Theoretical accounts on deinstitutionalization and the reform of mental health services: a critical review

  • Enric J. Novella
Scientific Contribution


This article offers a comprehensive critical review of the most popular theoretical accounts on the recent processes of deinstitutionalization and reform of mental health services and their possible underlying factors, focusing in the sharp contrast between the straightforward ideas and models maintained by mainstream psychiatry and the different interpretations delivered by authors coming from the social sciences or applying conceptual tools stemming from diverse social theories. Since all these appraisals tend to illuminate only some aspects of the process while obscuring others, or do not fit at all with some important points of the actual changes, it is concluded that the quest for an adequate explanation is far from having been completed. Finally, some methodological and conceptual strategies for a renewed theoretical understanding of these significant transformations are also briefly discussed, including a comprehensive empirical evaluation of the facts, the consideration of the shifting social values and needs involved in mental health care provision and the historical analysis of deinstitutionalization policies within the framework of the broader social and cultural trends of the decades following World War II.


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



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 also very grateful to Professor Heinz-Peter Schmiedebach, Dr. Kai Sammet and two anonymous reviewers of this journal, who read an earlier draft of the manuscript and provided valuable critical insights.


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© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  1. 1.Department of PsychiatryHospital Clínic UniversitariValenciaSpain

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