deinstitutionalisering

Deinstitutionalisering, also known as deinstitutionalization, is the process of reducing long-term psychiatric hospital care and replacing it with community-based services. The movement emerged in the mid-20th century, driven by civil rights concerns, advances in psychotropic medications, and growing concerns about the costs and human rights implications of large asylums. The goal was to treat people with mental illnesses in the least restrictive setting, promote autonomy, and support integration into society.

In many countries, beds in psychiatric institutions were closed or downsized, and resources were shifted to community care, including outpatient clinics, housing with supports, day programs, assertive community treatment, and outreach services. Legal reforms in many jurisdictions strengthened patient rights, informed consent, and due process.

Implementation varied widely. In the United States and parts of Europe, rapid downsizing outpaced the development of adequate community infrastructure, contributing to increased homelessness, contact with the criminal justice system, or gaps in care for some individuals. In other countries with strong welfare states, deinstitutionalization was more gradually integrated with social and housing policies.

Criticism of deinstitutionalization focuses on underfunded community services, insufficient housing options, and disruptions in continuity of care. Proponents emphasize improved civil liberties, user choice, and normal living conditions when supported by robust services. Today, deinstitutionalization is often regarded as an ongoing reform, requiring sustained investment in community-based mental health care, housing, and social supports to achieve its aims.