Moving out of the asylumDeinstitutionalization and reinstitutionalization: major changes in the provision of mental healthcare
Section snippets
The first asylums
The origins of modern psychiatry as a medical specialty date back to the Age of Enlightenment. It emerged around 1800 and its development was closely linked to the establishment of large asylums. There were several reasons for societies to invest in asylums, as detailed below.
Social welfare movement: the developing movement for social welfare was also applied to the mentally ill, and their quality of care tended to reflect the responsibility of states to care for ‘feeble’ people in society.
Outcomes
Deinstitutionalization has led to dramatic and, some would say, long-desired changes in psychiatric services. Health systems in North America, Europe and Australia in particular have embraced the philosophy of community mental healthcare.1, 2, 3, 4 Costs have been reported to be generally the same as for inpatient hospitalization, or even lower for discharged patients living in the community,5 although costs for different forms of care clearly depend on political decisions affecting how well
Re- or transinstitutionalization
Although the number of conventional psychiatric hospital beds has continued to decrease in most Western industrialized countries, recent data suggest that we may already be witnessing a new phenomenon of ‘reinstitutionalization’. Table 1 shows changes in the numbers of conventional psychiatric hospital beds, beds in forensic psychiatry, places in supported housing, involuntary hospital admissions and people in prison in six European countries.9 Although each country has different traditions and
Conclusion
Deinstitutionalization has dominated and marked major changes in mental healthcare provision in the second half of the 20th century. We now face the new phenomenon of re- or transinstitutio-nalization, which is international, expensive and ethically problematic. This calls for both specific research on the provision, costs, potentials and effects of different forms of institutions, including the experience of patients in them, and a professional and public debate on the values, aims, ethics and
References (12)
- et al.
The success of de-institutionalisation: empirical findings from case studies on state hospital closures
Int J Law Psychiatry
(2000) - et al.
The process of de-institutionalisation: an international overview
Curr Opin Psychiatry
(2000) - et al.
Limits of de-institutionalisation: experience in England
Psychiatr Prax
(2000) Housing for psychiatric patients inside and outside of hospitals
Psychiatr Prax
(2000)The history, economics and financing of mental health care. Part 2: the 20th century
J Psychosoc Nurs Ment Health Serv
(2000)Have psychiatric services in Hong Kong been impacted by the de-institutionalisation and community care movements?
Adm Policy Ment Health
(2000)
Cited by (105)
Psychiatric hospitalization in Korea, 2011–2020: the impact of the Mental Health Act revision of 2017 in consideration of the COVID-19 pandemic
2022, Asian Journal of PsychiatryCitation Excerpt :However, the overall decrease in admission among people with schizophrenia demonstrates that the law led to a meaningful decrease in admission among the most relevant population and not a simple conversion to another form of admission. The decrease in the number of psychiatric admissions and involuntary admissions after the revision is consistent with many developed countries in North America and Europe (Fakhoury and Priebe, 2007; Rothbard and Kuno, 2000; Freeman et al., 1985). However, while the decrease in psychiatric beds was evident in most countries which adopted deinstitutionalization and was generally accompanied by a decrease in involuntary hospitalization and the entire psychiatric hospitalization, the reduction in beds did not translate into a decrease in admissions in some countries.
Community-Level Relationships Between Mental Health Treatment and Criminal Justice Outcomes in Finland
2023, Nordic Journal of CriminologyInstitutionalisation and oppression within the mental health system in England: Social work complicity and resistance
2023, Social Work’s Histories of Complicity and Resistance: A Tale of Two ProfessionsPolice officers’ perceptions of their role at overdose events: a qualitative study
2023, Drugs: Education, Prevention and Policy