Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries.
OBJECTIVE
To establish whether reinstitutionalisation is occurring in mental health care and, if so, with what variations between western European countries.


METHODS
Comparison of data on changes in service provision.


METHODS
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Priebe
Stefan
S
Unit for Social and Community Psychiatry, Queen Mary University of London, Newham Centre for Mental Health, London E13 8SP. s.priebe@qmul.ac.uk
Badesconyi
Alli
A
Fioritti
Angelo
A
Hansson
Lars
L
Kilian
Reinhold
R
Torres-Gonzales
Francisco
F
Turner
Trevor
T
Wiersma
Durk
D
D001509:Bed Occupancy / Q000706:statistics & numerical data*; D003134:Commitment of Persons with Psychiatric Disorders / Q000639:trends; D005060:Europe; D005555:Forensic Psychiatry / Q000458:organization & administration / Q000592:standards; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D007326:Institutionalization / Q000458:organization & administration* / Q000639:trends; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration* / Q000639:trends