Deinstitutionalization: avoiding the disasters of the past

Area of Science:

• Mental Health Services Research
• Social Policy Analysis

Background:

• Deinstitutionalization has faced significant challenges due to a lack of consensus and inadequate planning.
• The existing mental health delivery system has proven insufficient for the needs of deinstitutionalized populations, particularly those with social and cognitive deficits.

Purpose of the Study:

• To analyze the root causes of problems associated with deinstitutionalization.
• To propose a reconceptualization of deinstitutionalization focusing on comprehensive care and services.
• To offer guidelines for future deinstitutionalization initiatives.

Main Methods:

• Critical analysis of the deinstitutionalization movement's history and outcomes.
• Review of existing mental health service delivery models.
• Development of a framework for improved community-based care and institutional phasing.

Main Results:

• Identified key failures including lack of consensus, inadequate testing of philosophical bases, and poor planning for alternative facilities.
• Highlighted the necessity of providing a full spectrum of treatments and services comparable to those in total institutions.
• Emphasized the need to address attitudinal and institutional biases and discriminatory practices.

Conclusions:

• Reconceptualizing deinstitutionalization requires a shift from housing to comprehensive treatment and service provision.
• Successful future deinstitutionalization necessitates improved planning, combating biases, and adequate funding for both community and remaining institutional services.
• A set of guiding principles is proposed to direct future deinstitutionalization efforts effectively.