Search results

1 – 10 of 41
Per page
102050
Citations:
Loading...
Access Restricted. View access options
Book part
Publication date: 4 July 2016

Russell K. Schutt

Reexamination and reinterpretation of the process of deinstitutionalization of public mental hospital inpatients.

Abstract

Purpose

Reexamination and reinterpretation of the process of deinstitutionalization of public mental hospital inpatients.

Methodology/approach

A comprehensive review of related research is presented and lessons learned for the sociology of mental health are identified.

Findings

The processes of both institutionalization and deinstitutionalization were motivated by belief in the influence of the social environment on the course of mental illness, but while in the early 19th century the social environment of the mental hospital was seen as therapeutic, later in the 20th century the now primarily custodial social environment of large state mental hospitals was seen as iatrogenic. Nonetheless, research in both periods indicated the benefit of socially supportive environments in the hospital, while research on programs for deinstitutionalized patients and for homeless persons indicated the value of comparable features in community programs.

Research limitations/implications

While the process of deinstitutionalization is largely concluded, research should focus on identifying features of the social environment that can maximize rehabilitation.

Practical implications

The debate over the merits of hospital-based and community-based mental health services is misplaced; policies should instead focus on the alternatives for providing socially supportive environments. Deinstitutionalization in the absence of socially supportive programs has been associated with increased rates of homelessness and incarceration among those most chronically ill.

Originality/value

A comprehensive analysis of deinstitutionalization that highlights flaws in prior sociological perspectives and charts a new direction for scholarship.

Details

50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities
Type: Book
ISBN: 978-1-78560-403-4

Keywords

Abstract

Details

The Organizational Response to Social Problems
Type: Book
ISBN: 978-0-76230-716-6

Access Restricted. View access options
Book part
Publication date: 18 May 2001

Russell K. Schutt

Case management is a technology for enhancing the continuity of care provided to clients in a community-based mental health service system. From among diverse case management…

Abstract

Case management is a technology for enhancing the continuity of care provided to clients in a community-based mental health service system. From among diverse case management models, the Massachusetts Department of Mental Health adopted the service broker model for statewide implementation and identified changes in the structure of inter-occupational and interorganizational relations in the agency that would be needed to accommodate this technology. This chapter analyzes the process of implementing this technology, based on interviews with administrators of mental health service areas during the implementation period. Potential obstacles to the implementation of a new technology are discussed and the resulting variation in adherence to the selected case management model is described. Sources of conflict about the case management model and effective responses to this conflict are identified. Conflict over the new model was strongest in areas where clinicians were most powerful and where boundaries around hospitals were strongest; such conflict was often resolved by subordinating case managers to clinicians and thus reversing the intended hierarchical structure. Implementation was facilitated by bridging strategies that facilitated cooperation among case managers and clinicians.

Details

The Organizational Response to Social Problems
Type: Book
ISBN: 978-0-76230-716-6

Available. Content available
Book part
Publication date: 18 May 2001

Abstract

Details

The Organizational Response to Social Problems
Type: Book
ISBN: 978-0-76230-716-6

Available. Content available
Book part
Publication date: 18 May 2001

Abstract

Details

The Organizational Response to Social Problems
Type: Book
ISBN: 978-0-76230-716-6

Access Restricted. View access options
Book part
Publication date: 18 May 2001

Mary L. Fennell, Susan M. Allen and Linda Laliberte

Community-based service providers (such as home health agencies, rehabilitation and mental health services) have found it necessary to cope with extremely uncertain and turbulent…

Abstract

Community-based service providers (such as home health agencies, rehabilitation and mental health services) have found it necessary to cope with extremely uncertain and turbulent environments due to a changing regulatory environment and restructuring of the acute health care system. This paper discusses three types of survival strategies adopted by community-care service providers in a medium-sized city in the Northeast. These agencies provide long-term social and health services to the disabled and frail elderly with chronic care needs. The implications of each strategy for service provision to people with chronic care needs are discussed.

Details

The Organizational Response to Social Problems
Type: Book
ISBN: 978-0-76230-716-6

Access Restricted. View access options
Book part
Publication date: 31 January 2000

Russell K. Schutt and Stephen M. Goldfinger

Prior research indicates that homeless consumers of mental health services have a marked preference for independent living, while clinicians tend to recommend staffed, group…

Abstract

Prior research indicates that homeless consumers of mental health services have a marked preference for independent living, while clinicians tend to recommend staffed, group housing. In order to understand this divergence and identify its consequences for mental health policy, we test influences on housing preferences suggested by rational choice and social structural perspectives. We use a randomized field trial of independent and group housing to identify the consequences for subsequent housing loss and consumer functioning of consumer- and clinician-determined housing placements. We find that consumer preference at baseline for independent living indicates greater vulnerability to housing loss, but the bases of preferences change after consumers gained experience with stable housing. We interpret the results as indicating the contingent rationality of preferences and the susceptibility of preferences to change with experience.

Details

Research in Community and Mental Health
Type: Book
ISBN: 978-1-84950-058-6

Access Restricted. View access options
Book part
Publication date: 18 May 2001

Benjamin P. Bowser, K. Deborah Whittle and David Rosenbloom

In 1989 the Robert Wood Johnson (RWJ) Foundation began a $24.6 million program community-based alcohol and drug abuse elimination project, called “Fighting Back.” Along with the…

Abstract

In 1989 the Robert Wood Johnson (RWJ) Foundation began a $24.6 million program community-based alcohol and drug abuse elimination project, called “Fighting Back.” Along with the U.S. Dept HHS, Community Substance Abuse Program (CSAP), the Fighting Back projects were alternative approaches to the Police War on Drugs. The 15 RWJ communities were given up to $200,000 for two-year planning grants to develop community-based organizations that would focus on better coordinating existing resources and attracting new resources to address high-density alcohol sales, drug trafficking, and drug abuse in low-income middle size communities. In the first year implementation phase, each project was given up to $700,000. None were to provide direct services; each organization was a catalyst for social change.The initial theories used to begin this project were community empowerment and resource mobilization. Based upon site visits and in-depth interviews, this chapter reviews the lessons learned from organizing such projects based upon these theories. We review the strategies used to successfully address their central challenges and these theory's utility. The RWJ and CSAP projects suggested a variation of community empowerment where consensus among keys players in and outside of each community was a precondition to community mobilization. Also community empowerment and resource mobilization were not sufficient. Through trial and error, each project learned important new lessons and strategies that were already available in other theories — collaboration, exchange, and general theory of race relations. It is suggested that use of additional theories based on prior experiences in successfully mobilizing the community could have further improved the successes of the RWJ and CSAP projects.

Details

The Organizational Response to Social Problems
Type: Book
ISBN: 978-0-76230-716-6

Access Restricted. View access options
Book part
Publication date: 18 May 2001

Robert J. Chaskin

Over the past decade or so, there has been a significant renewed emphasis on community-based approaches to promoting social change and economic development, delivering services…

Abstract

Over the past decade or so, there has been a significant renewed emphasis on community-based approaches to promoting social change and economic development, delivering services, and addressing the needs of people in poverty. One way in which such efforts strategically address this goal is by focusing on the organizational infrastructure of a community, seeking to change the ways that individual community-serving organizations relate to one another and to organizations and actors beyond the community. This paper focuses on one approach to this task: the establishment of broker organizations — local intermediaries responsible for fostering and convening partnerships and networks of relations among existing organizations. It briefly outlines the impetus and rationale for engaging in interorganizational relationships in this context, defines and explores the role of broker organizations as they have played out in a few illustrative cases, and distills some of the central issues that emerge regarding their promise and limitations.

Details

The Organizational Response to Social Problems
Type: Book
ISBN: 978-0-76230-716-6

Access Restricted. View access options
Book part
Publication date: 18 May 2001

Larry Davidson, Connie M. Nickou, Peter Lynch, Silvia Moscariello, Rajita Sinha, Jeanne Steiner, Selby Jacobs and Michael A. Hoge

Serious and persistent mental illness has posed a significant social problem for a majority of cultures across most historical periods. Most recently in the United States, the…

Abstract

Serious and persistent mental illness has posed a significant social problem for a majority of cultures across most historical periods. Most recently in the United States, the aftermath of the deinstitutionalization policies of the 1950–1970s has resulted in many individuals who in the past might have spent the majority of their adult lives living in hospitals roaming city streets homeless, impoverished, and vulnerable to victimization or to being arrested for minor offenses. This paper reviews the changes both in the population of individuals with serious mental illness and in the systems that care for them over the last 25 years, and suggests that a “Tower of Babel” scenario has resulted inadvertently from the shift from hospital to community care. Following the dissolution of the monolithic hospitals (i.e. Towers of Babel), mental health providers have been dispersed among a myriad of community agencies, each with its own vision and standards of community care. Without a shared map to guide their work, community systems have become characterized by disarray, paralysis, and a lack of integration and coordination of care for a population of individuals who typically require more than one service from more than one provider at any given time. To address these issues, we offer a core set of “principles of care” developed by one local service system in an attempt to (re-)constitute a common map for their shared territory. We closed with a discussion of the issues that remain unresolved despite this collaborative process, and with suggestions for future directions to explore.

Details

The Organizational Response to Social Problems
Type: Book
ISBN: 978-0-76230-716-6

1 – 10 of 41
Per page
102050