Has deinstitutionalization gone too far?

Abstract

Modern social psychiatry is aiming at integration of the mentally disordered in the community instead of institutionalization – with or without institutions. No doubt, the majority of mentally disordered patients have benefitted greatly from deinstitutionalized psychiatry.

Unfortunately, in the implementation of deinstitutionalized psychiatry, there has widely been a gap between the closure of the mental hospitals and the building up of the decentralized services. Instead of organizing decentralized services and then gradually reducing the capacity of hospital treatment, things happened in many places the other way around.

With data from the nationwide Danish Psychiatric Case Register, the author documents a series of negative indicators that have appeared parallel with the deinstitutionalization process.

· 100% increase in standard mortality rate of suicides for non-organic psychotic patients

· an exponential increase of 6.7% annually in number of criminal mentally disordered

· increase in coercive activities in the wards several hundred per cent for some of the measures

· increase in bed occupancy rate from approximately 80% to 100%

· Acute admission rates between 85% and 90%

· No signs of reduction in 1 year readmission rate of first time diagnosed schizophrenics from the very stable 45%–50% which has been seen for almost 20 years.

Beyond any doubt, social psychiatric rehabilitation is needed. An increase in the capacity in the psychiatric services and fitting of the treatment models to the patients’ needs so that the negative aspects we have seen can be properly handled must be on top of the agenda in the next few years.