The impact of deinstitutionalization of psychiatric hospitals on psychological distress of the community in Canada.
OBJECTIVE
There has been a plethora of studies that evaluate the impact of deinstitutionalization of psychiatric services, but they have not examined whether this policy has had an impact on the broader community. The present study addresses this gap by evaluating the impact of the deinstitutionalization of psychiatric hospitals on the mental health of the general population in Canada.


METHODS
This research builds on an empirical analysis of 40 years of the process of deinstitutionalization of psychiatric services in Canada (Sealy and Whitehead 2004). An experimental design is simulated through the use of a derived construct, earlier vs. later deinstitutionalization, in order to test whether the policy of deinstitutionalization has achieved the goal of decreasing levels of psychological distress for people in the community. This study attempts to rectify some of the methodological limitations of past evaluations by standardizing the rates of deinstitutionalization among the provinces and taking into consideration the impact of the interaction among levels of perceived social support and the various social correlates of psychological distress. Cross sectional data from the 1994/95 (n = 16,989) and the 1998/99 waves of the National Population Health Survey (n = 14,682) are used to measure levels of psychological distress.


RESULTS
Provinces that implemented this policy earlier have levels of psychological distress that are significantly lower than the provinces that implemented deinstitutionalization later. All high risk groups (people with lower levels of income and education, younger people, people living in urban areas) have significantly lower levels of psychological distress in 1998/99 (as compared to 1994/95) with the exception of single parents in the provinces that implemented deinstitutionalization earlier.


CONCLUSIONS
Based on the NPHS, the earlier implementation of deinstitutionalization is associated with lower levels of psychological distress of the community as compared to the provinces that implemented deinstitutionalization later.
Sealy
Patricia
P
Department of Nursing, University of Western Ontario, London, Ontario, Canada. psealy@uwo.ca
Whitehead
Paul C
PC
D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada; D003159:Community-Institutional Relations; D036262:Empirical Research; D005260:Female; D006778:Hospitals, Psychiatric / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009936:Organizational Innovation