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Deinstitutionalisation — from Hospital Closure to Service Development

Published online by Cambridge University Press:  02 January 2018

Graham Thornicroft*
Affiliation:
MRC Social Psychiatry Unit, Institute of Psychiatry, De Crespigny Park, London SE5 8AF
Paul Bebbington
Affiliation:
MRC Social Psychiatry Unit
*
Correspondence

Abstract

The necessary components of a comprehensive service of local non-institutional forms of care for the seriously mentally ill have been researched separately in pilot trials, but not within integrated programmes for defined populations. Reported outcomes are at least as favourable as for traditional long-term hospital care, but alternative provisions are no less costly. A case manager system may allow co-ordinated formal and informal services to meet the individual needs of chronically ill patients. Poorly integrated programmes will expose discharged patients to disadvantages.

Type
Review Article
Copyright
Copyright © The Royal College of Psychiatrists, 1989 

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References

Abrahamson, D. (1982) Patients' attitudes about discharge from mental hospital. Health Trends, 14, 9596.Google Scholar
Archarya, S., Ekdawi, M., Gallagher, L., et al (1982) Day hospital rehabilitation: a six year study. Social Psychiatry, 17, 15 CrossRefGoogle Scholar
Anstee, B. (1985) An alternative form of community care for the mentally ill. Health Trends, 17, 3940.Google ScholarPubMed
Anthony, W. (1972) Efficacy of psychiatric rehabilitation. Psychological Bulletin, 78, 447456.Google Scholar
Anthony, W., Cohen, A. & Vitalo, R. (1978) The measurement of rehabilitation outcome. Schizophrenia Bulletin, 4, 365381.Google Scholar
Appelbaum, P. (1987) Crazy on the streets. Commentary, 83, 3439.Google Scholar
Appleby, L. & Desai, P. (1985) Documenting the relationship between homelessness and psychiatric hospitalisation. Hospital and Community Psychiatry, 36, 732735.Google Scholar
Ashbaugh, J. & Manderscheid, R. (1985) A method for estimating the chronically mentally ill population in state and local areas. Hospital and Community Psychiatry, 36, 389392.Google ScholarPubMed
Audit Commission (1986) Making a Reality of Community Care. London: HMSO.Google Scholar
Avison, W. & Speechley, K. (1987) The discharged psychiatric patients: a review of social, social-psychological, and psychiatric correlates of outcome. American Journal of Psychiatry, 144, 1018.Google Scholar
Bachrach, L. (1976) Deinstitionalisation: an analytical review and sociological perspective. Rockville, Maryland: US Department of Health, Education and Welfare, NIMH.Google Scholar
Bachrach, L. (1980) Overview: model programs for chronic patients. American Journal of Psychiatry, 137, 10231031.Google Scholar
Bachrach, L. (1984a) Asylum and chronically ill psychiatric patients. American Journal of Psychiatry, 141, 975978.Google Scholar
Bachrach, L. (1984b) The Homeless Mentally Ill and Mental Health Services: An Analytical Review of the Literature. Washington: US Department of Health and Human Services.Google Scholar
Bachrach, L. (1986a) The future of the state mental hospital. Hospital and Community Psychiatry, 37, 467474.Google ScholarPubMed
Bachrach, L. (1986b) Deinstitutionalisation: what do the numbers mean? Hospital and Community Psychiatry, 37, 118121.Google Scholar
Banton, R., Clifford, P., Frosch, S., et al (1985) The Politics of Mental Health. London: Macmillan.Google Scholar
Barton, R. (1959) Institutional Neurosis. Bristol: John Wright.Google Scholar
Bassuk, E. (1984) The homelessness problem. Scientific American, 251, 4046.CrossRefGoogle ScholarPubMed
Bassuk, E. & Gerson, S. (1978) Deinstitutionalisation and mental health services. Scientific American, 238, 4653.CrossRefGoogle Scholar
Bassuk, E., Rubin, L. & Lauriat, A. (1984) Is homelessness a mental health problem? American Journal of Psychiatry, 141, 15461550.Google Scholar
Beard, J. (1978) The rehabilitation services of Fountain House. In Alternatives to Mental Hospital Treatment (eds Stein, L. & Test, M.). New York: Plenum.Google Scholar
Beard, L. (1982) The Fountain House model of psychiatric rehabilitation. Psychosocial Rehabilitation Journal, 5, 4753.Google Scholar
Becker, T. (1985) Psychiatric reform in Italy: how does it work in Piedmont? British Journal of Psychiatry, 147, 254260.CrossRefGoogle ScholarPubMed
Bennett, D. (1978) The Changing Pattern of Mental Health Care in Trieste. Geneva: World Health Organisation.Google Scholar
Bennett, D. (1979) Deinstitutionalisation in two cultures. Millbank Memorial Fund Quarterly, 57, 516531.CrossRefGoogle Scholar
Berry, C. & Orwin, A. (1966) No fixed abode: a survey of mental hospital admissions. British Journal of Psychiatry, 112, 10191025.CrossRefGoogle Scholar
Blaustein, M. & Viek, C. (1987) Problems and needs of operators of board-and-care homes: a survey. Hospital and Community Psychiatry, 38, 750753.Google ScholarPubMed
Bollini, P., Muscettola, G., Piazza, A., et al (1986) Mental health care in Southern Italy: application of case-control methodology for the evaluation of the impact of the 1978 psychiatric reform. Psychological Medicine, 16, 701707.CrossRefGoogle ScholarPubMed
Bond, G. (1984) An economic analysis of psychosocial rehabilitation. Hospital and Community Psychiatry, 35, 356362.Google Scholar
Borus, J. (1981) Deinstitutionalisation of the chronically mentally ill. New England Journal of Medicine, 305, 339342.CrossRefGoogle Scholar
Bosanquet, N. (1986) Public Expenditure on the NHS: Recent Trends and Outlook. York: Centre for Health Economics, University of York.Google Scholar
Bowen, A. (1979) Some mental health premises. Millbank Memorial Fund Quarterly, 57, 533547.CrossRefGoogle ScholarPubMed
Brandon, S. (1970) Crisis theory and the possibilities of therapeutic intervention. British Journal of Psychiatry, 117, 627633.Google Scholar
Braun, P., Kochansky, G. & Shapiro, R. (1981) Overview: deinstitutionalisation of psychiatric patients, a critical review of outcome studies. American Journal of Psychiatry, 138, 736749.Google Scholar
Brewin, C., Wing, J., Mangen, S., et al (1987) Principles and practice of measuring needs in the long-term mentally ill: the Medical Research Council Needs for Care assessment. Psychological Medicine, 17, 971998.Google Scholar
Brough, D., Bouras, N. & Watson, J. (1983) The mental health advice centre in Lewisham. Bulletin of the Royal College of Psychiatrists, 7, 8285.Google Scholar
Brown, B. (1975) Deinstitutionalisation and Community Support Systems. Statement by Director, National Institute of Mental Health, 4 November. Bethesda, Maryland: NIMH.Google Scholar
Brown, P. (1985) The Transfer of Care: Psychiatric Deinstitutionalisation and its Aftermath. London: Routledge and Kegan Paul.Google Scholar
Busfield, J. (1986) Managing Madness: Changing Ideas and Practice. London: Hutchinson.Google Scholar
Carrier, J. & Kendall, I. (1986) NHS management and the Griffiths Report. In The Year Book of Social Policy in Britain 1985–86 (eds Brenton, M. & Urgerson, C.). London: Routledge and Kegan Paul.Google Scholar
Castel, R., Castel, F. & Lovell, A. (1982) The Psychiatric Society. New York: Columbia University Press.Google Scholar
Castenada, D. & Sommer, R. (1986) Patients' housing options as viewed by parents of the mentally ill. Hospital and Community Psychiatry, 37, 12381242.Google Scholar
Caton, C. & Goldstein, J. (1984a) Housing change of chronic schizophrenic patients: a consequence of the revolving door. Social Science and Medicine, 19, 759764.Google Scholar
Caton, C. & Goldstein, J., Serrano, O., et al (1984b) The impact of discharge planning on chronic schizophrenic patients. Hospital and Community Psychiatry, 35, 255262.Google ScholarPubMed
Clark, D. (1974) Social Therapy in Psychiatry. Harmondsworth: Pelican.Google Scholar
Confederation of Health Service Employees, (COHSE) (1984) The Future of the Psychiatric Services. London: COHSE.Google Scholar
Craig, T., Goodman, A., Siegel, C., et al (1984) The dynamics of hospitalisation in a defined population during deinstitutionalisation. American Journal of Psychiatry, 141, 782785.Google Scholar
Creer, C. & Wing, J. (1974) Schizophrenia at Home. Surbiton, Surrey: National Schizophrenia Fellowship.Google Scholar
Cumming, E. & Cumming, J. (1957) Closed Ranks; an Experiment in Mental Health. Cambridge, Massachusetts: Harvard University Press.Google Scholar
Department of Health and Social Security (1975) Better Services for the Mentally Ill. London: HMSO.Google Scholar
Dick, P., Cameron, L., Cohen, D., et al (1985) Day and full-time psychiatric treatment: a controlled comparison. British Journal of Psychiatry, 147, 246250.Google Scholar
Dickey, B., Cannon, N., McGuire, T., et al (1986) The Quarterway House: a two year cost study of an experimental residential program. Hospital and Community Psychiatry, 37, 11361143.Google Scholar
Drake, R. & Wallach, M. (1988) Mental patients' attitudes toward hospitalisation: a neglected aspect of hospital tenure. American Journal of Psychiatry, 145, 2934.Google Scholar
Drake, R. & Sederer, L. (1986) Inpatient psychosocial treatment of chronic schizophrenia: negative effects and current guidelines. Hospital and Community Psychiatry, 37, 897901.Google Scholar
Early, D. (1978) Twenty years of industrial therapy in Britain. International Journal of Mental Health, 6, 8087.CrossRefGoogle Scholar
Elpers, J. (1987) Are we legislating for reinstitutionalisation? American Journal of Orthopsychiatry, 57, 441446.Google Scholar
Falloon, I. & Marshall, G. (1983) Residential care and social behaviour: a study of rehabilitation needs. Psychological Medicine, 13, 341347.Google Scholar
Falloon, I., Boyd, J. & McGill, W. (1985) Family management in the prevention of morbidity of schizophrenia. Archives of General Psychiatry, 42, 887896.Google Scholar
Farr, R. (1986) Gold Award: a network of services for the homeless chronic mentally ill. Hospital and Community Psychiatry, 37, 11481151.Google Scholar
Fenton, F., Tessier, L., Astruening, E., et al (1982) Home and Hospital Psychiatric Treatment. London: Croom Helm.Google Scholar
Fischer, P. & Breakey, W. (1986) Homelessness and mental health: an overview. International Journal of Mental Health, 14, 641.CrossRefGoogle Scholar
Ford, M., Goddard, C. & Lansdall-Welfare, R. (1987) The dismantling of the mental hospital? Glenside Hospital Surveys 1960–1985. British Journal of Psychiatry, 150, 479485.CrossRefGoogle Scholar
Franklin, L. (1988) Case management: a dissenting view. Hospital and Community Psychiatry, 39, 921.Google ScholarPubMed
Garety, P. & Morris, I. (1984) A new unit for long-stay psychiatric patients: organisation, attitudes and quality of care. Psychological Medicine, 14, 183192.CrossRefGoogle ScholarPubMed
General Accounting Office (1977) Returning the Mentally Disordered to the community: the Government Needs to do More. Washington, DC: Government Printing Office.Google Scholar
Glass, N. & Goldberg, D. (1977) Cost-benefit analysis and the evaluation of psychiatric services. Psychological Medicine, 7, 701707.Google Scholar
Goffman, E. (1961) Asylums. Harmondsworth: Pelican.Google Scholar
Goffman, E. (1968) Stigma. Harmondsworth: Pelican.Google Scholar
Goldberg, D. & Huxley, P. (1980) Mental Illness in the Community — The Pathway to Psychiatric Care. London: Tavistock.Google Scholar
Goldberg, D., Bridges, K., Cooper, W., et al (1985) Douglas House: a new type of hostel ward for chronic psychotic patients. British Journal of Psychiatry, 147, 383388.Google Scholar
Goldman, H. (1981) Defining and counting the chronically mentally ill. Hospital and Community Psychiatry, 32, 2127.Google Scholar
Goldman, H., Adams, N. & Taube, C. (1983a) Deinstitutionalisation: the data demythologised. Hospital and Community Psychiatry, 34, 129134.Google Scholar
Goldman, H., Morrissey, J. & Bachrach, L. (1983b) Deinstitutionalisation in international perspective: variations on a theme. International Journal of Mental Health, 11, 153165.Google Scholar
Goldman, H., Taube, C., Regier, D., et al (1983c) The multiple functions of the state mental hospital. American Journal of Psychiatry, 140, 296300.Google Scholar
Goldman, H., Feder, J. & Scanlon, W. (1986) Chronic mental patients in nursing homes: re-examining data from the National Nursing Home Survey. Hospital and Community Psychiatry, 37, 269272.Google Scholar
Goldstein, J. & Caton, C. (1983) The effects of the community environment on chronic psychiatric patients. Psychological Medicine, 3, 193199.CrossRefGoogle Scholar
Golomb, S. & Kocsis, A. (1988) The Halfway House. New York: Brunner Mazel.Google Scholar
Greenblatt, M. & Budson, R. (1976) A symposium: follow-up studies of community care. American Journal of Psychiatry, 133, 916921.Google Scholar
Griffiths, R. (1988) Community Care: An Agenda for Action. London: HMSO.Google Scholar
Grunebaum, H. (1986) Families, patients and mental health professionals. American Journal of Psychiatry, 143, 14201421.Google Scholar
Gudeman, J. & Shore, M. (1984) Beyond deinstitutionalisation. New England Journal of Medicine, 311, 832836.Google Scholar
Hall, J. (1979) Assessment procedures used in studies on long-stay patients. British Journal of Psychiatry, 135, 330335.Google Scholar
Hall, J. (1980) Ward rating scales for long-stay patients: a review. Psychological Medicine, 10, 277288.Google Scholar
Harris, M., Bergman, H. & Bachrach, L. (1986a) Individualised network planning for chronic psychiatric patients. Psychiatric Quarterly, 58, 5156.CrossRefGoogle ScholarPubMed
Harris, M., Bergman, H. & Bachrach, L. (1986b) Psychiatric and non-psychiatric indicators for rehospitalisation in a chronic patient population. Hospital and Community Psychiatry, 37, 630631.Google Scholar
Harris, M., Bergman, H. & Bachrach, L. (1988) Misconceptions about use of case management services by the chronic mentally ill. Hospital and Community Psychiatry, 39, 12761280.Google Scholar
Hartley, J. (1980) Psychological approaches to unemployment. Bulletin of the British Psychological Society, 32, 309314.Google Scholar
Hawks, D. (1975) Community care: an analysis of assumptions. British Journal of Psychiatry, 127, 276285.Google Scholar
Herzberg, J. (1987) No fixed abode. British Journal of Psychiatry, 150, 621627.Google Scholar
Hirsch, S., Platt, S., Knight, A., et al (1979) Shortening hospital stay for psychiatric care: effect on patients and their families. British Medical Journal, 279, 422426.Google Scholar
Hirsch, S. (1988) Psychiatric Bed and Resources: Factors Influencing Bed Use and Service Planning. London: Gaskell/The Royal College of Psychiatrists.Google Scholar
Hoult, J. & Reynolds, I. (1984) Schizophrenia: a comparative trial of community oriented and hospital oriented psychiatric care. Acta Psychiatrica Scandinavica, 69, 359372.Google Scholar
House of Commons (1985) Second Report from the Social Services Committee, Session 1984–85, Community Care. London: HMSO.Google Scholar
Houston, F. (1955) A project for a mental-health village settlement. Lancet, 26 November, 11331134.Google Scholar
Intagliata, J. (1982) Improving the quality of care for the chronic mentally disabled: the role of case management. Schizophrenic Bulletin, 8, 655674.Google Scholar
Johnstone, E., Owens, D., Gold, A., et al (1981) Institutionalisation and the defects of schizophrenia. British Journal of Psychiatry, 139, 195203.CrossRefGoogle ScholarPubMed
Johnstone, E., Owens, D., Gold, A., et al (1984) Schizophrenic patients discharged from hospital — a follow-up study. British Journal of Psychiatry, 145, 586590.Google Scholar
Jones, M. (1968) Beyond the Therapeutic Community. Yale: Yale University Press.Google Scholar
Jones, M. (1972) A History of the Mental Health Services. London: Routledge and Kegan Paul.Google Scholar
Jones, M. (1985) After Hospital: A Study of Long-Term Psychiatric Patients in York, 1985. York: Department of Social Policy and Social Work, University of York.Google Scholar
Jones, M. (1988) Experience in Mental Health — Community Care and Social Policy. London: Sage.Google Scholar
Kalman, T. (1983) An overview of patients satisfaction with psychiatric treatment. Hospital and Community Psychiatry, 34, 4854.Google ScholarPubMed
Kiesler, C. (1982) Mental hospitals and alternative care. American Psychologist, 37, 349360.Google Scholar
Knapp, M., Beecham, J. & Renshaw, J. (1987) The Cost-Effectiveness of Psychiatric Reprovision Services. Canterbury: Personal Social Services Research Unit.Google Scholar
Kroll, J., Carey, K., Hagedorn, D., et al (1986) A survey of homeless adults in urban shelters. Hospital and Community Psychiatry, 37, 283286.Google Scholar
Kruzich, J. & Berg, W. (1985) Predictors of self-sufficiency for the mentally ill in long-term care. Community Mental Health Journal, 21, 198207.CrossRefGoogle ScholarPubMed
Kunze, H. (1985) Rehabilitation and institutionalisation in community care in West Germany. British Journal of Psychiatry, 147, 261264.Google Scholar
Lamb, H. (1977) The state hospital: facility of last resort. American Journal of Psychiatry, 134, 11511152.Google Scholar
Lamb, H. (1979) The new asylums in the community. Archives of General Psychiatry, 36, 129134.Google Scholar
Lamb, H. (1980) Board-and-care home wanderers. Archives of General Psychiatry, 37, 135137.Google Scholar
Lamb, H. (1984) Deinstitutionalisation and the homeless mentally ill. Hospital and Community Psychiatry, 35, 899907.Google Scholar
Lamb, H. & Grant, R. (1982) The mentally ill in an urban county jail. Archives of General Psychiatry, 39, 1722.Google Scholar
Lamb, R. & Talbott, J. (1986) The homeless mentally ill. Journal of the American Medical Association, 156, 498501.CrossRefGoogle Scholar
Leach, J. & Wing, J. K. (1978) The effectiveness of a service for helping destitute men. British Journal of Psychiatry, 113, 481492.Google Scholar
Leavitt, A. (1984) The Impact of Deinstitutionalisation on ten San Francisco Bay Area Counties. San Francisco: Department of Public Health, City and County of San Francisco.Google Scholar
Lehman, A. (1983) The well-being of chronic mental patients. Archives of General Psychiatry, 40, 369374.Google Scholar
Lehman, A., Reed, S. & Possidente, S. (1982) Priorities for long-term care: comments from board and care residents. Psychiatric Quarterly, 54, 181189.Google Scholar
Lehman, A., Possidente, S. & Hawker, F. (1986) The quality of life of chronic patients in a state hospital and in community residences. Hospital and Community Psychiatry, 37, 901907.Google Scholar
Levine, M. (1981) The History and Politics of Community Mental Health. London: Oxford University Press.Google Scholar
Lieberman, A. & Coburn, A. (1986) The health of the chronically mentally ill: a review of the literature. Community Mental Health Journal, 22, 104116.Google Scholar
Linn, M., Caffey, E., Klett, J., et al (1977) Hospital vs community (foster) care for psychiatric patients. Archives of General Psychiatry, 34, 7883.CrossRefGoogle ScholarPubMed
Linn, M., Gurel, L., Williford, O., et al (1985) Nursing home care as an alternative to psychiatric hospitalisation. Archives of General Psychiatry, 42, 544551.Google Scholar
Mahoney, J. (1988) Finance and government policy. In Community Care in Practice (eds Lavender, A. & Holloway, F.). Chichester: Wiley.Google Scholar
Maj, M. (1985) Brief history of Italian psychiatric legislation from 1904 to the 1978 reform act. Acta Psychiatrica Scandinavica (supplement 316), 1525.Google Scholar
Mangen, S. (1988) Implementing community care: an international perspective. In Community Care in Practice (eds Lavender, A. & Holloway, F.). Chichester: Wiley.Google Scholar
Mann, S. & Cree, W. (1976) ‘New’ long-stay psychiatric patients: a national sample survey of fifteen mental hospitals in England and Wales 1972/3. Psychological Medicine, 6, 603616.Google Scholar
Marks, B. (1988) Social security benefits for the mentally ill. British Medical Journal, 297, 1148.Google Scholar
Marks, I., Connolly, J. & Muijen, M. (1988) The Maudsley Daily Living Programme. Bulletin of the Royal College of Psychiatrists, 12, 2224.CrossRefGoogle Scholar
Martin, L. (1984) Hospitals in Trouble. Oxford: Blackwell.Google Scholar
Mechanic, D. (1986) The challenge of chronic mental illness: a retrospective and prospective view. Hospital and Community Psychiatry, 37, 891896.Google Scholar
Mechanic, D. & Aiken, L. (1987) Improving the care of patients with chronic mental illness. New England Journal of Medicine, 317, 16341638.Google Scholar
Mendal, W. (1979) Staff burn-out: diagnosis, treatment and prevention. In New Directions for Mental Health Services: Community Support Systems for the Long-Term Patient, No. 2 (ed. Stein, L.). San Francisco: Jossey-Bass.Google Scholar
Miller, A. (1985) Deinstitutionalisation in retrospect. Psychiatric Quarterly, 57, 160171.Google Scholar
Minkoff, K. (1987) Beyond deinstitutionalisation: a new ideology for the post deinstitutional era. Hospital and Community Psychiatry, 38, 945950.Google Scholar
Mirabi, M., Weinman, M., Magnetti, S., et al (1985) Professional attitudes towards the chronically mentally ill. Hospital and Community Psychiatry, 36, 404407.Google Scholar
Mitchell, A. (1985) Psychiatrists in primary health care settings. British Journal of Psychiatry, 147, 371379.Google Scholar
Mollica, R. (1983) From asylum to community. New England Journal of Medicine, 308, 367373.Google Scholar
Mollica, R. (1985) From Antonio Gramsci to Franco Basaglia: the theory and practice of the Italian psychiatric reform. International Journal of Mental Health, 14, 2241.Google Scholar
Monk-Jorgenson, P. (1986) General practitioners' selection of patients for treatment in community psychiatric services. Psychological Medicine, 16, 611619.Google Scholar
Morrisey, J. & Goldman, H. (1984) Cycles of reform in the care of the chronically mentally ill. Hospital and Community Psychiatry, 35, 785793.Google Scholar
Morrisey, J. & Levine, I. (1987) Researchers discuss latest findings, examine needs of homeless mentally ill persons. Hospital and Community Psychiatry, 38, 811812.Google Scholar
Mosher, L. (1983) Radical deinstitutionalisation: the Italian experience. International Journal of Mental Health, 11, 129136.Google Scholar
Murphy, E. (1987) Community care: I. Problems. British Medical Journal, 295, 15051508.Google Scholar
Murphy, E. (1988) Community care: II. Possible solutions. British Medical Journal, 296, 68.Google Scholar
Newcombe, R. (1988) Evaluation of treatment effectiveness in psychiatric research. British Journal of Psychiatry, 152, 696698.Google Scholar
Nunnally, J. (1961) Popular Conceptions of Mental Health. New York: Holt, Rhinehard & Winston.Google Scholar
Pepper, B. (1987) A public policy for the long-term mentally ill: a positive alternative to reinstitutionalisation. American Journal of Orthopsychiatry, 57, 452457.CrossRefGoogle Scholar
Pepper, B., Kirschner, M. & Rylewicz, H. (1981) The young adult chronic patient: overview of a population. Hospital and Community Psychiatry, 32, 463469.Google Scholar
Perris, C. & Kemali, D. (1985) Focus on the Italian psychiatric reform: an introduction. Acta Psychiatrica Scandanivica, 71 (Supplement 316), 914.Google Scholar
Peterson, C. (1986) Changing community attitudes toward the chronic mentally ill through a psychosocial program. Hospital and Community Psychiatry, 37, 180182.Google Scholar
Priest, R. (1976) The homeless person and the psychiatric services. British Journal of Psychiatry, 128, 128136.Google Scholar
Pryor, M. & Distefano, M. (1986) Follow-up of participants in vocational rehabilitation program at a state hospital. Hospital and Community Psychiatry, 37, 12611262.Google Scholar
Rachlin, S. (1976) The case against closing state hospitals. In State Mental Hospitals: What Happens When They Close? (eds Ahmed, S. & Plog, P.). New York: Plenum.Google Scholar
Rawnsley, K. (1986) British and Italian psychiatric care. Journal of The Royal Society of Medicine, 79, 626.Google Scholar
Rosenblatt, A. (1984) Concepts of the asylum in the care of the mentally ill. Hospital and Community Psychiatry, 35, 244250.Google Scholar
Rothman, D. (1971) The Discovery of the Asylum. Boston: Little, Brown and Company.Google Scholar
Royal College of Psychiatrist (1987) A carer's perspective: consensus on caring for the mentally disordered in our communities. Bulletin of the Royal College of Psychiatrists, 11, 237239.Google Scholar
Royal College of Psychiatrists (1988) A carer's perspective. Bulletin of the Royal College of Psychiatrists, 11, 237239.Google Scholar
Schulberg, H. & Bromet, E. (1981) Strategies for evaluating the outcome of community services. American Journal of Psychiatry, 138, 930935.Google Scholar
Schwartz, C., Myers, J. & Astrachan, M. (1974) Psychiatric labelling and the rehabilitation of the mental patient. Archives of General Psychiatry, 31, 329334.Google Scholar
Scull, A. (1979) Museums of Madness. London: Allen Lane.Google Scholar
Scull, A. (1984) Decarceration (2nd edn). Cambridge: Polity.Google Scholar
Scull, A. (1985) Deinstitutionalisation and public policy. Social Science and Medicine, 5, 545552.CrossRefGoogle Scholar
Sharfstein, S. (1978). Economics and the chronic mentally ill. Schizophrenia Bulletin, 4, 399414.Google Scholar
Shepherd, G. (1984) Institutional Care and Rehabilitation. London: Longman.Google Scholar
Shugar, G., Smith, I., Katz, G., et al (1986) Moving experiences: a model for inpatient transfer based on interviews with patients and their families. Hospital and Community Psychiatry, 37, 10351040.Google Scholar
Social Services Committee (1985) 1984/85 Session, second report: Community care with special reference to adult mentally ill and mentally handicapped people. London: HMSO.Google Scholar
Solomon, P., Gordon, B. & Davis, J. (1986) Reconceptualising assumptions about community mental health. Hospital and Community Psychiatry, 37, 708712.Google Scholar
Stein, L. & Test, M. (1980) Alternative to mental hospital treatment. Archives of General Psychiatry, 37, 392397.Google Scholar
Strathdee, G. & Williams, G. (1984) A survey of psychiatrists in primary care: the silent growth of a new service. Journal of the Royal College of General Practitioners, 34, 615618.Google ScholarPubMed
Sturt, E. & Wykes, T. (1987) Assessment schedules for chronic psychiatric patients. Psychological Medicine, 17, 485493.CrossRefGoogle ScholarPubMed
Talbott, J. (1978) The Death of the Asylum. New York: Grune & Stratton.Google Scholar
Talbott, J. (1984) The need for asylum, not asylums. Hospital and Community Psychiatry, 35, 209209.Google Scholar
Tansella, M. (1986) Community psychiatry without mental hospitals — the Italian experience: a review. Journal of the Royal Society of Medicine, 79, 664669.Google Scholar
Tansella, M., De Salvia, D. & Williams, P. (1987) The Italian psychiatric reform: some quantitative evidence. Social Psychiatry, 22, 3748.Google Scholar
Tantam, D. (1985) Alternatives to psychiatric hospitalisation. British Journal of Psychiatry, 146, 14.Google Scholar
Tantam, D. & Klerman, G. (1979) Patient transfer from one clinician to another and dropping out of out-patients treatment. Social Psychiatry, 14, 107113.Google Scholar
Tessler, R. & Goldman, H. (1982) The Chronic Mentally Ill, Assessing the Community Support Program. Cambridge: Ballinger.Google Scholar
Test, M. & Stein, L. (1980) Alternative to mental hospital treatment: III. Social cost. Archives of General Psychiatry, 37, 409412.Google Scholar
Thornicroft, G. (1988) Progress towards DHSS targets for community care. British Journal of Psychiatry, 153, 257258.Google Scholar
Tooth, G. & Brooke, E. (1961) Trends in mental hospital population and their effect on future planning. Lancet, i, 710713.Google Scholar
Torrey, E. (1986) Continuous treatment teams in the care of the chronic mentally ill. Hospital and Community Psychiatry, 37, 12431247.Google Scholar
Towell, D. & McAusland, T. (1984) Managing psychiatric services in transition. Health and Social Services Journal, 25, 18.Google Scholar
Trute, B. & Loewen, A. (1978) Public attitude toward the mentally ill as a function of prior personal experience. Social Psychiatry, 13, 7984.Google Scholar
Wasow, M. (1986) The need for asylum for the chronically mentally ill. Schizophrenia Bulletin, 12, 162167.Google Scholar
Watts, F. & Lavender, A. (1987) Rehabilitation: investigation and treatment. In A Handbook of Clinical Adult Psychology (eds Lindsey, S. & Powell, G.). Aldershot: Gower.Google Scholar
Weinstein, R. (1979) Patient attitudes toward mental hospitalisation: a review of quantitative research. Journal of Health and Social Behaviour. 20, 237258.Google Scholar
Weisbrod, B., Test, M. & Stein, L. (1980) Alternative to mental hospital treatment. Archives of General Psychiatry, 37, 400405.Google Scholar
Weisman, G. (1985) Crisis-oriented residential treatment as an alternative to hospitalisation. Hospital and Community Psychiatry, 36, 13021305.Google Scholar
Weller, B., Weller, M., Coter, R., et al (1987) Crisis at Christmas 1986. Lancet, i, 553554.Google Scholar
Wilkinson, G. (1988) I don't want you to see a psychiatrist. British Medical Journal, 297, 11441145.Google Scholar
Wilkinson, G., Falloon, I. & Sen, B. (1985) Chronic metal disorders in general practice. British Medical Journal, 291, 13021304.CrossRefGoogle Scholar
Wilkinson, G., & Freeman, H. (1986) The Provision of Mental Health Services in Britain: The Way Ahead. London: Gaskell.Google Scholar
Williams, P., De Salvia, D. & Tansella, M. (1986) Suicide, psychiatric reform, and the provision of psychiatric services in Italy. Social Psychiatry, 21, 8995.Google Scholar
Wing, J. (1960) Pilot experiment in the rehabilitation of long-term hospialised male schizophrenic patients. British Journal of Preventative and Social Medicine, 14, 173180.Google Scholar
Wing, J. (1971) How many psychiatric beds? Psychological Medicine, 1, 189190.CrossRefGoogle ScholarPubMed
Wing, J., (ed.) (1982) Long-term community care: experience in a London borough. Psychological Medicine Monograph (Supplement).Google Scholar
Wing, J. & Brown, G. (1970) Institutionalism and Schizophrenia. Cambridge: Cambridge University Press.Google Scholar
Wing, J. & Furlong, R. (1986) A haven for the severely disabled within the context of a comprehensive psychiatric community service. British Journal of Psychiatry, 149, 449457.CrossRefGoogle ScholarPubMed
Wing, J., Sturt, E. & Creer, C. (1985) The assessment of patients' needs for community care. Social Psychiatry, 20, 7586.Google Scholar
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