for severe and milder mental health diagnoses, for male and female patients, and in each age category from 15 to 44 years...

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