2. KEY WORD
• Institutionalization :- the state of being placed
or kept in a residential institution.
• Deinstitutionalization :- the release of
institutionalized individual from institutional
care to care in the community.
3. HISTORY :-
• Before World War II, effective medications
were largely unavailable, and the mentally ill
were separated from the community and
housed in institutions for the protection of
patients as well as society.
• Nursing care for these patients was primarily
custodial. The institutions provide structure,
social contest, food, clothing and medical
services to mentally ill patients.
4. • By 1900 the state hospitals were overcrowded and
understaffed. The construction of new hospitals had
not kept pace with the growing population. Conditions
in state hospitals deteriorated. Institutionalization
caused passive depend dent behavior among
psychiatric inpatients and resistance to discharge.
• More recently scientific advances have led to the use
of effective medications and somatic therapies to treat
symptoms of psychiatric illness. It became costly to run
these large buildings and continue to employ staff .
• The combination of these effects. as well as new laws
pertaining to the care of the mentally ill, resulted in a
movement called deinstitutionalization .
5. DEINSTITUTIONALIZATION :-
Deinstitutionalization was both a historical fact
and a set of legal mandates governing the
treatment of mentally ill persons In
deinstitutionalization policy, people who
formerly required long hospital stays become
able to leave the institutions and return to
their communities and homes.
6. PHILOSOPHY :-
The philosophy of deinstitutionalization,
changing health care economics and advances
in the treatment of mental illness, especially
psychopharmacology developments,
significantly influenced the transformation of
state mental hospitals.
7. Positive effects of deinstitutionalization :-
• Allow for the integration of family and social
system in care of patients.
• Better care would be provided to mentally ill
patients in their home communities surrounded
by those who were not mentally ill.
• It was a huge step in returning a sense of worth,
ability and independence to those who had been
dependent on others for their care for so long.
8. Negative effects of deinstitutionalization :-
• Unfortunately adequate support services were not in place
in many communities and a decreased quality of life for the
mentally ill resulted.
• Revolving door syndrome: Patients were often returned to
hospitals, stabilized and discharged again in a cycling
pattern.
• Emergency department use by acutely disturbed
individuals has increased dramatically.
• General hospital psychiatric units are overwhelmed at
times with a continuous flow of patients being admitted
and discharged.
• Severe and persistent mental illness who are not receiving
adequate care commit homicides.
• Homelessness among patients increased.
• State prisons are occupied by severely mentally ill Patients.
9. Three Essential Components of a Sound
Deinstitutionalization Process :-
• 1. Prevention of inappropriate mental hospital
admissions through the provision of community
facilities.
• 2. Discharge to the community of long-term
institutional patients who have received
adequate preparation.
• 3. Establishment and maintenance of community
support systems of non-institutionalized patients.
10. INSTITUTIONALIZATION
• In recent years the focus of psychiatric care
has moved away from extended care
predominantly in patient settings and toward
shorter lengths of inpatient stays and a wider
choice among the continuum of care options.
• Most inpatient psychiatric settings now have
an average length of stay of 5 to 10 days when
compared to 24 to 30 days during 1980s
11. Indications for Institutionalization
Inpatient Hospital Admission
• Prevention of harm to self or others
• Management of severe symptoms
• Need for a rapid, multidisciplinary diagnostic
evaluation that requires frequent observation
by specially trained personnel
12. Treatment Objectives
• Rapid evaluation and diagnosis
• Decreasing behavior that is danger us to self
or others.
• Preparing the patient and significant care
givers to manage the patient's care in a less
restrictive setting
• Arranging for effective aftercare to facilitate
continued improvement in the patients
condition and functional level
13. • Community support services programs were
developed to meet the needs of persons with
mental illness outside the institution . These
programs focus on rehabilitation, vocational
needs. education and socialization as well as
management of symptoms and medications.
• In India alternative community based services
are not adequately developed and existing
mental hospitals are not fully equipped with
therapeutic activities. What is now required is
the need for a balanced approach, i.e. inpatient
treatment needs to be improved and
community based health programs
strengthened.
14. • There is an urgent need to sensitize govern merits
on the importance of mental health and clearly
define the goals and objectives of community
based health programs.
• Innovative community based health programs
which are culturally and gender appropriate and
reach out to all segments of the population need
to be developed.
• Well organized community based care is urgently
required besides increasing the number of
psychiatric beds in general hospitals.
16. QUESTION/ANSWER
• What is mean of institutionalization?
• What is deinstitutionalization treatment?
• Describe the essential component of
deinstitutionalization?
• List out the positive and negative effects of
deinstitutionalization?
• What are the indication for patient who are
taking admission in institutionalization?
• Enumerate the treatment objective of
institutionalization ?
17.
18. ASSIGNMENT
Write the origin of institutionalization and
deinstitutionalization!
(date of submission- 26-09-2020,saturday)
19. BIBLIOGRAPHY
• R.Sreevani “A text book of Guide to mental health and
psychiatric nursing”3rd edition, published by Jaypee
brothers, ltd, New Delhi. Page no.-295-296
• KP Neerja “a textbook of essential of psychiatric
nursing “ published by jaypee brothers.
• Marry C. Townsend “a textbook of psychiatric mental
health nursing”6th edition.
• Ahuja N.A. “a textbook of psychiatry”6th edition jaypee
brothers, New Delhi.
• http://www.wikipedia.org.
• www.encyclopedia.com
