Deinstitutionalisation for long-term mental illness: an ethnographic study.
OBJECTIVE
Deinstitutionalisation of seriously mentally ill people in the developed world, including Australia, has occurred since the middle of this century. Evaluation of the effects of this change on the lives of individuals is of paramount importance to ensure that policies are acceptable and effective. Increasingly, multifaceted studies are considered essential for comprehensive health research. The qualitative aspect of this study complements the clinical and economic components.


METHODS
An ethnographic approach enabled contextual, qualitative data to be gathered from within the social world of 47 hospital residents as they moved to the community. A social anthropologist acting explicitly as a participant observer undertook fieldwork over two and a half years both pre- and post-discharge. Qualitative data were collected, stored and analysed separately from quantitative and economic data.


RESULTS
Ethnographic findings generally supported and, in many cases, mirrored clinical results. Of the total cohort of 47 patients transferred to the community, the 40 who continue to live outside of hospital all reported a preference for community living. The importance of freedom and simple liberties cannot be underestimated as factors that enabled this resilient group of people to work creatively through difficult periods.


CONCLUSIONS
Properly planned and resourced deinstitutionalisation not only maintains people with a prolonged mental illness outside of hospital, it also enhances their quality of life. Subjective descriptive material focusing on personal experiences adds meaning to quantitative research data allowing health professionals to more fully understand the implications of health policy on the lives of individuals.
Newton
L
L
Department of Psychological Medicine, University of Sydney, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Rosen
A
A
Tennant
C
C
Hobbs
C
C
Lapsley
H M
HM
Tribe
K
K
D000883:Anthropology / Q000379:methods; D001315:Australia; D003688:Deinstitutionalization; D005500:Follow-Up Studies; D006760:Hospitalization; D006778:Hospitals, Psychiatric; D006801:Humans; D007902:Length of Stay; D001523:Mental Disorders / Q000534:rehabilitation*; D011788:Quality of Life