Institutionalisation

Institutionalisation is the process by which individuals become integrated into and dependent on the routines, rules, and authority structures of an institution, such as a hospital, prison, or care facility. The term is used across disciplines, including psychiatry, criminology, and social policy, to describe how long-term exposure to institutional life can shape behavior, expectations, and social functioning.

In psychiatry and mental health, institutionalisation refers to adapting to life inside a closed setting, often with reduced autonomy, altered social skills, and difficulties adjusting to community life after discharge. In criminal justice, inmates may undergo "prisonisation," adopting prison norms, developing distrust of external institutions, and relying on the institution for daily structure. In social care, long-term residential services can produce dependency, diminished self-help abilities, and challenges when transitioning to independent living.

Historically, large asylums and custodial facilities expanded in the 19th and early 20th centuries, driven by public health and moral reform. Starting mid-20th century, deinstitutionalization movement emphasized community-based care, rights, and normalization, shifting emphasis away from long-term confinement toward supported living arrangements and preventive services.

Consequences of institutionalisation include reduced autonomy, social isolation, skill atrophy, and difficulties re-entering society. Outcomes are influenced by the quality and availability of community supports, staff approaches, and policy frameworks. Ethical considerations focus on autonomy, consent, dignity, and the obligation to provide least restrictive, rights-based care.

Policy responses aim to minimize dependence through person-centered planning, gradual discharge, and supported housing, while recognizing the need for appropriate safeguards. Critics argue that deinstitutionalization was uneven and sometimes left individuals without sufficient community resources. Related topics include deinstitutionalization, community-based care, and care management.