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Deinstitutionalization Versus Transinstitutionalization

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Forensic Psychiatry and Psychology in Europe

Abstract

For up to 40 years, European countries have turned towards deinstitutionalization to improve quality of life of psychiatric patients, reintegration into society and mounting costs of the exploitation of psychiatric hospitals. Increasingly, though, the use of deinstitutionalization has often been linked to an increase of patients towards forensic care, whether it concerns forensic hospitals or prison, which would be an unwanted and worrisome side effect of deinstitutionalization. In the current chapter, we will go into the main literature on the topic of transinstitutionalization. Especially, the Austrian situation is of interest, as it has been well documented and described. We found the link between deinstitutionalization and transinstitutionalization to be complex, and deinstitutionalization is only one of the several factors that can induce transinstitutionalization. Community-based care, a population shift, a critical number of beds, a zeitgeist and changes in civil commitment legislation are all just as important when it comes to the emergence of transinstitutionalization. Next to this, we added funding and education as possible elements that might be of importance as well. We concluded that transinstitutionalization is a real threat for specific patients when deinstitutionalization occurs but in a complex and multifactored way.

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References

  1. Priebe S, Badesconyi A, Fioritti A, Hansson L, Kilian R, Torres-Gonzales F, Turner t, Wiersma D. Reinstitutionalisation in mental health care; comparison of data on service provision from six European countries. BMJ. 2005;330:123–6.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Yoon J, Dominio ME, Norton EC, Cuddeback GS, Morrissey JP. The impact of changes in psychiatric bed supply on jail use by persons with severe mental illness. J Ment Health Policy Econ. 2013;16(2):81–92.

    PubMed  Google Scholar 

  3. Hodgins S, Lalonde N. Major mental disorders and crime: changes over time. In: Cohen P, Slomkowski C, Robins LN, editors. Historical and geographical influences on psychopathology. London: Erlbaum; 1999. p. 57–84.

    Google Scholar 

  4. Hodgins S, Muller-Isbner R, Allaire JF. Attempting to understand the increase in the number of forensic beds in Europe: a multi-site study of patients in forensic and general psychiatric services. Int J Forensic Ment Health. 2012;5(2):173–84.

    Article  Google Scholar 

  5. Kalisi S. Reinstitutionalisation by stealth: the forensic mental health service is the new chronic system. Afr J Psychiatry. 2013;16:13–7.

    Google Scholar 

  6. Salize HJ, Schanda H, Dressing H. From the hospital into the community and back again—a trend towards re-institutionalisation in mental health care? Int Rev Psychiatry. 2008;20(6):527–34.

    Article  PubMed  Google Scholar 

  7. Vázquez-Barquero JL. García Deinstitutionalization and psychiatric reform in Spain. J Eur Arch Psychiatry Clin Neurosci. 1999;249(3):128–35.

    Article  Google Scholar 

  8. Ravelli DP. Deinstitutionalisation of mental health care in the Netherlands: towards an integrative approach. Int J Int Care. 2006;6:e04.

    Google Scholar 

  9. Salize HJ. Placement and treatment of mentally ill offenders—legislation and practice in EU member states final report—15 Feb 2005.

    Google Scholar 

  10. Little GL, Robinson K, Burnette K, Swan ES. Antisocial personality disorder and criminal justice: evidence based practices for offenders and substance abusers. Memphis: Eagle Wing Books; 2010.

    Google Scholar 

  11. Fazel S, Danesh J. Serious mental disorder in 23000 prisoners: a systematic review of 62 surveys. Lancet. 2002;359:545–50.

    Article  Google Scholar 

  12. Kramp P, Gabrielsen G. The organisation of the psychiatric service and criminality committed by the mental ill. Eur Psychiatry. 2009;24:401–11.

    Article  CAS  PubMed  Google Scholar 

  13. Schanda H, Stompe T, Ortwein-Swoboda G. Dangerous or merely difficult. The new population of forensic mental hospitals. Eur Psychiatry. 2009;24:365–72.

    Article  CAS  PubMed  Google Scholar 

  14. Schanda H. Psychiatry reforms and illegal behaviour of the severely mentally ill. Lancet. 2005;365(9457):367–9.

    Article  PubMed  Google Scholar 

  15. Teague GB, Bond GR, Drake RE. Program fidelity in assertive community treatment: development and use of a measure. Am J Orthopsychiatry. 1998;68(2):216–32.

    Article  CAS  PubMed  Google Scholar 

  16. Stein LI, Test MA. Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry. 1980;37:392–7.

    Article  CAS  PubMed  Google Scholar 

  17. Van Veldhuizen R, Bähler M, Polhuis D, van Os J, editors. Handboek FACT. Utrecht: de Tijdstroom; 2008.

    Google Scholar 

  18. Malone D, Newron-Howes G, Simmonds S, Marriot S, Tyrer P. Community mental health teams (CMHTs) for people with severe mental illnesses and disordered personality. Cochrane Database Syst Rev. 2007;(3):CD000270.

    Google Scholar 

  19. Williams C, Firn M, Wharne S, MacPherson R. Assertive outreach in mental healthcare: current perspectives. Chichester, West Sussex: Blackwell Publishing Ltd.; 2011.

    Google Scholar 

  20. Marshall M, Lockwood A. Assertive community treatment for people with severe mental disorders. Cochrane Database Syst Rev. 2011;2011(4):CD001089.

    Google Scholar 

  21. Cherner R, Aubry T, Ecker T, Kerman N, Nandlal J. Transitioning into the community: outcomes of a pilot housing program for forensic patients. Int J Forensic Ment Health. 2014;13(1):62–74.

    Article  PubMed  PubMed Central  Google Scholar 

  22. OECD health statistics. 2013. https://doi.org/10.1787/health-data-en.

  23. Olfson M, Mechanic D. Mental disorders in public, private and non-profit and proprietary general hospitals. Am J Psychiatr. 1996;153:1613–9.

    Article  CAS  PubMed  Google Scholar 

  24. Hodgins S, Müller-Isberner R. Preventing crime by people with schizophrenic disorders: the role of psychiatric services. Br J Psychiatry. 2004;185:245–50.

    Article  CAS  Google Scholar 

  25. Thornicroft G, Tansella M. Components of a modern mental health service: a pragmatic balance of community and hospital care: overview of systematic evidence. Br J Psychiatry. 2004;185:283–90.

    Article  PubMed  Google Scholar 

  26. Prunnlechner-Neumann R, Blecha H-G, Kemmler G. Zwischen UbG und Maßnahmenvollzug: Ein spezielles Angebot für eine Risikoklientel? Paper presented at the 4. Jahrestagung der Österreichischen Gesellschaft für Psychiatrie und Psychotherapie, April 21st–24th 2004, Gmunden, Austria.

    Google Scholar 

  27. Kallert T, Torres-Gonzalez F. Differences of legal regulations concerning involuntary psychiatric hospitalization in twelve European countries: implications for clinical practice. Int J Forensic Ment Health. 2007;6(2):197–207.

    Article  Google Scholar 

  28. Kallert T, Torres-Gonzalez F. Legislation on coercive mental health care in Europe. Frankfurt am Main: Peter Lang; 2006.

    Google Scholar 

  29. Cusack KJ, Morrissey JP, Cuddeback GS, Prins A, Williams DM. Criminal justice involvement, behavioral health service use, and costs of forensic assertive community treatment: a randomized trial. Community Ment Health J. 2010;46(4):356–63.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Solomon P, Draine J. Jail recidivism in a forensic case management program. Health Soc Work. 1995;20(3):167–73.

    Article  CAS  PubMed  Google Scholar 

  31. Young AS, Forquer SL, Tran A, et al. Identifying clinical competencies that support rehabilitation and empowerment in individuals with severe mental illness. J Behav Health Serv Res. 2000;27:321. https://doi.org/10.1007/BF02291743.

    Article  PubMed  CAS  Google Scholar 

  32. Robertson P, Barnao M, Ward T. Rehabilitation frameworks in forensic mental health. Aggress Violent Behav. 2011;16(6):472–84.

    Article  Google Scholar 

  33. Andrews D, Bonta J. The psychology of criminal conduct. New Providence: LexisNexis; 2010.

    Google Scholar 

  34. Ward T, Maruna S. Rehabilitation: key ideas in criminology series. London: Routledge; 2007.

    Book  Google Scholar 

  35. Burns T, Firn M, editors. Assertive outreach in mental health: a manual for practitioners. Oxford: Oxford University Press; 2002.

    Google Scholar 

  36. Osher FC, Steadman HJ. Adapting evidence-based practices for persons with mental illness involved with the criminal justice system. Psychiatr Serv. 2007;58(11):1472–8.

    Article  PubMed  Google Scholar 

  37. Aos S, Miller MA. Evidence-based public policy options to reduce crime and criminal justice costs: implications in Washington state. Int J Evid Based Res Policy Pract. 2009;4(2):170–96.

    Google Scholar 

  38. Nedopil N, Stübner S. Ambulatory aftercare of forensic patients after release. Psychatr Prax. 2009 Oct;36(7):317–9.

    Article  Google Scholar 

  39. Lamberti JS, Weisman R, Faden DI. Forensic assertive community treatment: preventing incarceration of adults with severe mental illness. Psychiatr Serv. 2004;55(11):1285–93.

    Article  PubMed  Google Scholar 

  40. Harris VL. Insanity acquittees and rearrest: the past 24 years. J Am Acad Psychiatry Law. 2000;28(2):225–31.

    PubMed  CAS  Google Scholar 

  41. Beach C, Dykema LR, Appelbaum PS, Deng L, Leckman-Westin E, Manuel JI, McReynolds L, Finnerty MT. Forensic and nonforensic clients in assertive community treatment: a longitudinal study. Psychiatr Serv. 2013;64(5):437–44.

    Article  PubMed  Google Scholar 

  42. Bond GR, Burns BJ, Edgar ER, et al. Moving assertive community treatment into standard practice. Psychiatr Serv. 2001;52:771–9.

    Article  Google Scholar 

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Authors and Affiliations

  1. Justice Department Belgium, Faculty of Medicine, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Antwerp, Belgium

    Thomas Marquant

  2. Faculty of Medicine, University of Granada, Granada, Spain

    Francisco Torres-Gonzalez

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  1. Thomas Marquant
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  2. Francisco Torres-Gonzalez
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Correspondence to Thomas Marquant .

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Editors and Affiliations

  1. Antwerp University Hospital, University Forensic Centre (UFC) & University of Antwerp, Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Edegem/Wilrijk, Belgium

    Kris Goethals

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Marquant, T., Torres-Gonzalez, F. (2018). Deinstitutionalization Versus Transinstitutionalization. In: Goethals, K. (eds) Forensic Psychiatry and Psychology in Europe. Springer, Cham. https://doi.org/10.1007/978-3-319-74664-7_19

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  • DOI: https://doi.org/10.1007/978-3-319-74664-7_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74662-3

  • Online ISBN: 978-3-319-74664-7

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