Deinstitutionalisation and the move to community care: comparing the changing dimensions of mental healthcare after 1922 in the Republic of Ireland and England.

The advent of deinstitutionalisation and the introduction of community care in the latter part of the twentieth century have revolutionised mental-health service provision across Europe, although implementation, timing and services have varied widely in different countries. This article compares the changing dimensions of mental-health provision in post-independence Ireland with that in England, and will shed light on the current state of mental healthcare in both countries. The article calls for more research into the impact of deinstitutionalisation, such as the challenges faced in the community for those in need of continuing care.

Aprendendo com histórias: narrativas de experiências de uma cidade com a loucura / Learning from stories: narratives of experiences in a city with madness / Aprendiendo con historias: narrativas de experiencias de una ciudad con la locura

A cidade de Cariacica-ES foi sede do primeiro hospital psiquiátrico público do estado-local que produziu marcas na memória de uma cidade, que se acostumou a manter a loucura à distância, trancafiada nos muros do manicômio. Com as lutas provenientes da Reforma Psiquiátrica, os manicômios tiveram seus muros abalados e a proposta de um cuidado territorial começou a ser posta em prática: a loucura passou a habitar outros espaços da cidade. O presente artigo foi construído a partir de uma experiência investigativa que utilizou como método a História Oral, no intuito de conhecer, a partir de relatos de experiências de moradores e profissionais da saúde mental, os modos como a loucura foi acolhida em Cariacica-ES para além do espaço manicomial, a partir dos Serviços Residenciais Terapêuticos, após a abertura dos muros físicos do antigo Hospital Adauto Botelho.

The city of Cariacica-ES was the headquarters of the first public psychiatric hospital in the state, a place that produced marks in the memory of a city used to seeing madness far away, excluded and locked in the walls of the mental institution. With the struggles arising from the Psychiatric Reform, the asylums had their walls knocked down, and the proposal for territorial care began to be put into practice: madness began to inhabit other spaces in the city. This article was made from an investigative experience which used Oral History as a method to know, from the experiences of residents and mental health professionals, how madness was welcomed in Cariacica city beyond a mental asylum space, and from the Therapeutic Residential Services, after the opening of the physical walls of the former Adauto Botelho Hospital. (AU)

La ciudad de Cariacica, situada en el estado de Espírito Santo, fue sede del primer hospital psiquiátrico público, un lugar que dejó huellas en la memoria de una ciudad acostumbrada a ver la locura desde la distancia, encerrada en los muros del hospital. En virtud de las luchas surgidas de la Reforma Psiquiátrica, los manicomios tuvieron sus muros derribados y se empezó a poner en práctica la propuesta del cuidado territorial, la locura comenzó a habitar otros espacios de la ciudad, componiéndolos. Este artículo se construyó a partir de una experiencia investigativa que utilizó la Historia Oral como método, con el fin de conocer, a partir de relatos de experiencias de residentes locales y profesionales de la salud mental, cómo la locura fue acogida por la ciudad, más allá del espacio hospitalario, a partir de los Servicios Residenciales Terapéuticos, tras la apertura de los muros físicos del antiguo Hospital Adauto Botelho. (AU)

The history of mental health policy in Turkey: tradition, transition and transformation.

This article offers a brief history and the evolution of mental health policy in Turkey. It aims to analyse how mental health policies were transformed and why certain policies were introduced at specific times. The modern history of mental health policy is divided into three periods: the institutionalization of psychiatry and hospital-based mental health services; the introduction of community-based mental healthcare services; and lastly, the policy of deinstitutionalization after the 1980s. These periods have been categorized in a way that basically coincides with Turkey's modern political history.

The ambivalent role of the institution in the history of child and adolescent psychiatry: a case study of the Hawthorn Centre in Michigan, USA.

Historians have examined the role of psychiatric institutions in the USA and addressed whether this form of care helped or harmed patients (depending on the perspective of the time period, historical actors, and historians). But the story for children's mental institutions was different. At the time when adult institutions were in decline, children's mental hospitals were expanding. Parents and advocates clamoured for more beds and more services. The decrease in facilities for children was more due to economic factors than ideological opposition. This paper explores a case study of a hospital in Michigan as a window into the different characteristics of the discussion of psychiatric care for children.

The right to live independently and be included in the community.

The segregation and isolation of people with disabilities are global problems, rooted in legislation and policy, social norms and traditional practices. The right to live independently and be included in the community, contained in article 19 of the United Nations Convention on the Rights of Persons with Disabilities, was created to combat the phenomenon of institutionalization and to spur efforts towards its eventual eradication. This essay offers a commentary on article 19, drawing on its drafting history, on the interpretation provided by the responsible UN body and on the efforts by that body to monitor and encourage compliance. It emphasizes the extent of the transformation required to realize the full ambition of the article and the need for cooperation across UN treaty bodies.

Building a mental hospital in apartheid South Africa.

In April 1962, a new mental hospital was inaugurated in Belville, a town near Cape Town, South Africa. Stikland Mental Hospital was planned as mental health care was changing with the introduction of psychotropic drugs and renewed debates about deinstitutionalization-and as the South African legislature formalized the system known as "apartheid." This article focuses on this hospital, which embodied many global ideas about treatment and management of the mentally ill but which also incorporated the local politics of strict racial segregation. It had been planned in response to overcrowded mental hospitals in the 1950s, but by the time it opened, new forms of treatment had produced a surplus of beds for White patients. Architecturally, the hospital was conceived with the general principles of the villa plan in mind, although utilitarian aspects, such as patient and staff numbers, gardens, and budgets, dominated the design of the buildings. The public relations exercises undertaken highlight the negotiations involved in building a mental hospital in 1960s South Africa, but the example of Stikland also showcases new plans for research and training in mental health professions in the 1960s and 1970s. Disciplines such as clinical psychology benefited from the professional training opportunities provided. Overall, Stikland Mental Hospital therefore provides an important perspective on deinstitutionalization outside its familiar settings and historical accounts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

« Imaginaire et sensibilités ¼ : la mise en récit de la déshospitalisation psychiatrique en Ontario.

This paper proposes a historiographical discussion based on the article « Les contrecoups de la déshospitalisation psychiatrique. L'exemple du parcours transinstitutionel de Françoise ¼. Françoise's transinstitutional journey presented in the collective publication La fin de l'asile ? Histoire de la déshospitalisation psychiatrique dans l'espace francophone au XXe siècle, gives me the opportunity to reveal the subtext of this article, and to describe the method and the historical reasoning that gave life to the psychiatric journey of an anonymous person named Françoise. This process is organized around three main points: my positioning as a researcher, the issues related to my narrative approach, and a statement on my historical reasoning in an interdisciplinary perspective. Influenced and inspired by the work of Alain Corbin, George Duby, Roy Porter, Natalie Zemon Davis and Arlette Farge, my approach focusses on the feelings and emotions hidden in historical sources. I remain connected to a subjective intuition, and stay away from positivist reflexes. Based on my research experience with psychiatric records, my conclusion explores the renewal of historical writing , in which I suggest that it is possible to write the history of ordinary people while telling stories with sensitivity.

Ce texte propose une réflexion historiographique basée sur l'article « Les contrecoups de la déshospitalisation psychiatrique. L'exemple du parcours transinstitutionel de Françoise ¼ tiré du récent ouvrage collectif La fin de l'asile ? Histoire de la déshospitalisation psychiatrique dans l'espace francophone au XXe siècle. L'auteure revient sur cet article, afin de mettre au jour le sous-texte et de raconter la méthode ainsi que le raisonnement historique qui ont donné vie au parcours psychiatrique d'une anonyme nommée Françoise. Cet exercice s'articule autour de trois points d'ancrage : son positionnement en tant que chercheure, les enjeux concernant l'approche narrative qu'elle explore et un constat sur le raisonnement historique intriqué dans une perspective interdisciplinaire. Influencée et inspirée des travaux d'Alain Corbin, George Duby, Roy Porter, Natalie Zemon Davis et Arlette Farge, l'historienne insiste sur sa démarche inéluctablement tournée vers une approche soucieuse de repérer dans les sources des traces de sentiments et d'émotions tout en étant connectée à une intuition subjective, loin des réflexes positivistes. En guise de conclusion, en lien avec son expérience dans les sources avec lesquelles elle travaille le plus ­ les dossiers psychiatriques ­, une réflexion sur le renouvellement de l'écriture historienne et sa conviction qu'il est possible d'écrire l'histoire des gens ordinaires tout en les racontant avec sensibilité.

Evolution of forensic psychiatry in Italy over the past 40 years (1978-2018).

In Italy, following the closure of psychiatric hospitals in 1978 and the release of psychiatric patients into community care, there was a mismatch between common psychiatric patients and the convicted mentally ill who were sentenced to serve in state forensic psychiatric hospitals. The recent closure of such structures following the Prime Minister's Decree of April 1, 2008, fostered the need to create new structures. These are called "REMS," and they are based in the community and led by psychiatrists and healthcare staff who may rely on the collaboration of public security staff. This act completed a course of progressive deinstitutionalization of all psychiatric patients. However, some problems remain, and persons regarded as "partially mentally disabled" at the time of crime perpetration must serve part of their sentence in prison and the rest in the aforementioned structures or in psychiatric rehabilitation communities, depending on their claimed "social dangerousness." Psychiatric services now face the ambiguity of treating persons who are considered dangerous by court orders, while the civil law criteria for involuntary hospitalization is based only on the need of care. The complete closure of forensic hospitals may be considered a decisive step forward in the humanization of society, but there are still some issues to address to make it work better. The implementation of multidisciplinary teams and effective psychotherapy, psychoeducational, and rehabilitation interventions can help.

[Psychiatric nurses experiences of the humanization movement during the first and second waves of deinstitutionalization in Quebec (1960-1990)]. / Les infirmières psychiatriques témoins d'un mouvement d'humanisation au cours des premières et deuxièmes vagues de la désinstitutionnalisation au Québec (1960-1990).

Introduction : This study examines the humanization movement at the Saint-Jean-de-Dieu psychiatric hospital between the 1960s and the 1990s.Context : Conducting a historiography of psychiatric deinstitutionalization in Quebec during the twentieth century shows that the institution was a place of social control and, above all else, a place where psychiatric patients were neglected and dehumanized.Objective : While the historiography since the 1960s has focused on a largely one-dimensional and critical reading of the way in which deinstitutionalization took place in Quebec, I have instead chosen to focus on the changes that took place within the Quebec hospital's walls.Method : In addition to the medical records of the patients who were interned in 1961, I conducted interviews to examine the experiences and emotions of nurses who worked in the psychiatric hospital between the 1960s and 1990s.Results : The examination of medical records revealed patients' reluctance and resistance to reintegrate into society. The interviews with nurses revealed that they often felt close to their patients.Discussion : The words and memories of nurses enrich and deepen the complexity of the history of psychiatric nursing practices, extend the existing historiography, and open new avenues for research in the field.Conclusion : The deinstitutionalization movement promoted mental health policies that transformed the old psychiatric hospital. This new analytical approach contributed to renewing the history of psychiatric nursing practices.

The Final Years of Central State Hospital.

There is a rich literature on the deinstitutionalization movement in the US but few, if any, parallel histories of state mental hospitals. Under attack from the 1950s on, state hospitals dwindled in size and importance. Yet, their budgets remained large. This paper offers a case study of one such facility, Indiana's Central State Hospital, between 1968 and 1994. During these years, local newspapers published multiple stories of patient abuse and neglect. Internal hospital materials also acknowledged problems but offered few solutions. In 1984, the US Department of Justice intervened, charging Central State with having violated patients' civil rights, the first such action filed under the 1980 Civil Rights of Institutionalized Persons Act. Although Indiana signed a consent decree promising major reform, long-lasting change proved elusive. Civil and criminal lawsuits proliferated. In 1992, as Central State continued to attract negative attention, Indiana Governor Evan Bayh ordered the troubled hospital closed. His decision promised to save the state millions of dollars and won plaudits from many, but not all, mental health advocates. Even as the last patients left in 1994, some families continued to challenge the wisdom of eliminating Indiana's only large urban mental hospital, but to no effect.

Management of psychiatric patients before deinstitutionalization: an inquiry into the years 1907-1913 in Pisa

Aim: Asylums comprises the main focus of historical research on early 20th century psychiatry. To assess the characteristic of asylum transfers in a clinical population, we analyzed newly found clinical records from University of Pisa Clinic for Mental and Nervous Illness. We focused on the early years of this structure's activities considering all admissions from 24th April 1907 to 31st January 1913. Methods: We collected demographic and clinical data from 1,068 patients performing Chi-Square Tests to study correlation between asylum transfer and diagnosis and gender difference; independent sample Student's t-tests were also performed to compare mean Age, mean number of Days of Hospitalization and mean number of Subsequent Admissions to the Clinic observed in patients transferred to an asylum versus those who had been discharged. Multiple logistic regression model was employed to identify the best predictors of asylum transfers. Results: Most patient were discharged, and only a third of the hospitalization led to asylum confinement. Our data outlines a peculiar discharge rationale, suggesting that the Clinic acted like a "sieve-institution" to prevent asylum overcrowding from treatable, non-chronic conditions. Discussion: These data suggest that our historical view of psychiatric care is probably not complete, and that a different approach to source materials could provide new research paradigms.

Internados en casa: del manicomio a la «institución doméstica total» / Caged at home: from the asylum to the «total domestic institution»

A partir de una etnografía realizada en Barcelona y Tarragona entre 2013 y 2014 se problematizan las interacciones y relaciones de personas diagnosticadas con trastorno mental grave y sus familiares en el espacio doméstico. A través de una comparación de las dinámicas y lógicas del hospital mental extraídas de las etnografías del custodialismo y las del espacio doméstico, se pone de relieve la proyección y reproducción de dinámicas manicomiales en el ámbito familiar. Desde una lectura cultural del espacio doméstico, los ejemplos etnográficos sirven para argumentar que el modelo de externalización actual perpetúa la cronificación y la hospitalización doméstica de los pacientes (AU)

Based on an ethnography carried out in Barcelona and Tarragona between 2013 and 2014, this article problematizes the interactions and relationships of people diagnosed with severe mental disorder and their relatives at home. Through a comparison of the dynamics and logics of the mental hospital as described in classic ethnographies of mental asylums and those of domestic spaces, the projection and reproduction of asylum features at home are highlighted. From a cultural perspective of the domestic space, these ethnographic examples suggest that the current externalized model of psychiatric care causes domestic hospitalization and tends to perpetuate the patient’s chronification (AU)

'Heading up a blind alley'? Scottish psychiatric hospitals in the era of deinstitutionalization.

This article examines Scottish provision of psychiatric care in the 1960s and 1970s. It demonstrates that institutional services did not rapidly disappear across the UK following the Ministry of Health's decision to shut down psychiatric hospitals in 1961, and highlights Scotland's distinctive trajectory. Furthermore, it contends that psychiatric hospitals developed new approaches to assist patients in this era, thereby contributing towards the transformation of post-war psychiatric practice. Connecting a discussion of policy with an analysis of provision, it examines the Department of Health for Scotland's cautious response to the Ministry's embrace of deinstitutionalization, before analysing Glasgow's psychiatric provision in the 1970s. At this point the city boasted virtually no community-based services, and relied heavily on its under-resourced and overburdened hospitals. Closer analysis dispels any impression of stagnation, revealing how ideologies of deinstitutionalization transformed institutional care.

Children come first? A brief history of children's mental health services.

This article provides a brief history on the evolution of child mental health services. From 1961 when modern day mental health programming began with the Joint Commission on Mental Health and Illness to key developments in children's mental health services and prevention in modern day.

["Should the staff's attitude towards the patients remain unchanged, I will not guarantee anything." Protest masculinity and coping of "rebellious patients" at the Heidelberg University Psychiatric Hospital on the eve of deinstitutionalization]. / "Sollte sich die Einstellung des Personals gegenüber den Patienten nicht ändern, garantiere ich für nichts mehr!" Protestmännlichkeit und KrankheitsbewäItigung von "aufsässigen Patienten" der Psychiatrischen Universitätskinik Heidelberg am Vorabend der Psychiatriereform.

This article analyses the illness experiences of male patients from the Heidelberg University Psychiatric Hospital during the protests against Psychiatry in the year 1973. Protest is one of the most important expressions of masculinity in socially disadvantaged men, such as men with mental disorders. The analysis of 100 medical records shows that some patients tried to construct themselves as men in a way that was explicitly motivated by antipsychiatric ideas: They questioned psychiatric authority, behaved "sexually inappropriate", or used drugs. On the eve of psychiatric reform in West Germany those patients were well aware that the alternative--complying with the treatment--would put them at considerable risk. In addition to the usual inference of hegemonic or normative masculinities as risk-factors, the behavior of those ,,rebellious patients" has to be interpreted as individual coping strategies.

[Beyond the asylum -An other view on the history of psychiatry in the modern age]. / "Ausserhalb der Mauern" - Für eine neue Geschichte der Irrenanstalten in der Moderne.

If one thinks medicine, madness and the past, one image immediately pops into mind: that of the mental asylum. Following the famous work by Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason, many historians have thus considered that the medicalization of insanity in the modern age had mostly led to a "great confinement" and a greater segregation of all individuals deemed mentally unfit during the "asylum era': However, new research demonstrates that this classic narrative of the psychiatric past needs to be revised. It discloses that, ever since the 191h century, a whole other medical culture existed as a challenge to asylums, a culture that advocated the integration of the mad and fought to disassociate psychiatry from the dominant model of confinement all throughout the occidental world. This article aims at presenting the results of these historical works that depict another aspect of the psychiatric history, exploring "boarding out" practices, instead of asylum ones.

Creating a science of homelessness during the Reagan era.

UNLABELLED: POLICY POINTS: A retrospective analysis of federally funded homeless research in the 1980s serves as a case study of how politics can influence social and behavioral science research agendas today in the United States. These studies of homeless populations, the first funded by the National Institute of Mental Health, demonstrated that only about a third of the homeless population was mentally ill and that a diverse group of people experienced homelessness. This groundbreaking research program set the mold for a generation of research and policy characterizing homelessness as primarily an individual-level problem rather than a problem with the social safety net. CONTEXT: A decade after the nation's Skid Rows were razed, homelessness reemerged in the early 1980s as a health policy issue in the United States. While activists advocated for government-funded programs to address homelessness, officials of the Reagan administration questioned the need for a federal response to the problem. In this climate, the National Institute of Mental Health (NIMH) launched a seminal program to investigate mental illness and substance abuse among homeless individuals. This program serves as a key case study of the social and behavioral sciences' role in the policy response to homelessness and how politics has shaped the federal research agenda. METHODS: Drawing on interviews with former government officials, researchers, social activists, and others, along with archival material, news reports, scientific literature, and government publications, this article examines the emergence and impact of social and behavioral science research on homelessness. FINDINGS: Research sponsored by the NIMH and other federal research bodies during the 1980s produced a rough picture of mental illness and substance abuse prevalence among the US homeless population, and private foundations supported projects that looked at this group's health care needs. The Reagan administration's opposition to funding "social research," together with the lack of private-sector support for such research, meant that few studies examined the relationship between homelessness and structural factors such as housing, employment, and social services. CONCLUSIONS: The NIMH's homelessness research program led to improved understanding of substance abuse and mental illness in homeless populations. Its primary research focus on behavioral disorders nevertheless unwittingly reinforced the erroneous notion that homelessness was rooted solely in individual pathology. These distortions, shaped by the Reagan administration's policies and reflecting social and behavioral scientists' long-standing tendencies to emphasize individual and cultural rather than structural aspects of poverty, fragmented homelessness research and policy in enduring ways.

Deinstitutionalization and the rise of violence.

The deinstitutionalization of individuals with serious mental illness was driven by 4 factors: public revelations regarding the state of public mental hospitals, the introduction of antipsychotic medications, the introduction of federal programs to fund patients who had been discharged, and civil libertarian lawyers. The result is approximately 3.2 million individuals with untreated serious mental illness living in the community. Beginning in the 1970s in the United States, there began to be reported increasing incidents of violent behavior, including homicides, committed by these untreated individuals. Such incidents became more numerous in the 1980s and 1990s, and have further increased since the turn of the century. Existing studies suggest that individuals with untreated severe mental illness are responsible for at least 10% of all homicides and approximately half of all mass killings. Studies have also shown that when these individuals are treated, the incidence of violent behavior decreases significantly. Examples of treatment mechanisms that have proven effective include assisted outpatient treatment (AOT), conditional release, and mental health courts.

[Franco Basaglia: a conveyor of contradictions]. / Franco Basaglia: un passeur de contradictions.

The thinking of Franco Basaglia helps to improve understanding of the complexity of the relationships between theory and practice. Medicine must be thought out on the basis of the political organisation where it is situated and the psychiatric institution reflects an organisation founded on exclusion. It is essential to re-establish a place for an individual's difference in psychiatric practice. The challenge is to enable the patient to emerge as a subject.