Browsing by Subject "deinstitutionalization"

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  • Sadeniemi, Minna; Almeda, Nerea; Salinas-Perez, Jose A.; Gutierrez-Colosia, Mencia R.; Garcia-Alonso, Carlos; Ala-Nikkola, Taina; Joffe, Grigori; Pirkola, Sami; Wahlbeck, Kristian; Cid, Jordi; Salvador-Carulla, Luis (2018)
    Mental health services (MHS) have gone through vast changes during the last decades, shifting from hospital to community-based care. Developing the optimal balance and use of resources requires standard comparisons of mental health care systems across countries. This study aimed to compare the structure, personnel resource allocation, and the productivity of the MHS in two benchmark health districts in a Nordic welfare state and a southern European, family-centered country. The study is part of the REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care) project. The study areas were the Helsinki and Uusimaa region in Finland and the Girona region in Spain. The MHS were mapped by using the DESDE-LTC (Description and Evaluation of Services and Directories for Long Term Care) tool. There were 6.7 times more personnel resources in the MHS in Helsinki and Uusimaa than in Girona. The resource allocation was more residential-service-oriented in Helsinki and Uusimaa. The difference in mental health personnel resources is not explained by the respective differences in the need for MHS among the population. It is important to make a standard comparison of the MHS for supporting policymaking and to ensure equal access to care across European countries.
  • Alanko, Anna (Helsingin yliopisto, 2017)
    The study investigates policy level attempts to improve mental health care. It analyses the rationale of the proposals to improve Finnish mental health policy between 1964–2016. Such proposals have been presented in policy documents such as committee reports, working group memorandums, government bills and project reports. The most prominent examples of the improvement proposals are reducing psychiatric hospital care, increasing outpatient treatment, increasing the possibilities for mental health services users to work, emphasising the autonomy of the service users, and increasing the equal position of mental health care service users and other citizens. The study seeks to find out what has been in the focus in reforming mental health care, how the people using mental health services have been perceived, and finally, what has been left unproblematised. Since the late 1970s, Finnish mental health care has been subject to continuous reforms. A key feature of these reforms has been psychiatric dehospitalisation, i.e. reducing psychiatric hospital care. Dehospitalisation is a trend with complex origins, which became global after the Second World War and reached Finland by the mid-1970s. Dehospitalisation stems from various and conflicting origins, such as citizens’ rights movements, the development of the psychiatric profession, the economic interests of the state, as well as from pharmaceutical development. Dehospitalisation and mental health policy in general are deeply connected with welfare policy, but it the relationship is not straightforward. In Finland dehospitalisation was planned as part of an expansive welfare policy, but its’ implementation has sometimes recalled austerity politics. Another phenomenon that affects mental health policy is the expansion of mental health care: the simultaneous increase in the provision, demand, methods and areas of jurisdiction of mental health care. The dissertation shows that in the reform initiatives set forth in the policy documents, similar suggestions are given in different contexts. In the analysed policy documents, dehospitalisation has been proposed as a solution to almost any problems perceived in mental health care. Dehospitalisation also seems to have materialised, as the number of psychiatric hospital beds is now many times lower than it was in the beginning of the period. Along with the diminishing number of hospital beds, new residential care facilities have been established which seem to be as institutionalising as the previous psychiatric hospitals. Also increasing the amount of outpatient treatment has materialised, but it seems that the services are used by a new group of citizens with milder problems. During the period between the 1960s and the early 1990s, those with a serious mental health problem were considered the core focus group of mental health policy, independently of whether they were within the labour market. Moreover, providing sheltered work for those with serious problems was considered a method of rehabilitation. After the mid-1990s the emphasis on paid work has increased. Those who are able to work in the labour market are the new focus group the mental health policy. The pursuit of mental health care service users’ increased autonomy is ideologically connected to the aim of dehospitalisation. However in the latter phases of the period, after the mid-1990s, the improvement suggestions start to assume the autonomy of the service users instead of seeking ways of supporting it. The changing understanding of autonomy also reflects to the notion of ‘user expertise’. This recently emerged way of thinking lifts the expertise of people having experience with their own mental health problems. However the emphasis on ‘expertise with experience’ fails to take into account that there is a high demand for professional mental health services. In the conclusions I argue that as a whole the well-meaning improvement proposals fail to problematise many structural factors contributing to the unequal provision of mental health care. Instead of achieving the revolving goal of increasing the equality of mental health care service users, the rationale has left room for excluding even further those with the most serious problems.