Forty years of deinstitutionalization of psychiatric services in Canada: an empirical assessment.
OBJECTIVE
To empirically analyze the implementation of the policy of deinstitutionalization of psychiatric services over a 40-year period.


METHODS
We assessed the policy of deinstitutionalization in terms of the following components: 1) population-based psychiatric beds, days of care in psychiatric hospitals (PHs); 2) days of care in psychiatric units in general hospitals (GHs); and 3) per capita expenditures on psychiatric services.


RESULTS
There was a rapid closure of beds in PHs in the 1970s and 1980s, but this was associated with an increasing rate of days of care in psychiatric units in GHs (that is, transinstitutionalization). It was not until the 1990s that the overall days of inpatient care began to decrease. Per capita expenditures on community-based psychiatric services increased throughout this period.


CONCLUSIONS
Standardized rates reveal tremendous variation among the provinces in the timing and intensity of deinstitutionalization.
Sealy
Patricia
P
Chelsey Park Long-Term Care, London, Ontario.
Whitehead
Paul C
PC
D002170:Canada; D003156:Community Mental Health Services / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D003688:Deinstitutionalization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D036262:Empirical Research; D005102:Health Expenditures / Q000706:statistics & numerical data / Q000639:trends; D006271:Health Facility Closure; D006284:Health Plan Implementation; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D010360:Patient Transfer; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*