The history of deinstitutionalization and reinstitutionalization

Abstract

Until the mid-1950s asylum care was the routine approach to managing mental illness in the UK, especially those patients with the more prolonged forms of psychosis such as schizophrenia. It is uncertain why there was a move to community-based treatments, but this probably derived from a change in social philosophy, new and effective forms of psychopharmacology and the rundown state of the asylum buildings. Bed numbers gradually declined, a process enhanced by some model closure projects (e.g. Friern Barnet in North London), substantial closures of the asylums taking place from the 1980s onwards. Inquiries into hospital scandals, and research supporting the effectiveness of community care further encouraged these developments, along with changes in the Mental Health Act. However, despite the more recent development in the 1990s of specialist community teams (e.g. home treatment), the demand for beds has substantially increased over the last 10 years, leading to particular developments in the private sector, especially of ‘forensic’ resources. This resort to reinstitutionalization, on a Europe-wide basis, reflects a culture of risk management, an overriding concern for public safety, and the burdens and pressures upon services trying to manage ‘revolving-door’ psychotic patients. Despite the stable settlement of many ex-asylum patients, the ‘new long-stay’ have generated a sense of service neglect fuelled by regular homicide inquiries. A return to reinstitutionalization seems likely.