DEINSTITUTIONALISATION: FROM ASYLUMS TO COMMUNITY CENTRES
Deinstitutionalisation is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder.1
Asylums in the 19th century
The 19th century saw a large expansion in the number and size of asylums in western industrialised countries. Although initially based on principles of moral treatment *, they became too big, non-therapeutic, isolated in location, and often neglectful of patients.
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• Are there any expsychiatric hospitals in the area where you Uve?
• lf so, what have they been changed lnto?
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1 Early Treatment of Mental Disorders posted byArun Kanth
Asylums in the 20th century
By the beginning of the 20th century, those institutions were overcrowded. Funding was often cut, especially during periods of economic crisis and wartime. Asylums frequently had poor living conditions, lack of hygiene and abuse of patients.
Community-based alternatives in the 1920s
The first community-based alternatives were suggested and implemented in the 1920s and 1930s, although asylum numbers continued to increase until the 1950s. The campaign for deinstitutionalisation continued in various countries during the 1950s and 1960s with the advent of antipsychotic drugs.
Deinstitutionalisation shortcomings
Although deinstitutionalisation has been positive for the majority of patients, it also has shortcomings. Expectations that community care could mean social integration have been disregarded; many ex-patients remain unemployed, have limited social contact, and often had bad living conditions.
New community services
New community services are often uncoordinated and unable to meet complex needs. Services in the community sometimes isolate the mentally ill within a new ghetto, where they meet but have little contact with the rest of the public. Existing patients are often discharged without sufficient preparation or support. A greater proportion of people with mental disorders become homeless.2 Families often play a crucial role in the care of those who used to be placed in long-term treatment centres. In addition, many mentally-ill people resist help because of the nature of their conditions.
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2 According to a 2016 study, 564,708 people were homeless on a given night in the United States. 250,000 (45%) ofthese people
had a mental illness. At a minimum, 140,000 (25%) were seriously mentally ill.
*Moral treatment: approccio ai problemi mentali, basato sull'inserimento del malato in una comunità con enfasi della morale religiosa, clima paternalistico e rimozione di strumenti di costrizione.