Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries.
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OBJECTIVE: To establish whether reinstitutionalisation is occurring in mental health care and, if so, with what variations between western European countries. DESIGN: Comparison of data on changes in service provision. SETTING: Six European countries with different traditions of mental health care that have all experienced deinstitutionalisation since the 1970s--England, Germany, Italy, the Netherlands, Spain, and Sweden. OUTCOME MEASURES: Changes in the number of forensic hospital beds, involuntary hospital admissions, places in supported housing, general psychiatric hospital beds, and general prison population between 1990-1 and 2002-3. RESULTS: Forensic beds and places in supported housing have increased in all countries, whereas changes in involuntary hospital admissions have been inconsistent. The number of psychiatric hospital beds has been reduced in five countries, but only in two countries does this reduction outweigh the number of additional places in forensic institutions and supported housing. The general prison population has substantially increased in all countries. CONCLUSIONS: Reinstitutionalisation is taking place in European countries with different traditions of health care, although with significant variation between the six countries studied. The precise reasons for the phenomenon remain unclear. General attitudes to risk containment in a society, as indicated by the size of the prison population, may be more important than changing morbidity and new methods of mental healthcare delivery.
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Main limitations for psychotherapy in acute settings consist of short hospital stays and patients' difficulties to engage due to treatment resistance, high distrust, emotional distress, severe cognitive deficits, and dual diagnoses.
“Main limitations consist of short hospital stays (111) and patients’ general difficulties to engage with traditional psychotherapy concepts due to treatment resistance (112, 113), high distrust levels toward the entire environment (114), emotional distress (115), severe cognitive deficits (116), and dual diagnoses (117).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [113]
Citation (111) is attached to the claim about short hospital stays. The Methods and Results compare numbers of beds and admissions across countries, but neither those passages nor the additional searches for hospital-stay length and psychotherapy address whether short stays limit psychotherapy in acute settings. The other engagement difficulties are attached to different citations. (LLM, conf=0.78)
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- Authors
- Priebe, S., Badesconyi, A., Fioritti, A., Hansson, L., Kilian, R., Torres-Gonzales, F., Turner, T., & Wiersma, D.
- Affiliations
- Queen Mary University of London (GB)
- Lund University (SE)
- Universität Ulm (DE)
- Universidad de Granada (ES)
- University Medical Center Groningen (NL)
- Corresponding author
- Priebe, Stefan
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2004-11-26
- Volume
- 330
- Issue
- 7483
- Pages
- 123-126
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC544427
- OpenAlex
- W2114153799
- Cited by
- 463
- References
- 26
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 6 · 2023: 8 · 2022: 18 · 2021: 15 · 2020: 25 · 2019: 32 · 2018: 29 · 2017: 21 · 2016: 30 · 2015: 16 · 2014: 22 · 2013: 23 · 2012: 25
- FWCI
- 22.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- Multiple Sclerosis Society of Canada
- Multiple Sclerosis Society
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Clinical Psychology › Historical Psychiatry and Medical Practices
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Keywords
- mental health services, deinstitutionalization, involuntary admission, supported housing, psychiatric hospital beds, prison population, risk containment, European comparison
- MeSH terms
- Bed Occupancy, Mental Disorders, Commitment of Persons with Psychiatric Disorders, Commitment of Mentally Ill, Europe, Forensic Psychiatry, Hospitals, Psychiatric, Humans, Institutionalization, Mental Health Services
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