Between 1955 and 1985 the United States reduced the population confined in its public mental hospitals from around 600,000 to less than 110,000. This dissertation provides a novel analysis of the movement that advocated for psychiatric deinstitutionalization. To do so, it reconstructs the unfolding setting of the movement’s activity historically, at a number of levels: namely, (1) the growth of private markets in the care of mental illness and the role of federal welfare policy; (2) the contested role of states as actors in driving the process by which these developments effected changes in the mental health system; and (3) the context of relevant events visible to contemporaries. Methods of computational text analysis help to reconstruct this social context, and thus to identify the closure of key opportunities for movement action. In so doing, the dissertation introduces an original method for compiling textual corpora, based on a word-embedding model of ledes published by The New York Times from 1945 to the present. The approach enables researchers to achieve distinct, but equally consistent, actor-oriented descriptions of the social world spanning long periods of time, the forms of which are illustrated here. Substantively, I find that by the early 1970s, the mental health system had disappeared from public view as a part of the field of general medicine — and with it a target around which the existing movement on behalf of the mentally ill might have effectively reorganized itself. Drawing together the case and the method, conceptually, is the idea of a standpoint: a framework within which objects obtain significance.

published_or_final_version / Mental Health / Master / Master of Social Sciences

Aim: The aim of this study was to explore the lived experiences of reintegration into the community of mental health care users in the Libode district. Methodology: A phenomenological approach was used in this study to explore the lived experiences of reintegration into the community of mental health care users. It describes the feelings experienced by mental health care users concerning their reintegration into the community, and explores barriers to their reintegration into the community. The study was conducted in the Libode mental health clinic in the Libode district. A total of six participants volunteered to participate in the study. The interviews were audio-taped then transcribed. The data were manually analysed using Tesch’s approach of phenomenological analysis. Findings: The results of the study revealed that the participants were not living independent lives following their discharge from the mental health institution. The evidence suggests that the environment is not conducive to meeting the needs of mental health care users. They lack support from families and communities which impacted on them negatively, contributing to the high relapse and readmission rate. This study explores the barriers to their reintegration into the community such as the following: poor medication compliance, lack of vocational skills, unemployment, substance abuse, stigma and discrimination which were the main barriers to their reintegration into the community. The study consequently makes recommendations for practice and policy which can contribute to an improved quality of service delivery. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2010.

Thesis (MPhil (Sociology and Social Anthropology))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: South Africa has transformed its mental health service provision from in-hospital care to community-based rehabilitation. Although the idea is sound, the process places the caregiving families under an immense pressure. The aim of this study was to explore the impact that the de-institutionalisation process has had on the families as they care for their child with intellectual disability. The study was conducted by means of qualitative, unstructured interviews with families that have had a child de-institutionalised from Alexandra Hospital in the Western Cape. All of the patients were diagnosed with a dual diagnosis of intellectual disability and mental illness. Even though the patients were in group-homes or attended a day care centre, final responsibility for the patients lay with the parents. Three main themes emerged from the interviews that describe the impact of deinstitutionalisation, viz. the characteristics of the family member with intellectual disability (aggressive, abusive and self-destructive behaviour of the patient), the effect that these characteristics had on the family (marital stress and health risks to the care giver), and community and resource factors. The study placed the family central to its environment and discussed the impact deinstitutionalisation had on its environment as a whole. It was concluded that the burden that de-institutionalisation places on the families far exceeded their ability to cope with these circumstances. This status quo could be improved if adequate resources and skills are given to families prior to de-institutional / AFRIKAANSE OPSOMMING: In Suid-Afrika is geestesgesondheidsorg van hospitaliserende na gemeenskapsgebaseerde rehabilitasie, omskep. Terwyl hierdie stap wel as lewensvatbaar mag voorkom, plaas die proses ‘n hewige las op die sorggewende gesin. Die doel van hierdie studie was om die omvang van die impak hiervan op ‘n gesin met ’n lid met intellektuele gestremdheid en psiegiatriese siekte, te bepaal – nadat so ‘n pasient uit die inrigting ontslaan is. Die ondersoek is uitgevoer by wyse van kwalitatiewe, ongestruktureerde onderhoude met gesinne wie se lede met die diagnose uitgeplaas is deur die Alexandra Hospitaal in die Wes-Kaap. Elkeen van die pasïente is gediagnoseer met ernstige intellektuele gestremdheid, asook bykomende gedragsafwykings. Ten spyte van die feit dat die betrokke pasïente deur groepshuise of dagsorg eenhede versorg word, bly hulle hul ouers se verantwoordelikheid. Drie temas het ontstaan wat die impak van ontslag uit die inrigting omskryf, te wete die karaktertrekke van die gestremde gesinslid (aggressie, misbruikende en vernielsugtige gedrag van die pasïent), die effek van hierdie karaktertrekke op die gesin (stres op die huwelik en potensiële gesondheidsrisiko wat dit vir die versorger inhou), en die gemeenskap en ondersteunende faktore. Tydens die ondersoek is die gesin sentraal geplaas ten opsigte van die omgewing. Die impak van ontslag van die gediagnoseerde pasïent uit die inrigting op die omgewing as geheel, word bespreek. Daar is tot die slotsom gekom dat die vermoë van die gesin wat die las moet dra as gevolg van die ontslag, ver oorspan word. Hierdie toedrag van sake sou egter verlig kon word indien toereikende hulpbronne en vaardighede aan sulke gesinne beskikbaar gestel word alvorens so ‘n pasïent ontslaan is.