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7 Cards in this Set
- Front
- Back
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Evolution of Mental health care
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1900-1970: Pre-deinstitutionalization: Jail or Provincial Hospital
1970-1990: Post-Deinstitutionalization: Plus outpatient clinic, inpatient unit, ER, Alcohol Program (seperate), Child MH clinic (seperate) Today: All over the map Complex, numerous care providers Difficulty in figuring out where to enter the system and how to maneuver through it Lack of continuity of care |
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Deinstitionalization idea and philosophy
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Shift away from dependence on mental hospitals
Transinstitutionalization – increase in number of mental health beds in GHs Growth of community based outpatient services for people with mental illnesses Philosophy: – Normalization – Integration – Active treatment in the community (versus warehousing in hospitals) "Hospital without walls" (services in community, seamlessly, good access) |
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Deinstitutionalization as policy
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- Shifting resources away from large mental hospitals (bed closures & divestments)
– Increase services in acute care hospitals (rise of general hospital psychiatric units) – Improve links to primary care (shared care models) – Provide specialized community services to provide hospitals without walls for the most seriously ill (eg: Assertive Community Treatment Teams) – Reinvest savings from hospital sector to community – Better clinical and social outcomes for people with a mental illness |
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Deinstitutionalization in reality/as implemented
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Fractured, multiple entry points
Leadership void Beds in psychiatric hospitals reduced Rise of general hospital psychiatric units Community reinvestments not made Funding for system reduced over time Community services fragmented Links with primary care problematic Lack of system evaluation and monitoring |
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Deinstitutionalization outcomes
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Poor and inequitable access to hospital resources
Prevention and promotion sidelined in favour of emergency care High medical co-morbidities Lack of coordination of services across sectors No continuity of care for patients or families Homelessness and criminalization (transinstitutionalization) Recasting of need for treatment in terms of danger to self or others Reinforced worst stereotypes of the mentally ill (b/c now only the worst get the beds) |
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Mental health and global village
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Limited data - gaps and inconsistencies
Global progress in reducing the burden associated with mental illness has been slow Country-specific information on mental health systems problematic Unequal distribution of resources across and within countries The majority of the world’s population lives in countries where mental health resources are deficient |
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Domains to targeet in low and middle income countries
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Legislative & policy framework - need to protect (ie those you put in jail, rights);
Community mental health services Primary health care- most MH falls here in countries that don't have other MH resources (WHO recommends) - still need inpatient mental health beds Human resources & funding - big issue, where $ from and who gets? V. little financial resources to MH; create a budget, Public education - level of knowledge about and what to do about illness is v poor in some countries Links with other sectors Monitoring and research - poor pretty much everywhere |
