Eldercare Service Redesign in Finland: Deinstitutionalization of Long-Term Care

ABSTRACT

Deinstitutionalization is an important trend in the redesign of long-term eldercare in Finland. It refers to a process where traditional institutional care is partly replaced by home care services and the creation of homelike housing units. The first part of this article provides an overview of eldercare service redesign by using national statistics. The second part consists of qualitative analysis of the deinstitutionalization of eldercare. The data consist of 27 interviews conducted among municipal care administrators and is analyzed using thematic and discourse analysis. Main findings show a deep policy change taking place in eldercare deinstitutionalization discourse lying at its center. A distinction between explicit and implicit deinstitutionalization discourse is made. The former clearly states that institutional care needs to be cut back making it possible for all older people to live at home or in homelike housing facilities. Implicit deinstitutionalization discourse is underpinned by comments of a different type, more critical and problem-centered. Within intensive service housing, for instance, fee policy is reformed. The main results include the observation that explicit deinstitutionalization discourse is in line with the national policy aims of putting home first, while implicit discourse deals with hidden or unexpected consequences. The article discusses future research in the conclusion.     

母权神话：“知母不知父”的西方谱系（上）

本文是《“知母不知父”的西方谱系》的上半部分,勾勒了19世纪后半期西方人类学界几位主要的母权论者和母系论者的思想。文章从梅因和库朗热对父权论的讨论开始,考察了麦克伦南、摩尔根和恩格斯对母权社会的讨论,指出,人类学界的母权论是针对古典学界的父权论发出的,并且都将母权时代当作更接近自然但也更原始的阶段,把父权社会当作更文明但也更不平等的历史阶段。     

The end of the asylum (town): community responses to the depopulation and closure of the Saskatchewan Hospital, Weyburn

Never is the fraught relationship between the state-run custodial mental hospital and its host community clearer than during the period of rapid deinstitutionalization, when communities, facing the closure of their mental health facilities, inserted themselves into debates about the proper configuration of the mental health care system. Using the case of Weyburn, Saskatchewan, site in the 1960s of one of Canada's earliest and most radical experiments in rapid institutional depopulation, this article explores the government of Saskatchewan's management of the conflict between the latent functions of the old-line mental hospital as a community institution, an employer, and a generator of economic activity with its manifest function as a site of care made obsolete by the shift to community models of care.     

Unbending the mind: or, commercialized leisure and the rhetoric of eighteenth-century diversion

This essay opens by asking why the formative period in the “commercialization of leisure” in England (c. 1690–1760) happens also to be the period during which intrusion, obstruction, and interruption first began to thrive as conspicuous rhetorical techniques in commercial literature. The essay answers this question through a series of close readings that reveal the complex reciprocity between what I call “cultural diversion” and “discursive diversion,” between those social amusements which provide relief from the serious concerns of daily life and those linguistic and textual devices which characteristically disrupt so much of the discourse of the late seventeenth and early eighteenth century—devices such as extravagant metaphors, rows of asterisked ellipses, and, most pervasively, digressions. Where modern discussion of such devices has tended to rely on the critical touch-stone of “self-consciousness,” this essay restores disruptive rhetoric to what I see as its original cultural context by demonstrating how frequently self-conscious authors associate the form and function of devices like digression with London’s “Reigning Diversions.”     

Policy Changes in Community Mental Health: Interventions and Strategies Used in Sweden over 20 Years

The deinstitutionalization of mental health care has changed the responsibilities of involved authorities and has led to a continuous need for new treatment forms and interventions. This article describes this development in Europe, and in particular how these new conditions have been handled in Sweden over the past 20 years at the level of governmental policy‐making. Three major policy documents from 1994, 2009 and 2012 were included in this study. To increase our understanding of the policies' contents, we have used theoretical concepts concerning governance, implementation and political risk management. Although our main interest was to find out how the government handles interventions for users of the mental health care system, we found that the policy work is progressing stepwise. The first document, from the deinstitutionalization era, did not discuss interventions clearly. Instead, it was mainly concerned with both practical and economical areas of responsibility. The second document, from the post‐deinstitutionalization era, was more focused on what services should be delivered to the users, while the most recently published document to a greater extent addressed the question of how the support is supposed to be designed. The trend in European community mental health policy has been to advocate services in open forms that are integrated into the society's other care systems. This is also the case in Sweden, and continuous work is being done by the government to find strategies to support the development, and to meet the needs at both political and local levels.     

Visiting the mentally ill: volunteer visitors at Saskatchewan hospital, Weyburn 1950-1965

This article offers a glimpse into the lives and activities of some of the patients, volunteers and staff in the Saskatchewan mental health system during the period of deinstitutionalization. Drawing on her own experience as a patient in psychiatric wards as well as ongoing research in the history of mental health, it features the role of Regina Volunteer Visitors in Saskatchewan Hospital, Weyburn and examines the importance of occupational and recreational therapies and activities in improving the lives of the patients in that institution. It emphasizes the perspectives of patients and volunteers who actively worked to develop recreational activities, with the intention of helping individuals connect with the surrounding communities. The views and perspectives presented here are drawn from a variety of historical and oral interview sources, including views from visitors to the asylum and patients who lived within its walls. The author has also been a consumer of mental health services, and spent time in the Provincial Mental Hospital in North Battleford. The article therefore makes an important contribution to enhancing our understanding of the social history of deinstitutionalization, not only for its unique source base, but also because those sources have been examined and explained to readers through the perspectives of a former patient herself. This article draws significant attention to the changing opportunities for patients as they interacted with the women's volunteer groups, as well as to how the changes brought about by the encroaching deinstitutionalization, care in the community, and decisions from "above" affected the individuals on the ground.     

南瓜在中国西北地区的引种推广及其影响

原产美洲的南瓜在16世纪上半叶就引种到中国的东南沿海,经过半个多世纪的传播,直到16世纪晚期才在西北地区始有记载,之后在西北地区渐次推广.南瓜在西北地区的引种路径、时间,明、清、民国时期南瓜在西北地区的推广情况和南瓜推广的动因及影响需要进行梳理.     

Media and Professional Interest in Homelessness over 30 Years (1974–2003)

Media and professional interest in homelessness represent important sources of data that may be useful in understanding broader societal factors influencing this pressing social issue. The present study examined the volume and content of coverage of homelessness in four major newspapers and the professional literature indexed in PsycINFO over the past 30 years. Media coverage showed a steep increase during the mid-1980s, a steady decline throughout the late 1980s and into the 1990s, and a plateau since the mid-1990s. Professional coverage demonstrated a less pronounced and delayed pattern of growth, with no sign of decline during the past decade. Content analysis of 574 newspaper articles revealed a sympathetic focus on deinstitutionalization and other structural causes of homelessness during the period of increasing coverage in the mid-1980s, as well as positive media coverage in terms of an emphasis on critical programs and services during more recent years. Content analysis of 324 professional journal articles showed that deficits and deviant characteristics of homeless people were discussed to a significantly greater extent than the structural causes of homelessness over the entire 30-year time period. Possible interactions among media coverage, professional interest, public opinion, the prevalence of homelessness, and policy initiatives are discussed.     

Deinstitutionalization reconsidered: geographic and demographic changes in mental health care in British Columbia and Alberta, 1950-1980

Using demographics on admission to, and discharge from, mental hospitals in Alberta and British Columbia, this paper analyzes the social process commonly framed as deinstitutionalization between 1950 and 1980. A focus on the two most western Canadian provinces permits an exploration of these changes in these regional contexts. Pressured by new funding arrangements, a shift towards community care, and growing criticism of the alleged oppressive nature of large institutions, the three main mental hospitals scaled down as of the 1950s. This trend did not mean, however, that the overall number of hospitalized patients decreased during this time period. The total number of hospitalizations, particularly short-term admissions, actually expanded, while trans-institutionalization also occurred. This case study mirrors larger trends of postwar mental health care, illustrating the social, political, and cultural challenges experienced in the reconstruction of institutional care.     

An interdisciplinary look at the deinstitutionalization of the mentally ill

Deinstitutionalization of the mentally ill has had an enormous impact on the mentally ill, the community, family members and taxpayers. This paper assesses the impact of deinstitutionalization on each of these groups. The approach is interdisciplinary in nature, using schools of thought found in the fields of political and economic thought in analyzing the effect of deinstitutionalization on each stakeholder group. Although assessments vary by stakeholder group, some overall observations can be made. Ironically, both libertarian and utilitarian arguments favor deinstitutionalization, although for different reasons. A deontological view, however, finds deinstitutionalization lacking.     

Part I: Gravestones and Epitaphs. “Grinning Skulls,Smiling Cherubs,Bitter Words”

We have said that gravestone studies is our own corner of research in American attitudes toward death. We begin with a discussion of burying grounds not only because it is our own, but because we have chosen gravestone s t d i e s to represent the historical backdrop against which our contributors view important twentieth century attitudes toward death in America. “Grinning Skulls, Smiling Cherubs, Bitter Words” discusses burial grounds and gravestone motifs in New England from the late seventeenth century through the early nineteenth century, and connects shifts in gravestone imagery to changes in social, intellectual and religious life in New England. “Ideologies in Stone: Meanings i n Victorian American Gravestones,” by Kenneth Ames, expands the geographical area nationwide, and covers the chronological period between 1850 and 1920. Like “Grinning Skulls,”“Ideologies in Stone” is concerned to connect the confines of the burying ground with the social values of the culture that produces it.     

Integrated services in Australian early childhood education and care: what can we learn from our past?

Recent Australian interest in the integration of early childhood services is largely informed by international research and policy developments, particularly from the United Kingdom. Service integration is widely recognised as an effective means of holistically meeting the needs of children and families and ameliorating disadvantage. What is less well known is that Australia has a history of integrated early childhood services. This paper focuses on three points in 20th century Australia when advocacy for integrated early childhood service provision was evident: post‐World War I when the first Mother and Baby Welfare Clinic was established; during the late 1930s to mid 1940s with the advent of the Lady Gowrie Centres; and in the 1970s when several reports recommended the integration and co‐ordination of early years services. Attending to this history acknowledges this innovative Australian work, and provides potentially valuable, and somewhat cautionary, lessons for contemporary advocacy for integrated early childhood services.     

A house divided: deinstitutionalization, medicare and the Canadian Mental Health Association in Saskatchewan, 1944-1964

Defined as a set of distinct processes that included the declining use of large psychiatric institutions and the increasing use of outpatient services and general hospitals, deinstitutionalization occurred earlier in Saskatchewan than other provinces in Canada. It was led by a CCF government dedicated to major change across a number of sectors including mental health, assisted by one of the most influential and well-organized social movement organizations of the 1950s, the Saskatchewan Division of the Canadian Mental Health Association (SCMHA). However, by the late 1950s and early 1960s, the SCMHA opposed the CCF government's policy priority on medicare which it felt came at the expense of mental health care, in particular the implementation of a regional psychiatric hospital system called the Saskatchewan Plan. As a consequence, the SCMHA, once such a powerful ally of the CCF government in health reform, formed a strategic and temporary coalition with the anti-medicare forces in the province. Given the fact that a number of medical staff within the government's department of public health were prominent members of the SCMHA, the CCF government found that it occupied an increasingly divided house at the very time it was struggling to introduce medicare in the midst of civil unrest and a doctors' strike.     

The Deinstitutionalization of Children in Bulgaria – The Role of the EU

In this article, the role of the EU as a key factor for the development of the deinstitutionalization of children is explored. A series of hypotheses concerning EU funding, policies and politics are addressed with regards to how the EU as a whole has affected the deinstitutionalization of children. The article explains the presence of association between instigation of public interest and civil mobilization and the launch of a nationwide reform – in particular how advocacy both at national and EU level led to the adoption of a national reform strategy in Bulgaria. Further, the association between the availability of an innovative approach to spending the EU funds and the decision generally to reform the system for institutional care for children is presented. The article explains the difference that €107.6 million will make for Bulgaria's abandoned children if the European structural funds are realized with their full potential. On the other hand, it reveals the challenges that the process is facing. A great deal of non‐governmental organization (NGO) experience concerning EU involvement in the process has been generalized and construed in order to achieve the best possible understanding of the whole process, the key players and the fundamental issues.     

The topography of medieval popular protest

ABSTRACT

Assumptions about the topography of popular revolt have been essential in constructing sociological and historical models that demarcate a ‘pre-modern’ from the ‘modern’ period. In Charles Tilly’s words, the ‘repertoires of collective action’ before the mid-nineteenth century were ‘parochial, particular, and bifurcated’, while afterwards, they became ‘cosmopolitan, autonomous, and modular’ (2008). By relying on primary sources across the Italian peninsula, France, Flanders and Britain and for the early modern period across German-speaking regions into Russia, this article shows that the plethora of late medieval revolts were rarely, if ever, confined to a neighbourhood or bounded by local religious congregations or family ties. Instead, they were citywide and north of the Alps fused alliances with the peasantry and other cities. With popular protest pushing eastward in the early modern period, these long-distant dimensions became more extensive, crossing linguistic boundaries and thousands of kilometres. In addition, this article raises new questions, such as why peasants and urban rebels in Italy, in contrast to northern Europe, resisted cross-mural alliances, and to what extent late medieval popular insurrection differed from those of the early modern period. The article ends with a call for new models to understand these differences.     

Citizenship Lessons from the Past: The Contours of Immigrant Naturalization in the Early 20th Century*

Objectives. What were the determinants and patterns of naturalization in the first two decades of the 20th century? Low levels of citizenship acquisition among contemporary immigrants are frequently contrasted to the assumed rapid naturalization of prior European migrants, but in truth we know little about the earlier period. Historic data are well suited to investigate four explanations for naturalization: individuals' resources and skills; regulatory and bureaucratic barriers to citizenship; relative costs and benefits of citizenship; and the degree of political mobilization directed to immigrants. Methods. I use U.S. Census microfile data to run logistic regression models, and documentary material to examine the contours of immigrant naturalization in the early 20th century. Results. I find that while individual attributes matter, place of residence could be even more important; in 1900, where an immigrant lived influenced naturalization more than birthplace, ability to speak English, or literacy. Residence effects seem linked to a state's relative openness to immigration and local political mobilization. Over time, however, residence effects attenuate as the 1906 Naturalization Act and establishment of a federal naturalization bureaucracy appear to make citizenship patterns more uniform across the country. Conclusions. These findings suggest that historic and contemporary explanations of immigrants' naturalization should focus as much on the context of reception as the presumed quality of immigrants.     

FROM TENDER CARE TO TENDERED CARE: THE CASE OF THE VICTORIAN MATERNAL AND CHILD HEALTH SERVICE

Restructuring the public sector along market principles has been a major policy development of the late twentieth century in most western countries. This paper examines the impact of recent political and administrative change on a Victorian universal primary health program, the Maternal and Child Health Service (MCHS). The first section establishes the development of the service in the years when an interventionist state provided bureaucratic support for the expansion of public health activities. In the next significant period of organisational change, the 1980s‐early 1990s, key interest groups articulated their positions in view of the administrative imperatives of corporate managerialism. Dramatic ‘marketisation ’ of the service then occurred with the impact of compulsory competitive tendering (CCT) in the mid‐1990s. The paper argues that attention to the complex processes of change shows the interplay of interest groups, discursive positions and administrative regimes, with new strategies emerging to counter the contracting state.     

二十世纪红学历程

19世纪末到20世纪初这一时期,为我国学术的转型期.这里不仅包括着学术主题的变化,也包括学术研究由综合学科向各个单科专门化方面的发展.真正意义的红学应该说是从世纪之交的三位被人称为国学大师的人的参与而正式确立起来的.20世纪红学,是由几次大的高潮连接起来的一是世纪初新红学之建立,二是50年代之批判红学,三是70年代红学热,四是八九十年代之多元化红学新潮.以小说为研究主题也只是一个过渡期,到20世纪二三十年代以后,史学、文学、哲学、经济、社会学以及化学、地质学、生物学等,便逐渐各自成为专门学科,各类专家也便相继出现了.将50年代红学称之为"批判红学",将70年代的红学称之为"政治红学",还算是比较切题的.到了80年代后期经济大潮袭来之后,不论红学研究队伍还是研究者的知识积累方面都受到了巨大的冲击.不能固定地认为只有考证本子和作者两个问题才是红学,红学是一个综合性的科学,它不仅包括有史学、哲学、社会学、文艺学、文化学,辽包括文献学、版本学、谱牒学等.     

印度的环境主义研究

印度的环境主义萌芽于20世纪初，完整意义上的环境主义诞生于20世纪70年代初。尽管印度学者对环境主义的研究各有其侧重点，但整体来说仍然具备一些共同的特征。印度的环境主义研究在国际学术界独树一帜。     

Nineteenth century African-American and White biological living conditions in Texas

Using a source of 19th century Texas state prison inmate records, the present study contrasts the biological living conditions of comparable 19th century African and European Americans. Average Black stature ironically increased during the antebellum period and decreased immediately after emancipation, while average White stature declined throughout the second half of the 19th century. Texas Black BMI values declined during the late 19th and early 20th centuries; however, White BMI values increased, indicating considerable 19th century biological inequality by race. Therefore, the known material inequality that existed in the 19th century American South is reinforced with biological markers.