The development of de-institutionalization in Europe

In this article movements from institutional to community care for psychiatric patients in various European countries are discussed. Programs considering the welfare of afflicted persons, diminution of psychopathology and improvements of functioning, as well as the costs of deinstitutionalization are reviewed. The review first deals with the prevention of admissions prior to referral to inpatient facilities, looking at the role of general practitioners and ambulatory services in preventing admissions. Secondly, alternatives for hospital care are considered. Thirdly, consideration is given to the possibilities of shortening the time patients stay in hospitals. Next, experiences in discharging long stay patients to alternatives for continued care in psychiatric hospitals are reported. Finally, the advantages are shown of integrating all regional mental health services under one administration. Selected national policies are described as well as the success of present programs are discussed. With few exceptions only European studies are reported.