The Psychiatric Reform
It was not until the end of the 1970s that the embryo of psychiatric reform, highly influenced by the European currents of the time. And the arrival of democracy, opened the way, causing a change and a break with what had happened before. Psychiatric Treatment Center in Lahore.
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Normalization Of the Patient
This process, together with the advancement of nursing knowledge and the attitude of the professionals, favored the transformation of the professional role of the nurse, more oriented towards individual, family and group practices, developing promotion and rehabilitation activities in different areas: hospitalization and community. Attending and trying to satisfy the needs and demands of users based on care, aimed at achieving autonomy and normalization of the patient.
In this psychiatric reform, some autonomous communities bet more decisively. This was the case of where in the last twenty-five years there has been a process of health reform that included mental health. The psychiatric reform officially began in 1984, with the approval by Parliament of Law 9/1984 of July 3, which created the Institute of Mental Health.
Initial Management of The Psychiatric Reform
Operating instrument for the initial management of the psychiatric reform process, which constituted as an autonomous body of an administrative nature, attached to the Ministry of Health, and managed between the eight Provincial Councils.
Purposes Of Institute of Mental Health
The purposes of Institute of Mental Health established by law were:
- Coordinate and integrate all resources related to mental health.
- Stimulate and guide the qualitative and quantitative development of resources for mental health in the n population.
- Legally and functionally prepare the integration of the different public resources related to mental health in the future single and general device for health.
- The general objective of the psychiatric reform was the substitution of traditional care structures for a new system of services that would ensure greater coverage and quality of care for ns’ mental health problems.
- The development of this reform emphasized in the Global Mental Health Program of the World Health Organization (WHO) and in the long-term programs on mental health in Europe, both the development of mental health services based on in the community, such as the integration of mental health care into the general health care system.
- Initiative of the health administration that sought to put an end to the situation of public psychiatric care services, dispersed among five different administrations, unevenly distributed throughout the territory, separated from the rest of the health system, and based mainly on two types of institutions widely criticized for professionals and citizens: the 8 provincial psychiatric hospitals and the 69 outpatient neuropsychiatry consultations of the Social Security.
This transformation has had two fundamental axes:
- The disappearance of the asylum institution.
- The formation of a system of health services.
The disappearance of the asylum institution, socially marginalizing, isolating, stigmatizing and with a high risk of violating Human Rights, which not only does not solve the problems of patients but also aggravates them with its own syndrome –institutionalism– through elements such as: social isolation, overcrowding, indifference to problems and social stigma.
Occupancy Of Beds in Psychiatric Hospitals
90% of the occupancy of beds in psychiatric hospitals was long-term, with an average of 13 years and 25% of patients staying more than 20 years. Therefore, they were “blocked” beds and not available to the population.
Dismantling Of Psychiatric Hospitals
The dismantling of psychiatric hospitals in took place progressively from 1985 to the end of the year 2000. In 1985 there were 2,672 admitted patients, and between this year and 1998 there were 1,729 Hospital Discharges.
In the “dismantling” of psychiatric hospitals during 1993, we can see that almost 29% of resident patients refers to nursing homes, followed by 19% of patients referred to centers for the mentally handicapped and the same percentage of they produced casualties due to death.
The psychiatric reform in concludes with the closure of the Provincial Psychiatric Hospital. Already in the year 1930 it had a structure of a single block built with 6 rooms in total. Later, in 1985, its functional structure consisted of: acute care units, long-stay units (neither of them had patient exits). And open clinics (where patients had therapeutic leave and exits), with a more than 280 beds. The average age of the population that remained in the long-stay regimen was 54 years, with a hospital stay of more than 20 years.
Hospital Discharges of Patients
In 1985, the total number of patients with long and medium stays in the Psychiatric Hospital was more than 200, of which 41% did not have the possibility of hospital discharge and the remaining 58% transfers to nursing homes.
Reduced Their Number of Beds in Psychiatric Hospitals
As psychiatric hospitals reduced their number of beds, it was necessary to develop other care resources in the community that would try to curb admissions and deinstitutionalize the greatest number of patients. From this moment on, the controversy began, some in favor and others against.
In any case, it not understands that the dates scheduled to close a hospital have the sole purpose of ending it, without first having developed an extra-hospital network that would make it unnecessary. The most appropriate attitude would be not to go against hospitalizations per se, but in favor of community care that is as broad and complete as possible. On the other hand, when deinstitutionalization sufficiently plans and managed,
Network Of Mental Health Services
The creation of a network of mental health services was the second important transformation of the psychiatric reform. Greater attention to mental health disorders in the community begins and a better alternative to psychiatric hospitals offers, diversified, and integrated into the network of the General Public Health System to respond to the health and socio-health problems of patients.
Normalization To Patients and Hospital Care
This service network makeup of the following socio-sanitary devices:
Mental Health Units of the General Hospital (USM-HG). They offer inpatient hospital care to patients in crisis situations, whatever the psychiatric pathology they present.
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