Abstract
Wherever a policy of deinstitutionalization of the mentally ill has been pursued without simultaneous attention to community support, it has given rise to social and psychological problems related to the social reintegration of this population [1-4]. Efforts to respond to these problems by reorienting mental health systems away from a narrow range of medical and hospital-centered services toward multifaceted community-centered resources have consistently met with political, cultural, economic, or institutional obstacles [5-8]. In this article, we shall examine the processes that can derail mental health system reform, even where there appears to be professional, community, and government consensus regarding the need for change, and the types of changes needed. The concept of ' 'demedicalization' ' reflects the type of reorientation to which we refer, in the two senses of the term: first, with respect to the decreasing dominance of psychiatry and the paramedical professions, and
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