Innovation in deinstitutionalization: A WHO expert survey
The majority of literature and research suggests that community-based services are effective and guided by evidenced-based principles. However, in practice, community-based services are still only sparsely used for providing mental health treatment and care. Many countries classified as having low to middle socioeconomic statuses have limited mental health funds, and those funds are put toward managed care in hospital settings, rather than in preventive or community-based care, resulting in the maintaining of an institutionalized form of care. In 2014, the World Health Organization (WHO) Department of Mental Health and Substance Abuse conducted a survey of experts in mental health to discern potential barriers to the use of community-based services in these countries. Approximately 78 identified mental health experts representing 42 countries agreed to participate in a survey related to the usefulness of different community-based mental health service approaches to care.
In Box 1, “Historical Country Examples of Poor Institutional Quality Care,” how many hospitals had clinical psychologists and psychiatric social workers on staff for patient care?
A.
B.
C.
D.
Question
2
Which of the following is not an identified principle for deinstitutionalization?
A.
B.
C.
D.
Which of the following is not an identified principle for deinstitutionalization?
Question
3
According to the main findings of the survey of experts, which of the following was not rated in the top five useful methods of downsizing institutional care?
A.
B.
C.
D.
According to the main findings of the survey of experts, which of the following was not rated in the top five useful methods of downsizing institutional care?
Question
4
What is the global and community impact when mental health budgets are predominantly focused on institutional care?
One possible answer might be the presence of a limited number of community agencies and resources, as well as decreased training and advancement of personnel.
Question
5
Many of the institutional care facilities in these low to middle socioeconomic status countries as described as inhumane and are in violation of a number of human rights in the description in Box 1 of the article. Briefly identify one such example in the survey report and discuss at least three factors related to the quality of care noted in the Qualitative Results section of the report.
One possible answer might be the Accra Psychiatric Hospital in Ghana. There are 300 men in cells designed for 50 men; there is no access to treatment, the staff is not trained, and patients are frequently beaten.