Deinstitutionalization is an ongoing process, as many jurisdictions continue to struggle with redesigning their psychiatric systems. Historically, reducing psychiatric beds and closing hospitals have resulted in deleterious outcomes for people with severe and persistent mental illness. More recent evidence suggests that careful implementation of deinstitutionalization policies can thwart potential adverse consequences and may even foster favorable outcomes. This study evaluated the extent to which the recent devolution of the only tertiary psychiatric hospital in British Columbia resulted in a direct shift of individuals to other institutional sectors, such as criminal justice and health sectors.
Admission rates to general hospitals, continuing care facilities, correctional institutions, and forensic psychiatric facilities were compared among two patient groups: those discharged before the realignment of the tertiary psychiatric hospital system (prerealignment cohort) (N=164) and those discharged after initiation of the system reforms (postrealignment cohort) (N=171).
Most of the patients in the postrealignment cohort have remained in the tertiary care settings to which they were originally discharged. For patients in the postrealignment cohort, contact with other institutional sectors was rare and shorter in duration than it was for patients in the prerealignment cohort.
This study provides preliminary evidence that recent efforts to realign British Columbia's provincial tertiary psychiatric hospital system have not resulted in a significant shift of the relocated patients to institutions in other sectors.
[Show abstract][Hide abstract] ABSTRACT: The objective of this study is to assess the clinical and social outcomes for a cohort of patients who were part of the redevelopment of psychiatric services in British Columbia.
This study used a naturalistic, quasi-experimental design, to examine the outcomes of a cohort of 189 long-stay patients at Riverview Hospital (RVH), some of whom moved into Tertiary Psychiatric Residential Facilities (TPRFs), some into the community in less structured facilities, and some remained at RVH. Data was collected from clinical files at RVH and at each participating site, semi-structured interviews and self-report measures were completed with patients. In addition, semi-structured interviews were also conducted with staff members.
There was very minimal evidence of transinstitutionalization to prisons or homelessness; one participant resided in a correctional facility, one resided in a forensic facility, and one participant spent some time homeless. In addition, the majority of participants remained in residences that provided 24h care. Eighty percent of our population was diagnosed with a schizophrenia spectrum disorder. Psychiatric symptoms remained fairly stable; some embarrassing social behaviors increased; however, aggressive behaviors showed no increase; neuropsychological deficits did not deteriorate, there were even some improvements. Participants demonstrated increases in several independent living skills including: money management, food preparation and storage, job skills, and transportation skills. In addition, participants experienced a significant increase in their perceived quality of life.
This study builds on existing research demonstrating that well-planned and appropriately resourced hospital closures can lead to positive psycho-social outcomes for participants and can successfully avoid negative outcomes such as transinstitutionalization to the judiciary system and homelessness.
Schizophrenia Research 06/2013; 149(1-3). DOI:10.1016/j.schres.2013.05.022 · 3.92 Impact Factor
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