Health Care Analysis

, Volume 18, Issue 3, pp 222–238 | Cite as

Mental Health Care in the Aftermath of Deinstitutionalization: A Retrospective and Prospective View

  • Enric J. Novella
Original Article


This paper offers a panoramic assessment of the significant changes experienced by psychiatric care in Western Europe and North America in the course of the last decades of deinstitutionalization and reform. Drawing on different comparative studies and an own review of relevant data and reports, the main transformations in the mental health field are analyzed around seven major topics: the expanding scope of psychiatry; the decline and metamorphosis of the asylum; the introduction of alternative and diversified forms of care; the new challenges posed by chronic mental illness; the emergence of modern psychopharmacology; the deployment of subspecialization; and the new forms of coercion implemented with community mental health practices. Following a renewed diagnosis on the essential features of the reformed mental health systems based on the pattern of social inclusion inherent to the new devices and philosophies of care, some major challenges for the future such as the overburdening of services or the overt exclusion of a significant part of potential users are also identified and briefly discussed.


Mental health services Contemporary health care Deinstitutionalization Psychiatric reform Community psychiatry Social exclusion 



Preparatory research for this paper was conducted during two academic stays at the Universities of Berlin (FU) and Hamburg funded by the German Service for Academic Exchange (DAAD) and the Medical Research Foundation MMA (Spain). I am very grateful to Professor Heinz-Peter Schmiedebach, Dr. Kai Sammet and Professor Rafael Huertas, who read earlier drafts of the manuscript and provided valuable critical insights.


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Spanish National Research Council, Centre for Human and Social Sciences (CSIC)MadridSpain

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