Relationships Between the Deinstitutionalization of Healthcare for Patients with Mental Disorder, Substance Abuse, and Isolated Death

• NCJ Number: 205149
• Journal: Journal of Forensic Sciences Volume: 49 Issue: 2 Dated: March 2004 Pages: 354-360
• Author(s): Ingemar B. Thiblin M.D.; Anna B. Fugelstad Ph.D.; Anders G. Leifman M.S.E; Anders P. Romelsjo M.D.; Gunnar S. Agren M.D.; Yoshihide Sorimachi M.D.
• Date Published: March 2004
• Length: 7 pages
• Publication Format: Article
• Publication Type: Report (Study/Research)
• Language: English
• Country: United States of America

Annotation

This study investigated the relationship between social isolation and isolated death in Stockholm County, Sweden, following a policy of deinstitutionalization for Sweden’s mentally disordered and addicted population.

Abstract

Isolated death (ID) occurs when an individual passes away but their death goes unnoticed for a period of time. Research has linked ID with social isolation. The authors hypothesize that if social isolation is more common among those with mental disorders and among those who abuse drugs and alcohol, there should be a noted increase in cases of ID following Sweden’s policy of deinstitutionalization, which should have resulted in an increase of socially isolated individuals within the population. Researchers examined the computerized records of 1,441 deaths in Stockholm County, Sweden, during the period 1992 through 2000 that were subjected to a medicolegal examination. The pattern of ID was analyzed, as was the proportion of ID’s with a record of mental disorder and/or alcohol and/or drug abuse. Results indicated the proportion of deceased with a history of mental disorder was high among all cases during the study period, but higher still among the ID’s and especially among ID’s of individuals younger than 65. In males and females who died before the age of 65, a history of drugs and/or alcohol abuse was more common than a history of mental disorder. During the test period, the actual increase in the incidence of ID was limited, but there was a pronounced increase in the number of former psychiatric patients whose deaths were subjected to a medicolegal analysis even when not meeting the criteria of an ID. Thus, the findings indicate the ID is poorly associated with the policy of deinstitutionalization in Sweden during the test period. However, the increase in the number of medicolegal analyses for deaths in individuals with psychiatric histories suggests that the policy of deinstitutionalization carries an increased risk of these patients dying under suspicious circumstances, thus motivating a medicolegal analysis of the death. The findings also suggest that more research is needed regarding how health care strategies impact morbidity and mortality among mentally ill patients. Tables, figures, references