[Alternatives to chronic hospitalization in mental health]

It is not possible to work on alternatives to chronic institutionalization without taking into account a reform of the mental health care system. A great deal of experience has been accumulated and a lot of unsolved problems have arisen since the beginning of the deinstitutionalization in USA and Europe in the 60s. The aim was the closing of psychiatric hospitals, and so the accent was put on the physical place of treatment instead on the quality of the treatment or on the actual needs of the people involved. A review of the experiences is made and some clues are given to avoid the major problems and errors that have presented. Political decisions, experienced professionals, a stable and sufficient budget, modification of some laws, the creation of community institutions that fulfill the patient's needs before moving them, postgraduate training in rehabilitation, flexibility and creativity with empirical and scientific grounds are needed for a successful reform of the mental health care system.