Ethical aspects of deinstitutionalization in mental health care and deinstitutionalization issues.
This study focuses on the ethical dilemmas posed by deinstitutionalization in mental health care. Deinstitutionalization is a process involving three elements: a) the move of institutional patients to the community b) the concurrent expansion of community-based services for the treatment of these individuals c) the avoidance of traditional institutional settings for the care of the mentally ill.
This study focuses on the ethical dilemmas posed by deinstitutionalization in mental health care. Deinstitutionalization is a process involving three elements:
a) the move of institutional patients to the community;
b) the concurrent expansion of community-based services for the treatment of these individuals
c) the avoidance of traditional institutional settings for the care of the mentally ill. Increasingly, people with severe mental health problems live in the community -whether in their own homes or in (semi-) residential care - rather than in psychiatric hospitals. Deinstitutionalization takes place all over Europe, although the way this transformation of mental health care is realized differs considerably between countries. The five countries who participate in this study (The Netherlands, Greece, Belgium, Italy, England) vary in the pace of deinstitutionalization, in their regulations of this process, in the organization and the intensity of the community based services and in the way the (unintended) consequences of deinstitutionalization are viewed and discussed.
The project has the following three objectives:
1. To gain insight in the state of the art of deinstitutionalization in the participating countries and in professional and community attitudes regarding the social integration of people with mental health problems;
2. To clarify and discuss the major ethical dilemmas surrounding deinstitutionalization, notably with regard to people with severe mental disorders, such as the duty to protect the welfare of the patient versus the duty to protect other citizens (their family, people living in the community) the respect for the principle of autonomy versus the respect for the principle of benevolence; autonomy of patients versus enforcement of societal views, care versus abandonment;
3. To provide tools for stimulating the moral debate in member states on ethical dilemmas concerned. Working contacts have been established in order to compare data on the deinstitutionalization programmes and to realize the other objectives of this study. Non-participating member states will be informed about the project by means of a Newsletter and can participate at the final Round Table Conference. This European project on deinstitutionalization issues aims at the identification of the major ethical dilemmas in the participating countries, the analysis of the cultural differences and similarities in these dilemmas and in the solutions presented for them. Key words Deinstitutionalization; professional ethics; community integration of people with severe mental health problems; conflicts of values and interests.