| 1. Planning, leadership, and funding |
Mental Health Policy: Responsibility/accountability |
Rose, 1979
|
| Reform fragility: charismatic leadership |
PAHO, 2008
|
| Reform fragility: Lack of synchronization between bed reduction and development of CBMHSs |
Freedman & Moran, 1984; Shen & Snowden, 2014
|
| Reform fragility: Unaccountability of failure |
Freedman & Moran, 1984; Rose, 1979; Rosenheck, 2000
|
| Funding: Continuity of community care |
McCubbin, 1994; Mechanic & Rochefort, 1990; PAHO, 2008
|
| Funding: Hospital funds not reallocated to CMHS |
Fakhoury & Priebe, 2002; PAHO, 2008
|
| 2. Knowledge / Science |
Conceptual limitations and ambiguities |
Bennett & Morris, 1983; Fakhoury & Priebe, 2002; Freedman & Moran, 1984; Mallik et al., 1998; McCubbin, 1994
|
| Evidence: Lack of evidence on DI processes |
Shen & Snowden, 2014
|
| Lack of research and innovation on alternatives to institutionalization |
Bennett & Morris, 1983
|
| 3. Power, interests, and influences |
Irrelevance of Mental Health in the political/policy agenda |
Mechanic & Rochefort, 1990; PAHO, 2008; Semke, 1999
|
| Market factors fostering re-institutionalization |
Barton, 1983; Dorwart et al., 1991; Fakhoury & Priebe, 2002; Freedman & Moran, 1984; Rose, 1979
|
| Uncoordinated and fragmentary advocacy actions. |
McCubbin, 1994; Mechanic & Rochefort, 1990; Rosenheck, 2000
|
| Vested interests: Pharmaceutical |
McCubbin, 1994
|
| 4. Services and supports in the community |
Centralized System |
Kleiner & Drews, 1992
|
| Patients: Challenging behaviours |
Allen et al., 2007
|
| Patients: Old Age |
Barry et al., 2002
|
| Services: Hospital centric models and practices |
Bennett & Morris, 1983; Kaffman et al., 1996
|
| Early discharge |
Kleiner & Drews, 1992; Stelovich, 1979
|
| Services: Lack of services and support in the community |
Fakhoury & Priebe, 2002; McCubbin, 1994; Oshima & Kuno, 2006; Weiss, 1990
|
| Housing: Inadequate, insufficient |
Grabowski et al., 2009; Mechanic & Rochefort, 1990; PAHO, 2008
|
| Dependence on disability benefits and/or pensions |
Chopra & Herrman, 2011; Freedman & Moran, 1984; Manuel et al., 2012
|
| Patients: Disempowerment / Fatalism |
Chopra & Herrman, 2011
|
| Insufficient Public Support |
Manuel et al., 2012
|
| Patients: No money |
Goering, 1984 |
| Clashing views on DI within the Workforce |
Kleiner & Drews, 1992; PAHO, 2008
|
| 5. Workforce |
Shortages in general |
Fakhoury & Priebe, 2002; Schmidt, 2000; Shen & Snowden, 2014; WHO, 2014 |
| Shortages of specific professions |
Ash et al., 2015
|
| Inadequate training |
Barton, 1983; Mayston et al., 2016; PAHO, 2008; WHO, 2014 |
| Moral concerns and fears |
Ash et al., 2015; Kleiner & Drews, 1992; PAHO, 2008
|
| Pessimism |
Aggett & Goldberg, 2005; Cohen, 1983; Kleiner & Drews, 1992
|
| Practices of exclusion |
Bryant et al., 2004; Chakraborty et al., 2011
|
| Stigma in workforce |
Barton, 1983; Semke, 1999
|
| Vested interests: Workforce |
Shen & Snowden, 2014; Swidler & Tauriello, 1995
|
| 6. Communities and the public |
Communities are hostile towards users |
Aggett & Goldberg, 2005; Bredenberg, 1983; Fakhoury & Priebe, 2002; O’Doherty et al., 2016; PAHO, 2008
|
| Communities are ill prepared to integrate users |
Bredenberg, 1983; Fakhoury & Priebe, 2002
|
| Public acceptance of social control |
Allen et al., 2007; Fakhoury & Priebe, 2002; Swidler & Tauriello, 1995
|
| Stigma & self-stigma |
Aggett & Goldberg, 2005; Chan & Mak, 2014; Fakhoury & Priebe, 2002; Manuel et al., 2012; Mechanic & Rochefort, 1990; O’Doherty et al., 2016; PAHO, 2008
|
| 7. Family / Carers |
Broken ties between families and services |
Aggett & Goldberg, 2005
|
| Lack of support and/or unfair expectations towards families |
Barton, 1983; Yip, 2006; Lavoie et al., 2012; Mechanic & Rochefort, 1990; Oshima & Kuno, 2006
|
| Scepticism and Opposition from families |
McCubbin, 1994; Oshima & Kuno, 2006
|
