Table 6.
Facilitators to the process of psychiatric deinstitutionalization
| Category | Descriptive themes | References |
|---|---|---|
| Planning, Leadership and Funding/Economic aspects | Centralized governance of the process | PAHO, 2008 |
| Austerity and fiscal pressure | PAHO, 2008 | |
| Disability insurance | Mechanic and Rochefort, 1990 | |
| Economic incentives for DI | Mechanic and Rochefort, 1990 | |
| Fiscal strain on state mental hospital | Mechanic and Rochefort, 1990; O’Doherty et al., 2016 | |
| International policy networks and advocacy | PAHO, 2008 | |
| Intersectoral alliances and coordination | PAHO, 2008 | |
| Knowledge/Science | Available evidence about alternatives | Weiss, 1990 |
| Conceptual Clarity | Freedman and Moran, 1984; Kleiner and Drews, 1992; McCubbin, 1994 | |
| Documented Experience | Shen and Snowden, 2014 | |
| Evidence of human rights violations | PAHO, 2008 | |
| Intellectual cross-fertilization toward CBSs | Mechanic and Rochefort, 1990; PAHO, 2008 | |
| Knowledge of effects of institutions on individual patients | Bennett and Morris, 1983; Mechanic and Rochefort, 1990; Kleiner and Drews, 1992; Anderson et al., 1998 | |
| Psychopharmacological developments | Bennett and Morris, 1983; Bredenberg, 1983; Freedman and Moran, 1984; Mechanic and Rochefort, 1990; Weiss, 1990; Kleiner and Drews, 1992; Anderson et al., 1998 | |
| Power, interests and influences | Human rights legislation | Anderson et al., 1998; PAHO, 2008 |
| Influence of civil rights movements | Mechanic and Rochefort, 1990; PAHO, 2008 | |
| Legal limitations to commitment/coercion | Freedman and Moran, 1984; Mechanic and Rochefort, 1990; | |
| Legal push toward community-based treatments | Freedman and Moran, 1984 | |
| Legal standards for facility construction/operation | Anderson et al., 1998 | |
| MH Legislation | Freedman and Moran, 1984; PAHO, 2008; Shen and Snowden, 2014 | |
| Advocacy from professional organizations/groups | Weiss, 1990; WHO, 2014 | |
| International policy pressure | Shen and Snowden, 2014 | |
| Services and supports in the community | Service-user movements and demands | Kleiner and Drews, 1992; Anderson et al., 1998 |
| Comprehensive and structured network of CB services | Lamb and Goertzel, 1977; Cohen, 1983; Conway et al., 1994; Evans et al., 2012 | |
| Continuity of care | Sytema et al., 1996 | |
| Income for patients | Alakeson, 2010 | |
| Individualization of care in the community | Kalisova et al., 2018 | |
| Integration of mental health in PHC | Kraudy et al., 1987; PAHO, 2008; Evans et al., 2012; John et al., 2010 | |
| Limit readmission by closing beds | PAHO, 2008 | |
| Recovery-based services in a psych ICUs | Ash et al., 2015 | |
| Scale up of outpatient services | Bennett and Morris, 1983; Abas et al., 2003 | |
| Self-directed support: Autonomy in the use/selection of services | Alakeson, 2010 | |
| Shared decision-making and service user involvement | Chan and Mak, 2014 | |
| Supporting PHC expertise to raise service-user confidence | Huang et al., 2017 | |
| Social Help | Lamb and Goertzel, 1977 | |
| Workforce | Anti-stigma practice | Mayston et al., 2016; Huang et al., 2017; Matsea et al., 2019 |
| PHC training | PAHO, 2008 | |
| WF training | Weiss, 1990; Wasylenki and Goering, 1995 | |
| Exogenous factors | Exogenous shocks (disasters, war) | Stelovich, 1979 |
| Redemocratization | Rizzardo et al., 1986 |