Deinstitutionalization in International Perspective: Variations on a Theme

Abstract

Deinstitutionalization has become an international fact of life in the 1980s. The articles in this issue of the International Journal of Mental Health attest to the international scope of deinstitutionalization, characterized by decreasing reliance on psychiatric hospitals as the sole providers of mental health services and increasing utilization of community-based services to complement and supplement institutional care. This concluding paper examines the commonalities and differences in the facts, processes, and philosophies of deinstitutionalization in international perspective. Although solid evidence is lacking, three general conclusions may be drawn from the papers presented here: 1. With respect to the facts of deinstitutionalization, it is interesting to note that there is considerable variation in the extent of deinstitutionalization both among and within countries. 2. It is clear that the mental hospital remains a critical element in the deinstitutionalized system of care in all of the countries considered here, although the extent of its use varies. 3. The process of deinstitutionalization involves the adaptation of mental health institutions to the sociopolitical and economic environment of each country. National variations in the process of deinstitutionalization reflect differences in culture and ideology. In each case, deinstitutionalization has been supported by profes