Title page for ETD etd-07042012-073819


Type of Document Master's Thesis
Author Lee Pow, Joni Maria
Author's Email Address jonileepow@gmail.com
URN etd-07042012-073819
Title The Occurrence and Effectiveness of Deinstitutionalization of the Mentally Ill in the Pre-antipsychotic Era
Degree Master of Arts (M.A.)
Department Psychology
Advisory Committee
Advisor Name Title
Baumeister, Alan Committee Chair
Cohen, Alex S Committee Member
Garand, James C Committee Member
Hawkins, Mike F Committee Member
Keywords
  • community psychiatry
  • readmissions
  • discharges
  • chlorpromazine
  • outpatient care
  • family care
Date of Defense 2012-06-20
Availability unrestricted
Abstract
Deinstitutionalization, as it occurred after the introduction of antipsychotics in 1954 has received much attention. However, little has been done to examine the occurrence and nature of deinstitutionalization before 1954. This study uses US census data on discharge and readmission rates of US mental hospitals from 1935 to 1964 to examine deinstitutionalization during both periods. Data are analyzed using an interrupted time-series model. The model was used to test for statistical significance of trends before and after the advent of antipsychotics, and to test for an effect of antipsychotics on deinstitutionalization. Discharge rates significantly increased in the period before antipsychotics, indicating that deinstitutionalization began before the introduction of these drugs. However, during this period, readmissions also increased significantly and there was no significant difference between discharge and readmissions rates, suggesting that community-based resources and services were inadequate (ineffective). Both discharges and readmissions increased significantly during the post-antipsychotic period with discharges being significantly higher than readmissions. These findings indicated that antipsychotics accelerated deinstitutionalization. Although state mental hospital population was reduced, reports of the disastrous outcome of deinstitutionalized patients suggest that either the drugs were ineffective in enabling patients to function in the community and/or that community-based services remained inadequate. This study also found that the increase in outpatient clinics after the introduction of drugs was less than the increase in discharges. These data suggest that as deinstitutionalization proceeded, the disparity between the resources necessary for successful integration into the community and the actual level of community-based support grew. It is concluded that deinstitutionalization as a public health policy failed, and that this failure was due both to a less than adequate efficacy of the drugs and to insufficient community-based support.
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