Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries

TLDR

The drivers of reinstitutionalisation are unclear, but risk‑containment attitudes reflected in prison populations may be more influential than changes in morbidity or new mental‑health delivery methods. The study aimed to determine whether reinstitutionalisation is occurring in mental‑health care and to describe its variation across six Western European countries. Researchers compared service‑provision data from England, Germany, Italy, the Netherlands, Spain, and Sweden between 1990‑1 and 2002‑3, focusing on forensic beds, involuntary admissions, supported‑housing places, psychiatric beds, and prison populations. Forensic beds and supported‑housing places rose in all countries, psychiatric beds fell in five but did not offset the increases, involuntary admissions varied, and prison populations grew markedly, confirming reinstitutionalisation with substantial inter‑country differences.

Abstract

<h3>Abstract</h3> <b>Objective</b> To establish whether reinstitutionalisation is occurring in mental health care and, if so, with what variations between western European countries. <b>Design</b> Comparison of data on changes in service provision. <b>Setting</b> Six European countries with different traditions of mental health care that have all experienced deinstitutionalisation since the 1970s—England, Germany, Italy, the Netherlands, Spain, and Sweden. <b>Outcome measures</b> Changes in the number of forensic hospital beds, involuntary hospital admissions, places in supported housing, general psychiatric hospital beds, and general prison population between 1990-1 and 2002-3. <b>Results</b> Forensic beds and places in supported housing have increased in all countries, whereas changes in involuntary hospital admissions have been inconsistent. The number of psychiatric hospital beds has been reduced in five countries, but only in two countries does this reduction outweigh the number of additional places in forensic institutions and supported housing. The general prison population has substantially increased in all countries. <b>Conclusions</b> Reinstitutionalisation is taking place in European countries with different traditions of health care, although with significant variation between the six countries studied. The precise reasons for the phenomenon remain unclear. General attitudes to risk containment in a society, as indicated by the size of the prison population, may be more important than changing morbidity and new methods of mental healthcare delivery.