Deinstitutionalization and reinstitutionalization: major changes in the provision of mental healthcare

The care of patients with mental illness has undergone major changes over the last two centuries. In the 19th century, large asylums were built throughout industrialized countries to provide care for patients with mental illness. Conditions in these asylums worsened during the 20th century and since the 1950s an increasing deinstitutionalization movement has resulted in their closure. Various services in the community were established to provide an alternative form of care. Recently however, reports about new forms of institutionalization have suggested ‘reinstitutionalization’ in mental healthcare is occuring. This contribution traces the changes from asylums to care in the community and describes the process of deinstitutionalization and its shortcomings worldwide. It discusses recent evidence and explains the debate on reinstitutionalization.