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Web End = Soc Psychiatry Psychiatr Epidemiol (2016) 51:561574 DOI 10.1007/s00127-016-1180-0
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Web End = What does dependency on community mental health services mean? A conceptual review with a systematic search
Tommaso Bonavigo1,2 Sima Sandhu2 Elisabetta Pascolo-Fabrici1
Stefan Priebe2
Received: 11 November 2015 / Accepted: 17 January 2016 / Published online: 29 January 2016 Springer-Verlag Berlin Heidelberg 2016
AbstractPurpose Although community mental health services aim to support patients autonomy and independence, they have repeatedly been criticised for making patients dependent. Yet, it remains often unclear what exactly is meant with dependency in this context. This review aimed to identify the meaning of the term dependency on community services in the literature.
Methods A systematic search and conceptual review of papers where dependency is used in the context of community mental health services. Narrative synthesis was used to identify thematic concepts linked to dependency in these settings.
Results Fifteen papers met the inclusion criteria. The analysis identied ve different concepts of dependency on community mental health services: dislocation from the outside world; inexibility and lack of freedom; obligation as resentment or appreciation; living with or without meaningful activities; and security.
Conclusions The ndings suggest that, distinct from the exclusively negative connotation of the term dependency in a conventional medical context, dependency on community mental health services contains both negative and positive aspects. The different aspects might guide the future evaluation of the care provided in such services.
Keywords Dependency Community mental health
services Mental disorder Deinstitutionalisation Review
Introduction
Since the 1950s, the deinstitutionalisation movement has led to a marked shift in mental health care from large asylums to community mental health services [1]. This process was initiated when psychiatric hospitals were regarded as total institutions [2], i.e., closed systems set apart from the rest of society and providing custodial care for their patients. Patients in asylums were reported to adapt to the environment of the hospital, and accept the lack of independence and responsibility. This adaptation made patients dependent on the asylum for all aspects of their daily lives from sustenance to...