This research proposal will discuss the positive and negative effects of deinstitutionalizing mentally ill patients. It aims to achieve the following objectives. Foremost, it will seek to understand why patients suffering from mental illness are released into the public. Consequently, it will focus on how these patients relate with other members of the public. Thus, it will discuss the advantages and disadvantages of releasing patients from mental institutions to the public. Consequently, it will assess prevalence and determinants of safety measures and practices mentally ill patients can adopt during deinstitutionalization. Socioeconomic factors also affect the patients’ behaviors and lifestyles. Thus, the research will discuss some of the disorders mentally ill patients acquire from deinstitutionalization. These disorders include depression, anxiety, and suicidal thoughts. Lastly, it will assess public attitudes and perceptions into accepting and relating with mentally ill patients.
A research proposal focusing on socioeconomic factors affecting deinstitutionalized mentally ill patients is vital. This is because it develops various concepts mentally ill patients undergo through as they struggle to gain acceptance in the society. Most patients deinstitutionalized and admitted in community based mental programs lack family and society support. Thus, they undergo discrimination, stigmatization and prejudice. More so, they lack economic resources to access and acquire treatment across the community based mental programs. This has led to victimization and abuse of mentally ill patients. Consequently, the mortality rates are increasing as deinstitutionalization fails to provide sufficient resources to ensure the patients’ social, physical, mental, and psychiatric conditions are catered for (Cameron, Jody, Jian & Arto, 2014). This report will therefore discuss both positive and negative effects of deinstitutionalization of mentally ill persons. The discussion will be crucial in drawing a conclusion either proposing or opposing the deinstitutionalization.
The United States Department of Health and Human Services provided the following description to differentiate between mentally healthy and unhealthy persons. A mentally healthy person is able to balance social mental stresses without suffering from psychological disorders. These psychological disorders include harboring suicidal thoughts and suffering from anxiety attacks and depression among others. The Substance Abuse and Mental Health program across the country also asserts mentally ill patients are more likely to suffer from drug abuse and addiction (Cameron, Jody, Jian & Arto, 2014).
The prevalence rates are higher among mentally ill patients deinstitutionalized as they suffer from social depression and anxieties. Thus, they consume drugs to enhance social inclusion and acceptance or cope with stigma and prejudice. Thus, deinstitutionalizing mentally ill patients can expose them to new infections and adverse social habits. However, it can also boost their self esteem and confidence levels as they relate with people from diverse backgrounds, races, and ethnicities. In order to achieve the positive effects of deinstitutionalizing mentally ill patients, they should be placed under the guidance of a mentally and socially stable caregiver (Sharon & Ilan, 2010).
Mental health can be achieved socially and clinically. Mentally ill patients are often labeled as different members of the community. Thus, they suffer from social stigma as they struggle to be accepted. Family members and friends on the other hand face a dilemma of either institutionalizing mentally ill patients or providing home-based health care. Home-based health care involves the patient living at home while regularly visiting community based mental clinics for checkups. Thus, the patients are often surrounded by family and friends as they strive to stabilize and balance their social emotions and psychological conditions. However, this can be challenging in a community stereotyping, excluding, prejudicing, and discriminating against mentally ill persons. Thus, it can be challenging for both the family and the mentally ill patients if they cannot afford admission fees to a mental clinic. More so, it can be damaging in relation to psychological and mental balances for mentally ill patients to suffer from discrimination (Cameron, Jody, Jian & Arto, 2014).
In 2010, research was conducted in Derbyshire Mental Health Trust Program to determine clinical and social factors affecting mental health. Mentally ill patients are encouraged to visit health care institutions to seek psychological help. This empowers them to achieve social, physical, and mental health through medical and psychological management practices. The research revealed more than thirty persons suffering from mental illness often stop medicating on either full or temporary occasions. This rate however differs among patients and the associating psychiatric disorders they may be suffering from. For example, mentally ill persons suffering from depressive and bipolar disorders either forget or refuse to consume their medications. The rates increase if the patient suffers from schizophrenia as they lack mental ability to follow the medical management instructions (DMHS, 2010).
According to Angermeyer Matschinger, mental illness affects members of the public. This is determined according to their attitude and socialization skills towards people suffering from mental illnesses. The author applied sociological role theory to understand why people discriminate against mentally ill patients. The sociological role theory asserts people use labels to socialize as they derive either positive or negative effects. Mental illness is a health care problem deriving negative labels across major societies. However, most members of the society do not hold the patients responsible for their health care condition. They should be more accepting, patient, and interactive and social towards mentally ill patients. However, they label them as mentally ill members of the community using negative stereotypes. This leads to discrimination, prejudice, and stigmatization. Consequently, mentally ill react emotionally to these three negative labels. This further affects their cognitive, behavioral, attitudinal, and social responses towards the society (Angermeyer, 2003).
Pamela Hyde and Paolo Vecchio working at the Center for Mental Health Services provided a discussion guide seeking to educate communities on mental illnesses. They asserted dealing with mental illnesses among the youth can be more challenging in comparison to adults. However, they also emphasized grouping members of the community and educating them to raise awareness can improve an understanding towards mental illnesses. The community group discussion platforms should be utilized for people to explain how they understand mental illness. They gives people an opportunity to apply personal experiences to inform, encourage and motivate other members of the community to apply positivity to associate and socialize with mentally ill patients. However, the authors asserted it is important to understand why mentally ill patients are deinstitutionalized (Pamela & Paolo, 2013).
According to Ines Aquino, mental health care has evolved for over fifty years globally. The evolutions include introducing community based care towards mentally ill patients. Living and clinical conditions across mental health care institutions ought to ensure high quality and standards are achieved. Diverse global nations have developed and implemented policies aimed at improving conditions across mental clinics. For example, United States and United Kingdom emphasize on deinstitutionalization to reduce congestion. However, Latin American nations are still debating on the deinstitutionalization process as they seek to close mental clinics. Thus, mental clinics are being replaced with community care programs (Ines, 2007).
There are diverse reasons for deinstitutionalizing mentally ill patients across the globe. Foremost, deinstitutionalizing is undertaken to achieve substantial changes among staffs providing mental health. The staffs are reallocated from mental health care facilities to community based programs. This is aimed towards developing and improving codes of conducts and sets of competencies in relation to mental health across community based programs. Thus, deinstitutionalization is undertaken to facilitate staffs being diverse. This ensures they provide adequate and effective mental health across various recovery and rehabilitation community, inpatient, and residential settings (Ines, 2007).
Mental health care requires teamwork. However, achieving teamwork can be challenging as it requires compatible organizational structures and sufficient funding. This should be coupled with diverse degrees of operational autonomy in relation to approaches and priorities utilized to provide mental health care. Teamwork can facilitate isolationism, rivalry, disagreements and hierarchies, which can be prevented and eliminated through deinstitutionalization. Thus, deinstitutionalization is adopted to develop multidisciplinary working efficiencies as well as democratic ways of providing mental health. Deinstitutionalization also achieves the following positive social effects among the patients. Through social integration, they can achieve a mental and psychological balance. Consequently, they can seek employment to achieve independence, avoiding re-hospitalization in mental institute (Ines, 2007).
However, according to Alison Read, deinstitutionalization can also achieve negative effects towards the patients’ mental and physical health conditions. Mentally ill patients are placed in institutions to achieve isolation from other members of the community while providing custodial mental health care. However, the isolation should be conducted to respect and uphold the patient’s human rights and dignities. Thus, mentally ill patients under custodial care are submitted to control mental health care. This increases and improves their psychological stability and balance. However, deinstitutionalization to facilitate community based mental health programs does not guarantee patients will receive full support especially from governments and agencies. Deinstitutionalization therefore hinders governments and agencies from providing resources and funds necessary to ensure community based programs have adequate and high quality housing facilities (Alison, 2009).
The author also asserts deinstitutionalization encourages use of inadequate and insufficient hospital facilities. Thus, they fail to meet and fulfill mental health care needs among the patients. For example, mentally ill patients undergoing psychiatric help require longer stays in a hospital in order to achieve psychological stability. However, such patients are often released back to the society prematurely before gaining mental stability. This increases their chance to suffer from acute mental disorders as they seek mental health care across hospitals lacking both human and capital resources. This can also encourage mentally ill patients seeking health care across insufficiently funded community based hospitals to engage in drug abuse and addiction. This is mainly experienced among mentally ill patients released back to the community without ensuring they access housing facilities. Homeless and mentally ill persons facing stigma and discrimination without employment to earn a living will therefore rely on drugs to cope and survive. These conditions can be more damaging among psychiatric patients deinstitutionalized as they lack funds to access medication and counseling (Alison, 2009).
Their mental, physical, and psychological health care conditions do not improve as they can also suffer from anxiety and depression leading to suicide. Deinstitutionalization also leads to increase in crime rates across the community. According to the Canadian Mental Health Association, most jails in the country host mentally ill convicts accused of committing crime. This is because a higher number of mentally ill persons are vulnerable as they can be victimized and abused. Thus, mentally ill patients can engage in disruptive behaviors leading to imprisonment. Consequently, criminals and sexual predators target mentally persons in the community. This has led to increasing mortality rates due to high number of suicides (CMHA, 2008).
To provide a thoroughly researched paper, the following hypotheses were applied. It is crucial to determine the rate of deinstitutionalization across United States. The rates acquired were aligned towards the clinical and social definition of deinstitutionalization. Deinstitutionalization refers to the act of discharging mentally ill patients from a mental or psychiatric clinic. The patients are therefore required to attend and seek mental health care across various community based hospitals. Thus, this research paper will discuss how patients who have either been deinstitutionalized or institutionalized fair in relation to their mental health. The discussion will be based on the various factors affecting discharge and admission rates in relation to mentally illness. The research proposal will focus on a period between 2005 and 2014 as it provides sufficient time to evaluate, compare, and discuss why deinstitutionalization rates are either increasing or decreasing. Lastly, a hypothesis will discuss how deinstitutionalized and institutionalized mentally ill patients recover or stabilize. This hypothesis will therefore provide relevant results vital in discussing if deinstitutionalization is positive or negative.
Sampling Procedures and Designs in the Study
This research proposal mainly relied on journal articles that have conducted studies on deinstitutionalization of mentally ill patients. Thus, it utilized participants authored in Derbyshire Mental Health Program. Extra participants were acquired from a group of mentally ill patients admitted at the local mental clinic. This group of participants was selected to provide views in relation to institutionalization. All the participants were aged above eighteen years. It included mentally ill patients undergoing psychiatric treatment for a period exceeding three months. The participating caregivers asserted they had worked in the mental clinic for more than one year. However, participants who could not communicate clearly due to heavy medication as well as speech and language barriers were excluded.
A sample size of four participants per group was selected. The four participants represented the following concepts. The first participant had to be suffering from mental illness and psychiatric conditions. The second one was selected to provide personal views on deinstitutionalization. Thus, they had to express their views from a past experience that involved deinstitutionalization. The third involved a participant who had never experienced deinstitutionalization. The last participant was a caregiver to provide their views on deinstitutionalization and institutionalization.
The paper applies a qualitative design due to the following two reasons. Foremost, this topic can be broad. Thus, there were limited articles discussing deinstitutionalization while addressing the specific aims this research proposal was evaluating and assessing. Consequently, it was important to apply the qualitative design as it allows various changes to be applied. For example, it allows a writer to develop different scenarios in relation to deinstitutionalization. This research proposal decided to apply a scenario where an institutionalized patient lost a best friend after being discharged. The participant explained various factors that led her best friend to commit suicide.
How to Administer Informed Consents
The Derbyshire Mental Health Program administered consent forms among the participants across the formed focus groups. Each focus group was assigned a facilitator who was required to present consent forms to the participants before commencing discussions. The institutionalized participants were also administered with consents. A signed agreement from the school dean was presented to the mental health care department at the hospital. The head of department provided a schedule to gather data from the participants. This schedule was critical as it would ensure the procedure of gathering data would not interrupt with the patient’s and caregiver’s plans.
Concerns for Special or Minority Populations
The caregivers at the mental clinic emphasized mentally ill patients from special and minority populations were also accepted. However, they explained that deinstitutionalization of mentally ill persons from special populations was neither encouraged nor practiced at the clinic. This is because they suffer from other illnesses requiring special medical attention. However, patients from minor populations such as Indians and Mexicans are neither discriminated nor treated in special ways. They are admitted into general wards and provided with mental health care without prejudice or discrimination. Thus, their rates of deinstitutionalization are neither less nor more.
The primary limitation in authoring this research proposal was derived from lack of experience. Conducting a research requires training and experience to reduce and avoid methodological errors. This research proposal therefore had to rely on research findings gathered from documented journal article to form a discussion and conclusion. It was therefore challenging to use a single study or sample size as the findings would either be misleading or biased. It was important to avoid generalization in describing and discussing multiple findings in relation to deinstitutionalization. This is because generalization can allow readers reading to make conclusions from personal inferences without being directly or indirectly influenced.
Mental health care services provided across the country and globally differ. This is because different States and nations record dissimilar populations of people suffering from mental illness. Thus, it was challenging to identify population needs while gathering data from the local mental clinic. It was also difficult to apply unique and specific population needs in discussing wants and desires among participating mentally ill patients. This was also attributed by a restricted coverage of children, youths, and adults suffering from mental illness. The research proposal therefore applied global based population estimates to discuss mental illness as well as socioeconomic factors affecting the patients due to deinstitutionalization. Thus, it was challenging to acquire and apply precise data and information from clients affected by deinstitutionalization of mentally ill patients. Finally, the research did not focus on specific races or ethnic groups. Thus, persons from minority groups suffering from mental illness likely to face more adverse effects were not specifically discussed.
Data analysis and Discussion
A qualitative analysis applying various stages of journal research was applied to analyze the data. The journal articles utilized in this research proposal identified a common pattern. The pattern involved correlating mental illness and socioeconomic factors leading to either discrimination or acceptance. The findings from the journal articles developed theoretical concepts to explain various issues affecting persons with mental illness. They also revealed mental health requires qualified, experienced and diverse professions working as a team. Reviewing various research findings from the journal articles revealed patients institutionalized in mental clinics receive higher quality treatment procedures in comparison to community based programs.
However, it is important to ensure the patients access outside social contacts from friends and family to ensure the institutions do not adversely affect their social skills. Both institutionalization and deinstitutionalization have positive and negative effects. However, deinstitutionalization does not assist the patients adopt towards social changes in order to achieve normalization. In United States, the rates of institutionalization are higher than deinstitutionalization. However, deinstitutionalization rates are gradually increasing (Joni, 2009).
The participants from the local mental clinic provided the following facts about deinstitutionalization and institutionalization. Patients who have experienced deinstitutionalization explained how their mental health deteriorated. They asserted seeking mental care from community based programs was challenging due to financial constraints. The participants also explained stigma, prejudice, and discrimination discouraged them from visiting available community based mental health programs. Deinstitutionalization therefore encourages patients to discontinue with medication due to socioeconomic factors (Harry, Rebecca & Kylie, 2005). The caregivers were in support of the views. They asserted deinstitutionalization lacks quality control coupled with restricted financial and human resources. Thus, deinstitutionalization does not guarantee a mentally ill patient will access and receive high quality and standard medical care. They emphasized patients suffering from mental illness and psychiatric conditions are more adversely affected after deinstitutionalization. This is because they stop medicating and seeking psychiatric assistance (Joni, 2009).
Patients who have never experienced deinstitutionalization asserted they would discourage the practice. Their views were based on other people’s experiences. A participant asserted she lost her best friend due deinstitutionalization. She affirmed her best friend suffered from social stigma and discrimination after deinstitutionalization. Consequently, she stopped her medication due to financial constraints. She developed social issues due to low self esteem and confidence. Restraining economic conditions rendered her homeless facilitating sexually harassment. This led her to develop psychiatric conditions. Coupled with lack of mental medication to treat her mental illness, she committed suicide.
Currently, deinstitutionalization provides more negative than positive effects. Thus, the government as well as healthcare departments and programs should develop a new plan to improve the deinstitutionalization process. The plan should involve providing sufficient funds to hire professional caregivers. The funds should also be utilized to acquire adequate medication and equipment applied in providing effective and efficient high quality mental care. More importantly, deinstitutionalization should be regulated to ensure all patients are catered for in accordance to their needs. This can guarantee patients suffering from psychiatric conditions are able to seek and acquire treatment and care from the community based programs. It can reduce the number of deinstitutionalized patients acquiring psychiatric issues. These regulations can play a vital role in reducing social stigma, prejudice, and discrimination. They can also ensure patients continue with their medication in order to lower suicidal rates.
Alison, R. (2009). Psychiatric Deinstitutionalization in BC: Negative Consequences and Possible Solutions, University of British Columbia.
Angermeyer, M. (2003). The Stigma of Mental Illness: Effects of Labeling on Public Attitudes towards People with Mental Disorder, Acta Psychiatry Scand Journal, 108(1): 304-309.
Cameron, W., Jody, W., Jian, W., & Arto, O. (2014). Gap Analysis of Public Mental Health and Addictions Programs (GAP-MAP) Final Report, University of Alberta.
Canadian Mental Health Association (CMHA). (2008). Mental Illness and Substance use Disorders: Key issues, Canadian Mental Health Department.
Derbyshire Mental Health Services (DMHS). (2010). An Investigation of the Experience of Mental Health Service users when they Decide they would like to Change or Withdraw from Prescribed Medication, Derbyshire Mental Health Services Trust Report.
Harry, L., Rebecca, M., & Kylie, M. (2005). Evidence Based Psychological Interventions in the Treatment of Mental Disorders: A Literature Review, The Australian Psychological Society Report.
Ines, A. (2007). The Deinstitutionalization Process and Mental Health Teams Working with Severely Mentally ill Persons in Sweden, University of Göteborg.
Joni, L. P. (2009). The Occurrence and Effectiveness of Deinstitutionalization of the Mentally Ill in the Pre-Antipsychotic Era, Louisiana State University.
Pamela, H., & Paolo, V. (2013). Community Conversations about Mental Health: Discussion Guide, Substance Abuse and Mental Health Services Administration (SAMHSA) Report.
Sharon, S., & Ilan, M. (2010). Mental Health Disparities Research: The Impact of Within and Between Group Analyses on Tests of Social Stress Hypotheses, Social Science & Medicine Journal, 70(1): 1111-1118.