Deinstitutionalization

Deinstitutionalization refers to the policy-driven reduction of reliance on long-stay psychiatric hospitals and the relocation of care for people with mental illness and developmental disabilities into community-based settings. It began in the mid-20th century and has been pursued in many countries with the goals of expanding individual autonomy, protecting human rights, and integrating people into ordinary life.

Key drivers include advances in psychiatric medications, reforms aimed at civil liberties, and concerns about the cost and quality of hospital care. Governments funded outpatient services, case management, housing, and supported employment to replace inpatient care. Notable milestones include the United States' Community Mental Health Act of 1963 and similar reforms in the UK and other European countries during the 1950s–1980s.

The movement substantially reduced the number of beds in public hospitals, but many regions faced gaps in community services. Critics argue that insufficient planning and resources led to homelessness, incarceration, or relapse for some individuals. Proponents contend that people gained greater rights and freedom, and that many benefited from community living. Outcomes have varied by country and over time, with some regions experiencing partial re-institutionalization when community supports lagged.

Today, deinstitutionalization is often framed as ongoing reform toward integrated, community-based care. Approaches include assertive community treatment, supported housing, and wraparound services designed to prevent crises and avoid readmission. Global differences persist due to economic resources, policy choices, and social stigma.

Related topics include community mental health, supported housing, civil commitment, and the human-rights framework for mental health care.