III. Organizational Analysis of Deinstitutionalization in a Psychiatric Hospital

Abstract

French

Background:

Few studies have been conducted of the organizational aspects that impact on the course of psychiatric deinstitutionalization.

Method

A case study was undertaken of 10 years of deinstitutionalization in a Montreal psychiatric hospital.

Results

Deinstitutionalization has forged ahead in the hospital over the past few years, although the course it has taken is not the one initially plotted by its promoters. Care management of deinstitutionalized patients remains under the control of the psychiatric hospital and its physicians. However, the patients' well-being has remained a focus of concern and does not seem to have been detrimentally affected by this development.

Conclusion

Deinstitutionalization is both a solution to the criticisms levelled at the hospital-psychiatric approach of managing persons with severe and persistent mental disorders and an extremely useful tool in the power struggle among the various stakeholders in mental health services reform. Deinstitutionalization has become unavoidable.

Keywords

deinstitutionalization mental health organizational analysis

References

Bennett

. Deinstitutionalization in two cultures. Milbank Q 1979;57:516.

Crompton

. Professions in the current context. Work, Employment, Society 1990;3(2):147–66.

Crompton

. Patterns of social consciousness amongst the middle class. In: Burrows

March

, editors. Consumption and class: Divisions and changes. London: Macmillan; 1992. p 140–65.

Reed

. Expert power and control in late modernity: An empirical review and theoretical synthesis. Organization Studies 1996;17(4):573–97.

Friedberg

. Le pouvoir et la règle. Dynamique de l'action organisée. Paris: Seuil; 1993.

Hoult

. Dissemination in New South Wales of the Madison model. In: Marks

Scott

, editors. Mental health care delivery: Innovations, impediments and implementation. Cambridge (UK): Cambridge University Press; 1990.

Stein

. Innovating against the current. Innovative community mental health programs. San Francisco: Jossey-Bass Publishers; 1992.

Yin

. Case study research. Newbury Park: Sage Publications; 1989.

Hinings

Greenwood

. The dynamics of strategic change. Oxford: Blackwell; 1988.

10.

Benson

. The interorganizational network as a political economy. Administrative Science Quarterly 1975;20:229–49.

11.

Allaire

Firsirotu

. L'entreprise stratégique: Penser la stratégie. Boucherville: Gaétan Morin; 1993.

12.

Kingdon

. Agenda, alternatives and public policies. Harper Collins Publishers; 1984.

13.

Ministère de la santé et des services sociaux. Politique de santé mentale, MSSS. Québec: Gouvernement du Québec; 1989.

14.

Bell

. The coming of post-industrial society. New York: Basic Books; 1973.

15.

Derber

Schwartz

Magrass

. Power in the highest degree: Professionals and the rise of a new mandarin order. New York: Oxford University Press; 1990.

16.

Blackler

. Knowledge and the theory of organizations: Organizations as activity systems and the reframing of management. Journal of Management Studies 1993;30(6):863–84.

17.

Norstand

. Takeover of the medical profession by nonphysicians. New England Journal of Medicine 1986;314(6):390.

18.

Eddy

. The challenge. JAMA 1990;263(2):287–90.

19.

Kurz

. A behavioural profile of physicians in management roles. In: Schenke

, editor. The physician in management in Tampa (FL): American Academy of Medical Directors; 1980. p 33–44.

20.

O'Connor

Lanning

. The end of autonomy? Reflections on the postprofessional physician. Health Care Manage Rev 1992;17(1):63–72.

21.

Woinsky

. The professional dominance perspective revisited. Milbank Q 1980;66(Suppl 2):33–47.

22.

Fogel

. The uniqueness of a professionally dominated organization. Health Care Manage Rev 1989;14(3):15–24.

23.

Ramon

. The reactions of English-speaking professionals to the Italian psychiatric reform. Int J Soc Psychiatry 1989;35(1):120–8.

24.

DiMaggio

Powell

. The iron cage revisited: Institutional isomorphism and collective rationality in organizational fields. American Sociological Review 1983;48:147–60.

25.

Ozcan

Shukla

Tyler

. Organizational performance in the community mental health care system: The need fulfillment perspective. Organization Science 1997;8(2):176–91.

26.

Mintzberg

. Structure et dynamiques des organisations. Paris: Editions d'organisation; 1982.

27.

Young

Saltman

. The hospital power equilibrium. Physician behaviors and cost containment. Baltimore (MD): The Johns Hopkins University Press; 1985.

28.

Ginzberg

. Psychiatry before the year 2000: The long view. Hosp Community Psychiatry 1987;38(7):725–8.

29.

Bachrach

. Psychosocial rehabilitation and psychiatry in the care of long-term patients. Am J Psychiatry 1992;149(11):1455–63.