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.

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.

There is a Road, No Simple Highway: Musings on Rural Community Practice.

The article was delivered as an invited address to the 2019 SCRA Biennial. The author, the 2019 recipient of the Award for Distinguished Contributions to Practice in Community Psychology, discusses the application of community psychology practice competencies to rural mental health practice and reviews the challenges faced by rural and remote residents, and the rural idyllic myth. The author shares musings and observations of key lessons learned from mentors and practice across over three decades.

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.

Views from an asylum: a retrospective case note analysis of a nineteenth century asylum.

PURPOSE: To investigate whether lifelong admission to psychiatric asylum care was usual practice before community psychiatric care was introduced. METHODS: Historical archives (1838-1938) for 50 patients at the Northampton General Lunatic Asylum in England were studied. Regression analyses were performed to investigate associations between predictor variables (age, gender, marital status, social class) and outcomes (diagnoses, length of stay and admission outcomes). RESULTS: 30 patients (70%) were discharged into the community. 15 (31%) patients were admitted longer than 1 year. Diagnosis of mania was significantly higher in patients who were married. Trend associations were observed for melancholia being diagnosed in higher social class patients and monomania being diagnosed in unmarried patients. No associations were found between predictor variables and length of stay or admission outcomes. CONCLUSIONS: These findings challenge the myth that asylum incarceration was a usual practice before the advent of community care. Most patients were discharged from psychiatric asylum hospital within a year of admission even before the advent of psychotropic medication.

Award for Distinguished Professional Contributions to Independent Practice: Sam J. Tsemberis.

The Award for Distinguished Professional Contributions to Independent Practice is intended to recognize outstanding independent practitioners in psychology. The award is given to a psychologist working in an area of clinical specialization, health services provision, or consulting, and services provided to any patient population or professional clientele in an independent setting. The 2016 recipient is Sam J. Tsemberis, who "has applied the best of psychological practice and science to address the complex social, health, and economic factors involved in chronic homelessness among persons diagnosed with mental illness and addictions." Tsemberis's award citation, biography, and bibliography are presented here. (PsycINFO Database Record

Psychiatry 50 years ago.

The 1960s was a period of reform and innovation in the provision of care for people with mental health problems. The most important development was the move away from residential institutions and the development of community services based on district general hospitals.

Trauma and the state with Sigmund Freud as witness.

Just before and after the end of World War I, Sigmund Freud took on an activist role and in his writings and speeches, redirected the concept of war trauma from individual failure to a larger issue of community responsibility. Testifying in Vienna as an expert witness for the state, Freud said that the military psychiatrists-not the soldiers-had "acted like machine guns behind the front" and were the "immediate cause of all war neurosis." Freud was called on by the legal community when Julius Wagner-Jauregg, a future Nobel Prize winner (and also future Nazi Party adherent), head of the municipal Clinic for Psychiatry and Nervous Diseases, was accused of the lethal use of electrotherapy on shell-shocked soldiers. As sociological as psychoanalytic in his responses, Freud's withering critique came just 2years after he avowed that "it is possible to foresee that the conscience of society will awake." That speech on the human right to mental health care affirmed Freud's alliance to the social democratic position and inspired the second generation of psychoanalysts to develop community-based clinics throughout Europe where treatment was free of cost, for war neurosis and beyond.

[Art, mental health, and public healthcare: profile of a care culture in the history of São Paulo city]. / Arte, saúde mental e atenção pública: traços de uma cultura de cuidado na história da cidade de São Paulo.

By studying the inclusion of artistic and cultural activities in the care provided throughout the history of public mental healthcare in greater São Paulo, Brazil, we can better understand and characterize the practices adopted in the Psychosocial Care Centers in the city today. Experiments carried out between the 1920s and 1990s are investigated, based on bibliographic research. The contemporary data were obtained from research undertaken at 126 workshops at 21 Psychosocial Care Centers in the same city between April 2007 and April 2008. The findings indicate that the current trend in mental healthcare, whose clinical perspective spans the realms of art and mental health and has territorial ramifications, has maintained some of the features encountered in earlier mental healthcare experiments.

[THE ORGANIZATION OF PSYCHIATRIC CARE IN ZEMSTVO MEDICINE (TO 150th ANNIVERSARY OF THE ZEMSTVO REFORM)].

In Russia, the organization of curative institutions for insane persons was initiated by prikaz (department) of public charity in the end of XVIII century. After the zemstvo self-government was introduced in 1864, curative institutions were assigned to zemstvo organizations. Since that time, psychiatric departments of zemstvo gubernia hospitals began to be selected as independent institutions headed by psychiatrists. The number of psychiatric beds augmented. Such methods as non-constraint of insane patients and occupational therapy received wide propagation in zemstvo psychiatric hospitals. In 1884, the first suburban colony for charity of chronically insane persons was organized in the Tverskaia gubernia. Up to beginning of XX century zemstvo psychiatric care transformed into independent specialized type of medical care provided in hospitals and in out-patient conditions (rural patronage).

Griffith Edwards, the Addiction Research Unit and research on the criminal justice system.

BACKGROUND: This paper reviews the early work of Griffith Edwards and his colleagues on alcohol in the criminal justice system and outlines the direction of research in this area in the Addiction Research Unit in the 1960s and 1970s. The paper outlines the link between that work and work undertaken in the more recent past in this area. METHODS: The key papers of the authors are reviewed and the impact of this work on policy and practice is discussed. CONCLUSIONS: There is a rich seam of work on deprived and incarcerated populations that has been under way at the Addiction Research Unit and subsequently the National Addiction Centre, Institute of Psychiatry, London. Griffith Edwards initiated this work that explores the risks and problems experienced by people moving between the health and criminal justice system, and demonstrated the need for better care and continuity across this system.

Mental health system historians: adults with schizophrenia describe changes in community mental health care over time.

This qualitative study examined changes in community mental health care as described by adults diagnosed with schizophrenia with long-term involvement in the mental health system to situate their experiences within the context of mental health reform movements in the United States. A sample of 14 adults with schizophrenia who had been consumers of mental health services from 12 to 40 years completed interviews about their hospital and outpatient experiences over time and factors that contributed most to their mental health. Overall, adults noted gradual changes in mental health care over time that included higher quality of care, more humane treatment, increased partnership with providers, shorter hospital stays, and better conditions in inpatient settings. Regardless of the mental health reform era in which they were hospitalized, participants described negative hospitalization experiences resulting in considerable personal distress, powerlessness, and trauma. Adults with less than 27 years involvement in the system reported relationships with friends and family as most important to their mental health, while adults with more than 27 years involvement reported mental health services and relationships with professionals as the most important factors in their mental health. The sample did not differ in self-reported use of services during their initial and most recent hospitalization experiences, but differences were found in participants' reported use of outpatient services over time. Findings underscore the importance of the lived experience of adults with schizophrenia in grounding current discourse on mental health care reform.

[A hundred years of child psychiatry and changes in the governance of the youth mental health services in the Netherlands- back to the future]. / Honderd jaar kinderpsychiatrie en overheid - back to the future.

BACKGROUND: Dutch child- and adolescent psychiatry (cap) is going through a complex phase now that the Youth Law has decreed that cap is to be placed under control of the municipality (i.e. local government) instead of the national government. AIM: To explain and discuss this development from a historical perspective. METHOD: Information was obtained from historical sources. RESULTS: The municipality, i.e. local government, has played an important role in parts of youth mental health since the beginning of the 20th century. In the 1980s, however, governance was transferred to the national government, only to be passed back to the municipality in the early years of the 21st century. CONCLUSION: The level of governance, be it local or national, can bring both advantages and disadvantages to the youth mental health services. Up till now there have been several transfers from one level of governance to the other. It would be better if the two levels of governance were combined and the various parts controlled by a combination of the most appropriate types of governance.

Community mental health nursing in Alberta, Canada: an oral history.

Community mental health nurses had a central role in the construction of new rehabilitative practices and community mental health services in the 1960s and 1970s. The purpose of this article is, first, to explore how nurses understood and created their new role and identity in the turbulent context of deinstitutionalization. The development of after care services for patients discharged from Alberta Hospital in Ponoka (AH-Ponoka), a large mental institution in Calgary, in the Canadian province of Alberta, will be used as a case study. I specifically focus on the establishment of outpatient services in a new psychiatric department at Foothills General Hospital in Calgary. Second, I examine how deinstitutionalization itself shaped community mental health nurses' work. Oral history interviews with nurses and other mental health professionals, who had a central role in this transformation process, provide a unique lens through which to explore this social change. The article concludes that new rehabilitative, community-based mental health services can better be understood as a transformation of former institutional practices rather than as a definite break with them.