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.     

“反精神医学”的谱系： 精神卫生公共性的历史及其启示

基于对上世纪后半叶以来“反精神医学”历史的考察,本文试图提出反精神医学运动如何影响精神卫生公共性建设的问题。文章结合当时欧美社会民权运动的背景,从“反精神医学”诸种思潮中梳理出其指涉公共性的各个面向,探讨其历史经验与启示。在传统精神医学陷入危机之时,反精神医学的精神卫生观转向以精神病患为主体,其中对“全控机构”的批判和标签论颠覆了传统精神医学的神话,成为“去机构化”意识形态的合力;同时,草根组织的援助改变了被收容者的社会处置方式;巴扎利阿的精神医疗改革则进一步解放了被收容者,其提出的废除精神病院、通过立法保障患者权益的案例,进一步彰显出精神卫生的公共性何以可能的历史经验。在此基础上,文章对精神卫生的公共性所指涉的目标和价值取向、精神卫生改革中的公众参与以及争取合法保障精神卫生相关权益的经验进行了讨论。     

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.     

Taiwan's path to national health insurance (1950–1995)

This study explores the evolution of statutory health insurance in the Republic of China on Taiwan from its inception in 1950 through to the inauguration of the National Health Insurance Programme in 1995. The main focus of the study is the timings of the adoption of the different statutory health insurance schemes targeted to the various segments of the population. It is argued that Taiwan's adoption of Labour Insurance for workers in 1950 could be best explained by the country's specific historical circumstance. The then-ruling Nationalist government was keen to build up Taiwan as a showcase for the whole of China. The inauguration of the National Health Insurance Programme in 1995 was predominantly subjected to the Nationalist government's adjustment to its changing political position.     

From closed ranks to open doors: Elaine and John Cummings' mental health education experiment in 1950s Saskatchewan

During late 1951 and early 1952, married couple, social biologist Elaine Cumming and psychiatrist John Cumming, led a mental health education experiment in Indian Head, Saskatchewan. The study, which was intended to inform strategies toward deinstitutionalization, sought to determine if attitudes regarding mental illness could be changed through commonly used educational practices. It was shaped by the shared interests of powerful philanthropic, charitable, psychiatric, academic and governmental bodies to create healthier citizens and a stronger democratic nation through expert knowledge. However, in addition to the disappointing findings indicating that attitudes remained unchanged, the town appeared to close ranks against the research team. Nonetheless, the Cummings' later association with sociologists at Harvard University enabled them to interpret the results in a way that lent the study credibility and themselves legitimacy, thus opening the door to their careers as very successful researchers and policy-makers.     

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.     

小组工作在综合医院精神科精神疾病康复中的运用——以昆明M医院精神科“沟通小组”为例

随着精神疾病发病率的不断上升,精神疾病负担的不断加剧,精神健康与精神疾病越来越受到人们的普遍关注,众多学者也开始了对精神疾病康复模式的探索,笔者以社会工作专业视角,利用小组工作介入形式,为M医院精神科精神病人及其陪护开展"沟通小组"活动,开始了综合医院精神科精神疾病康复的探索与实践。     

农村商业健康保险的定位及发展模式

商业健康保险是农村医疗保障体系的有机组成部分。它在满足农村居民个性化的风险保障需求以及提供专业化的经办管理服务方面能发挥积极作用。在农村医疗保障体系中,公共医疗保险居基础性地位,商业健康保险则居补充性地位,两者应协调发展,共同构建我国农村多层次医疗保障体系。现阶段,我国农村商业健康保险发展模式包括补充型发展模式、替代型发展模式以及第三方管理模式三种类型,其未来发展模式包括医保合作模式、第三方管理模式,以及最终打造成以健康保障为中心、集医疗服务提供与经办管理服务为一体的农村商业健康保险产业链发展模式。     

The header stack-barge: Folk technology on the north American plains

The header stack-barge was a device that farmers on the American and Canadian plains invented to adapt wheat harvesting machinery to the special requirements of their semi-arid region. Although it appeared at points scattered throughout the length of the North American plains, its greatest use was in Alberta and Saskatchewan during the 1930s. The development of the header stack-barge was an outstanding example of folk technology in the agricultural history of the Great Plains, showing the conditions under which folk invention might flourish and the way it might interact with government extension agents. The case of the header stack-barge then is of consequence both to folklore and to concepts of Great Plains regionalism.     

Treating Older Persons with Severe Mental Illness in the Community: Impact of an Interdisciplinary Geriatric Mental Health Team

Little information is available concerning community-based interventions to treat the growing number older persons with severe mental illness. This study examined treatment efficacy of a specialized interdisciplinary geriatric mental health team (mental health geriatric interdisciplinary teams or MHGITs) for 69 older clients with severe mental disorders. Depression, life satisfaction, health, and psychiatric and medical hospitalization data were gathered. A decrease in depressive symptoms and in psychiatric hospitalizations, and an increase in life satisfaction at 6 months were found. No change in health nor medical hospitalizations were reported. This study provides preliminary support for the feasibility and efficacy of a MGHIT approach in treating older community-dwelling adults with severe mental illnesses. Implications for social workers are discussed.     

A critical review of mental health and mental health‐related policies in China: More actions required

In China, there are over 170 million people suffering from mental illness. However, there is a lack of a critical review of the policies governing the provision of mental health services. Drawing on the framework of mental health policy developed by the WHO, this article critically examines mental health policies regarding legislation, financing, model of care and delivery, as well as manpower and the training of mental health professionals in China. This analysis raises a number of policy‐related questions concerning the lack of community‐based psychiatric services, inadequate coverage of mental health services in the rural areas, poor standard of education and an insufficient number of trained mental health professionals, and insufficient protection of the human rights of people with mental illness. The article ends by urging the various levels of governments to make a firm commitment to improve mental health care for people with mental illness in China.     

Exploring perceptions of mental health clients and professionals about Buddhism‐based therapies at mental health hospitals in Vietnam

With 80% of Vietnamese people holding key Buddhist beliefs, Buddhism has great impact on the thoughts, emotions, and behavior of Vietnamese people. However, almost no Buddhism‐based psychosocial interventions are offered at formal psychiatric hospitals across Vietnam, nor is there any plan to incorporate these interventions into mental health care. This exploratory study examines the perceptions of mental health clients and staff regarding the effectiveness of Buddhism‐based therapies (BBTs) in mental health treatment in Vietnam, using ethnographic observation and in‐depth interviews with 24 patients and eight professionals at the only psychiatric hospital employing BBT. Participants strongly believed in the positive impact of BBT to help clients manage or improve their symptoms. However, clients and staff advised that BBT should not be used alone; rather it should be used in combination with medication and was best employed for stress‐related disorders. They unanimously supported incorporating BBT into the formal mental health system, especially if the therapies were well developed through collaboration between Buddhist monastics and mental health professionals. Results of the paper suggest that Vietnam should think strategically about developing and incorporating BBT into the formal mental health care system.     

Mental health in postgraduate social work curriculum: Review of training contents in Indian schools of social work

Training of social workers according to the changing needs of the society is important. To this end, we decided to review the adequacy of mental health training in postgraduate programme in social work. The Mental Health Care Act 2017 defines psychiatric social worker (PSW) in India to have additional higher qualification beyond post‐graduation in social work. The number of such qualified PSWs appears to be limited due to small number of institutes that offer advanced training in the country. Though, the number of available PSWs with such qualifications is rising, the manpower in proportion to the mental health needs in the country continues to remain low. It is therefore, relevant to review the quality of psychiatric social work education at postgraduate level if this level is to be considered as the desirable qualification for PSW. In this context, postgraduate social work syllabi from 71 universities including autonomous institutions were reviewed using semi‐structured assessment. The results show a lack of uniform teaching components, training methods and insufficient skill orientation towards mental health interventions. These observations suggest that curricula and training are modified with strengthening and enhancing the quality of training of mental health at post‐graduate level in Social Work.     

The governance of primary mental health planning by Primary Health Networks

The establishment of Primary Health Networks (PHNs) was accompanied by assignment of responsibility for funding for primary mental healthcare. To ensure this funding is spent in line with government priorities, the Federal government developed a planning document with established priorities and guidance documents for how the planning document should be completed. This paper examines how these documents shape service delivery through enabling some activities and excluding others and identifies the assumptions that underpin these documents. Data were drawn from discourse and content analysis of completed planning documents from the PHNs and of the guidance documents and from reflection upon mental health planning from 55 interviews with key personnel from six PHNs. Service delivery is shaped by outcome measures that promote service access, cost‐effectiveness and clinical effectiveness, contributing to service options that favour self‐management for mild mental illness and clinical (but not social) services for people with severe mental illness. There is also limited scope for mental health promotion with prevention activities focused upon populations identified by the government as being at‐risk. This occurs to the detriment of other at‐risk populations.     

Deinstitutionalization and vocational rehabilitation for mental health consumers in Nova Scotia since the 1950s

In this paper we explore the broader policy determinants of the de-hospitalization of mental patients in Nova Scotia between the 1950s and 1980s and trace the background to the development of occupational rehabilitation programs in the community. For employment programs, the government chose to rely on non-profit NGOs as the suppliers of services. As a case study of such an organization, we examine the evolution of LakeCity Employment Services Association as a resource for people living with mental disabilities.     

The Use of Group Work to Fight Acute External Threats to a Community-Based Organization During Harsh Economic Times

This article addresses the use of group work in a community-based outpatient children's mental health agency to respond to financial threats by county and state government during the economic downturn of 2008–2009. Three specific threats that came within months of one another are discussed: (1) the threat to close down a chemical dependency treatment service for youth, (2) severe funding cuts to an outreach program for immigrant youth and their families, and (3) a state government plan to restructure/reform reimbursement for outpatient mental health services that promises to reduce access to care for underinsured families. Group work was used to organize, educate, and activate staff, board, community, and consumer groups, in large and small groups, to counter the threats and build a culture of advocacy. Lending a vision, empowering advocates, managing polarity, and shaping the advocacy message were essential elements of the advocacy process.     

"Work for those that can, security for those that cannot":The United Kingdom's new social security reform agenda

Following its election victory, the Labour government embarked on a programme to reform fundamentally the United Kingdom's post-war welfare state. The reforms are outlined in a number of government policy consultation papers and are intended to address neo-liberal concerns about the welfare state, although neo-liberal panaceas have been rejected in favour of a "third way". Strongly influenced by Mead, Layard, Giddens and Field, the government's welfare reform package is premised on a conception of citizenship that emphasizes equally the importance of "entitlements" and "obligations", especially the obligation to work. We argue that this reform approach is inherently flawed: it presumes that the poor are without work because they lack appropriate incentives, not because they lack jobs that will lift and keep them out of poverty. We argue that the government's welfare reform strategy is contradictory: while it aims to ameliorate poverty, the emphasis on obligations and compulsion may have the effect of reinforcing existing economic and social divisions. In approaching the second millennium, there is a clear need for a robust interventionist approach to welfare which emphasizes the right to a satisfactory standard of living.     

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.     

‘Problematising’ Australian policy representations in responses to the physical health of people with mental health disorders

Australia, like other jurisdictions, is recognising the poorer physical health of people with mental health disorders. This paper explores policy responses to this issue through discourse analysis of 22 Australian Federal and State government policy documents published in 2006–2011. The paper utilises Bacchi's ‘what's the problem represented to be?‘ approach to explore policy solutions in relation to the representation of the issue, enabling identification of issues which are not problematised and policy solutions that have not been considered. The poor physical health of people with mental health disorders is attributed in policy to poor lifestyle habits and limited access to monitoring of physical health care. Three policy solutions are offered: collaborative care delivery involving greater use of fee‐for‐service primary care to manage physical health; the monitoring of physical health status by mental health teams; and the promotion of lifestyle change. These solutions fail to address ongoing issues with collaboration between specialist mental health and primary care services. Reliance upon fee‐for‐service primary mental health care may, in fact, reduce rather than increase access to services. The strategies are discussed in light of neoliberal ideals of governance and personhood which are underpinned by informed consumer choice and personal responsibility for health.     

浅析奥巴马政府的医疗改革政策及其对中国的启示

针对美国医疗领域长期存在的医疗费用快速上涨、医疗保险制度性障碍和医疗服务质量等问题,奥巴马政府提出了以控制医疗费用、扩大医疗保险覆盖面、提高医疗服务质量为主要内容的医疗改革方案,意在实现"向全美国民众提供可承受的、可进入性的医疗保健"之目标。相关法案虽然几经修改,但最终在美国国会众、参两院获得微弱通过,并在日前由奥巴马总统签署。尽管其效果目前还无法判断,但方案本身在一定程度上已经能够为我国的医疗改革提供一些启示。