There is an ongoing trend in Western societies, including Australia, to move people with developmental disabilities out of institutions and into community based accommodation. When deinstitutionalisation occurs it impacts not only on the person with a disability but on their significant others and also on the organisation/s providing them with support. While government departments and support organisations say that they involve family members in deinstitutionalisation, little previous research has focussed on family members’ experiences of deinstitutionalisation to know if it is an engaging and empowering experience for them. Most previous studies of deinstitutionalisation, where they have spoken to significant others, have focussed on their perceptions of the benefits or disadvantages of deinstitutionalisation for their son or daughter with a disability directly rather than considering how it impacted upon the significant others. I identified this as a gap in our current knowledge and set out through this study to find out what deinstitutionalisation was like from the viewpoint of some significant others involved in it My research methodology was informed by a Symbolic Interactionist approach whereby I wished to investigate the meaning attached by significant others to the process and the outcomes of deinstitutionalisation through in depth interviews The application of selective coding procedures led to the development of the core category - for some significant others devolution is a disempowering process. This is a different viewpoint to that expressed in the majority of studies of devolution. In considering why this study revealed a different story, I identified through the data and from reviewing the available international literature, that deinstitutionalisation rekindles feelings of guilt regarding the decision to place their child in an out-of-home placement. Application of these principles might result in Empowering Partnerships which would in turn benefit all three players. I translated the three major categories and five principles into a Model of Empowering Partnerships in Devolution. / Master of Arts (Hons)

This thesis examined the social competency and affective functioning of people with mild intellectual disabilities through salient variables that impact on people with disabilities who have been deinstitutionalised. Its primary purpose was to extend the previous research on the impact of deinstitutionalisation by incorporating multi-dimensional self-concept, adaptive behaviour and quality of life, in combination with self esteem and locus of control, in longitudinal/comparison design. It is also aimed to examine the development of identity, self-esteem and social competencies from a qualitative perspective. Finally it assessed the efficacy of an interpersonal cognitive problem-solving intervention which incorporated techniques for the development of maintenance and generalisation and determined the impact of this intervention on real-life social behaviours. The findings have important implications for current theory of the self-concept for people with intellectual disabilities, the provision of programs and techniques to improve self-concept, and also for the provision of social skills programs to enhance the social competencies and the social integration for people who have been deinstitutionalised. / Doctor of Philosophy (PhD)

Thesis (Ph. D.)--University of Queensland, 2001. / Includes bibliographical references.

Despite broader trends toward the deinstitutionalization of people with intellectual disabilities and evidence that they have a higher quality of life in the community, many in Nova Scotia remain segregated in institutional settings. In response, this thesis examines the reasons why people with intellectual disabilities are institutionalized in the province, and the barriers that exist to embracing policies of deinstitutionalization. Through participant observation, document analysis, and qualitative interview research, several themes emerged regarding the social, economic, and political factors, as well as the conflicting beliefs among implicated community members, contributing to the continued existence of institutions. Drawing on an institutional ethnography approach, this thesis examines how these factors and beliefs are related to neo-liberal philosophies and broader ideological beliefs about disability.

This dissertation presents a discussion of life in the community for people experiencing psychiatric disabilities in the post-deinstitutional era, with the goal of developing knowledge that can suggest a focus for planning more relevant services and supports. While evaluations of deinsitutionalization have focused on possibilities for providing community, rather than hospital-based services for these individuals, the intention was to support a participatory life in the community, a life defined by much more than just care and treatment. The Mental Health Care Reform of 1995 in Sweden paved the way for this more community-based view of needs related to psychiatric disabilities, as local social services became responsible for supports to a participatory life, “like all others”.  The general aim of this dissertation was to explore and analyze the results of a series of surveys of psychiatric disability, in order to develop knowledge of the social context of the lives which individuals experiencing these disabilities live in the community. More specifically, the aim was to; • describe contacts/interactions between these individuals and the societal organisations with which they seek services or support. • describe characteristics and needs of the individuals identified in these studies as expressed by representatives of the helping system and users who participated in the studies. • develop knowledge of the mechanisms involved in these patterns of seeking support by exploring and analyzing the empirical results within the context of theoretical (social) approaches to understanding psychiatric disability. The findings of this research are based on an analysis of the quantitative and qualitative results of three studies involving seven municipalities in northern Sweden. Of the 2385 individuals who personnel identified as meeting the criteria for a serious psychiatric disability, approximately half did not have active contact with the formal mental health system. They did however seek services, supports and opportunities that they saw as relevant to their lives and needs as community members. These included health, housing and financial assistance as well as opportunities for education and employment. Various mechanisms operating in the community, including stigmatizing attitudes, exclusionary practices and organizational systems and rules, were seen by respondents as obstacles to these individuals developing meaningful and participatory roles. Social approaches, when utilized to explore and understand issues regarding psychiatric disability in the community, support a focus on the social landscape in which ndividuals experience disability-related needs, as well as the dynamics of the disability experience. While in the deinstitutional era, needs were assessed relative to the individual’s relationship to the psychiatric care system, in the post-deinstitutional era, they should be assessed from a participation-relative perspective, where their position as community member, rather than as patient or client, describes the social location of need. Specialized support to general community resources and services in addition to psychiatrically defined supports, would likely reach many, especially younger individuals who might otherwise become seriously disabled.

Thesis (Ph.D.)--University of Wollongong, 2002. / Typescript. Includes bibliographical references.

Made available in DSpace on 2014-12-17T14:47:03Z (GMT). No. of bitstreams: 1 TayssaSCP_DISSERT.pdf: 2247123 bytes, checksum: 1a79620a43fcdfd76a6bad9a24908960 (MD5) Previous issue date: 2013-12-12 / The Brazilian Psychiatric Reform proposes creating linkages / interactions of the mentally ill with civil society , through promoting citizenship and assistance to the mentally ill. The deinstitutionalization of mental health advocates from the guidelines decreased supply of hospital beds and consequently the creation of substitute services for psychosocial care, especially with regard to therapeutic practices emancipatory. From this scenario, the present study aims to investigate the relevance and challenges of the process of nursing work in CAPS III in Natal / RN. It is descriptive research with a qualitative and exploratory. The subjects are employees of the nursing team in CAPS III East of Natal / RN. This service has actions for the psychosocial care of the subjects treated with daily multidisciplinary care by behaving the length of treatment and follow-up activities, industrial and cultural activities. Employ the semi-structured interview as a tool for data collection. The data analysis was done by means of thematic analysis proposed by Bardin. Thus, this sought to bring to the discussion of how this process is consolidated in the daily service. Thus, purposed to contribute to the debate on deinstitutionalization in psychosocial care as a guideline in the process of mental health nursing work in a CAPSIII, Natal / RN / A Reforma Psiqui?trica brasileira prop?e a cria??o de v?nculos/intera??es do doente mental com a sociedade civil, por meio do resgate da cidadania e da assist?ncia ao doente mental. A desinstitucionaliza??o em sa?de mental preconiza a partir de diretrizes a diminui??o da oferta de leitos hospitalares e consequentemente, a cria??o de servi?os substitutivos de aten??o psicossocial, principalmente, no que tange ?s pr?ticas terap?uticas emancipadoras. A partir desse cen?rio o presente estudo tem como objetivo investigar a atualidade e os desafios do processo de trabalho da enfermagem nos CAPS III no munic?pio de Natal/RN. Trata-se de pesquisa do tipo descritiva com abordagem qualitativa e de car?ter explorat?rio do tipo estudo de caso. Os sujeitos s?o trabalhadores da equipe de enfermagem do CAPS III Leste de Natal/RN. Este servi?o possui a??es voltadas para a aten??o psicossocial dos sujeitos atendidos, com atendimento di?rio pela assist?ncia multiprofissional, comportando a extens?o de atividades de tratamento e acompanhamento, atividades laborais e culturais. Emprega-se a entrevista semiestruturada como instrumento de coleta de dados. A an?lise de dados se fez por meio da An?lise Tem?tica proposta por Bardin. Assim, o presente buscou trazer ? discuss?o de como esse processo se consolida no cotidiano do servi?o. Desta forma, intencionou-se contribuir para o debate sobre a desinstitucionaliza??o na aten??o psicossocial como diretriz da sa?de mental no processo de trabalho de enfermagem em um CAPSIII, Natal/RN

O presente trabalho tem como objetivo problematizar a itinerância como um modo de operacionalizar o cuidado no território. Com a emergência do Sistema Único de Saúde a noção de território se tornou um princípio organizador dos processos de trabalho nas políticas de Atenção Básica e Saúde Mental. No campo delicado de articulação entre estas políticas, as práticas itinerantes passaram a ter uma importância estratégica na desinstitucionalização das práticas e na construção da integralidade do cuidado. Tomamos a desinstitucionalização e a integralidade como os operadores conceituais que marcam a diferença que as reformas Psiquiátrica e Sanitária pretendem imprimir nas práticas de cuidado. Advertimos que ao ingressar numa postura de busca ativa no território de vida dos usuários, as práticas itinerantes se inserem num campo de tensões, no qual podem tanto ser convocadas a funcionar como uma peça do aparelho de Estado no controle da população, como se situar num lugar estratégico para a construção de um cuidado contextualizado aos modos de vida dos usuários. Defendemos que é possível resistir ao mandato social de controle e construir uma ética do cuidado com a itinerância ao explorar a potência política do movimento e transformar o território dos usuários num laboratório de invenção de vida. / This work aims to problematize the itinerancy as a way to operationalize the care in the territory. The emergence of the Sistema Único de Saúde the notion of territory has become an organizing principle of work processes in the policies of primary health care and mental health. In the delicate field of coordination between these policies, itinerant practices now have a strategic importance in the deinstitutionalization of practices and the construction of the integrality of care. We take the deinstitutionalization and integrality as conceptual operators that make the difference that Psychiatric and Health reforms want to print in the care practices. Warned that by joining in a posture of active search in the life territory of users, the itinerant practices fall in a field of tensions, which can both be called to work as a part of the State apparatus to population control, as in a strategic place for the construction of a carefully contextualized to life ways of users. We believe that is possible to resist the social control mandate and build an ethic of care with itinerancy to explore the political power of the movement and transform the territory of the users in a laboratory for life invention.

Esta dissertação constitui-se em uma produção de narrativas de viagem pelas ruas, trilhos e águas da Saúde Mental Coletiva a partir das experiências da narradora, na cidade de Porto Alegre. Valendo-se de sua trajetória singular de formação em Saúde Mental, a artista propõe um olhar curioso sobre a Reforma Psiquiátrica e a inserção do fazer teatral neste campo, a fim de constituir formas de inclusão da loucura na cidade e contribuir com processos de desinstitucionalização. Para fundamentar este percurso, utiliza os conceitos de Zona Autônoma Temporária, Nomadismo Psíquico e Biopolítica, bem como, apresenta ao campo da Saúde Coletiva um pouco da teoria teatral a fim de produzir intercessões entre arte, ciência e filosofia. A partir de sua participação no grupo de teatro Nau da Liberdade, que é composto por usuários, trabalhadores e estudantes da Saúde Mental, a narradora analisa a cena teatral contemporânea e propõe uma maneira de pensar a desinstitucinalização através da inserção cultural e da noção pertencimento a um bando. / This work consists in a production of travel stories through the streets, trails and waters of Collective Mental Health, from the teller’s experiences, in the city of Porto Alegre. Drawing on her unique career training in Mental Health, the artist proposes a curious look on the Psychiatric Reform and the insertion of theater acting in this field, in order to constitute forms of inclusion of madness in the city and to contribute to processes of deinstitutionalization. To support this route, she uses the concepts of Temporary Autonomous Zone, Psychic Nomadism and Biopolitics, and presents some of theater theory to the field of Public Health, aiming to create intersections between art, science and philosophy. From her participation in the theater group Ship of Freedom, which is composed of members, employees and students of Mental Health, the narrator examines the contemporary theater scene and proposes a way of thinking deinstitutionalization through the ideas of cultural inclusion and belonging to a band.

O presente trabalho objetiva evidenciar os efeitos da heterocisonormatividade na vida de sujeitos não heterossexuais e não cisgêneros que têm suas trajetórias existenciais marcadas pela injunção crime-loucura. Para tanto, explora os processos penais que delimitam a vida das pessoas em sofrimento mental que cometeram crimes, os chamados pacientes judiciários, que recebem uma medida de segurança. Utilizando-se da genealogia como aporte metodológico, adentra-se nas condições de proveniência e de emergência do "anormal", figura produzida e capturada pelo discurso médico-jurídico através de um longo processo da psiquiatrização do desejo e da sexualidade que ocorreu ao longo do século XIX até os dias de hoje. Legitimada a partir de uma determinada racionalidade científica, tal trama discursiva criminaliza moralmente as expressões da sexualidade e de gênero, colando-as entre si, para lançá-las no campo da abjeção O estudo foi composto por duas estratégias de aproximação do campo de pesquisa: 1) narrativas produzidas a partir do cotidiano de um programa de desinstitucionalização de pacientes judiciários ao qual o pesquisador encontra-se vinculado; 2) seis peças judiciais, com ênfase nos laudos psiquiátricos, de pessoas não heterossexuais e/ou não cisgêneras que receberam uma medida de segurança. A análise do material recolhido permite verificar que a base teórico-conceitual da presunção de periculosidade na qual se sustenta a tese da medida de segurança objetifica-se no laudo psiquiátrico. Tal engrenagem médico-jurídica aponta para uma valoração moral com que as expressões da sexualidade e de gênero do paciente judiciário considerado "desviante" são avaliadas. Por fim, sinalizam-se alternativas de produção de novos modelos de tratamento para o paciente judiciário, que buscam superar a ficção da presunção de periculosidade como base pretensamente científica, revisar a inimputabilidade como dispositivo jurídico que viola direitos inalienáveis dos sujeitos e, por fim, incluam as diretrizes da reforma psiquiátrica brasileira entre as garantias de acesso à saúde a todo cidadão. / The present study aims to show the effects of heterocisnormativity in the life of non-heterosexual and non-cisgender individuals whose existential trajectories are marked by the crime-madness injunction. In order to do so, it explores criminal cases that delimit the lives of people in mental suffering who committed crimes, the so-called judicial patients, who receive a measure of security. Using genealogy as a methodological contribution, it enters the conditions of provenance and emergency of the "abnormal", a figure produced and captured by the medical-legal discourse through a long process of psychiatry of desire and sexuality that occurred throughout the 19th century to the present days. Legitimized from a certain scientific rationality, this discursive plot morally criminalizes the expressions of sexuality and gender, sticking them together, to throw them into the field of abjection The study was composed of two strategies of approximation of the research field: 1) narratives produced from the daily routine of a deinstitutionalization program of judicial patients to which the researcher is linked; 2) six judicial papers, with emphasis on the psychiatric reports, of non-heterosexual and / or of non-cisgender individuals that received a security measure. The analysis of the collected material allows verifying that the theoretical-conceptual basis of the presumption of dangerousness on which the thesis of the security measure is based is objectified in the psychiatric report. Such medical-juridical mechanism expresses a moral valuation with which the expressions of the sexuality and gender of the judicial patient considered "deviant" are evaluated. Finally, alternatives for the production of new models of treatment for the judicial patient, which seek to overcome the fiction of the presumption of dangerousness as a supposedly scientific basis, are reviewed, reviewing the non-attributability as a legal device that violates the inalienable rights of the subjects and, finally, include the guidelines of the Brazilian psychiatric reform among the guarantees of access to health for every citizen.