title: Institutionalization of deinstitutionalization: a cross-national analysis of mental health system reform.
abstract: BACKGROUND
  Policies generate accountability in that they offer a standard against which government performance can be assessed. A central question of this study is whether ideological imprint left by policy is realized in the time following its adoption. National mental health policy expressly promotes the notion of deinstitutionalization, which mandates that individuals be cared for in the community rather than in institutional environments.
  
  
  METHODS
  We investigate whether mental health policy adoption induced a transformation in the structure of mental health systems, namely psychiatric beds, using panel data on 193 countries between 2001 and 2011.
  
  
  RESULTS
  Our striking regression results demonstrate that late-adopters of mental health policy are more likely to reduce psychiatric beds in mental hospitals and other biomedical settings than innovators, whereas they are less likely than non-adopters to reduce psychiatric beds in general hospitals.
  
  
  CONCLUSIONS
  It can be inferred late adopters are motivated to implement deinstitutionalization for technical efficiency rather than social legitimacy reasons.
authors.affiliation: School of Public Health, Yale University, 60 College Street, P.O. Box 208034, New Haven, CT 06520 USA.
authors.forename: Gordon C
authors.initials: GC
authors.lastname: Shen
authors.affiliation: School of Public Health, University of California at Berkeley, 235 University Hall, Berkeley, CA 94720 USA.
authors.forename: Lonnie R
authors.initials: LR
authors.lastname: Snowden
keywords: Diffusion of innovation; Governance; Institutional theory; Mental health policy