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Background: After a period of institution-based mental health care, in which the asylum system was the way in which the mental patients were treated, deinstitutionalization brought a set of significant changes and transformations in the conceptualization of mental illness and, by extension, the traditional therapeutic settings in which those in most need were assisted. However, this shift in the psychiatric domain was not only accompanied by valued achievements, but also by difficulties and challenges, as has been evidenced today., Aim/objective: The aim of this paper is thus to examine the pros and cons of the closure of asylums, and the subsequent implementation of deinstitutionalization over the 60 years or so of such important transformations in the field of psychiatry., Methods: In considering this question, I examine in detail recent works of literature based on scholarly knowledge. In addition, I identify various issues involved, as well as ways of confronting these so as to attempt to overcome the difficulties they present., Results and Conclusions: As I show here, the changes in the treatment and care of the mentally ill after asylum and deinstitutionalization brought a new air of hope to patients and their families, but also had undesirable effects. The paper also considers how mental health professionals today try to solve these effects on behalf of patients and society as a whole.

The advent of deinstitutionalisation and the introduction of community care in the latter part of the twentieth century have revolutionised mental-health service provision across Europe, although implementation, timing and services have varied widely in different countries. This article compares the changing dimensions of mental-health provision in post-independence Ireland with that in England, and will shed light on the current state of mental healthcare in both countries. The article calls for more research into the impact of deinstitutionalisation, such as the challenges faced in the community for those in need of continuing care., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This article offers a brief history and the evolution of mental health policy in Turkey. It aims to analyse how mental health policies were transformed and why certain policies were introduced at specific times. The modern history of mental health policy is divided into three periods: the institutionalization of psychiatry and hospital-based mental health services; the introduction of community-based mental healthcare services; and lastly, the policy of deinstitutionalization after the 1980s. These periods have been categorized in a way that basically coincides with Turkey's modern political history.

Historians have examined the role of psychiatric institutions in the USA and addressed whether this form of care helped or harmed patients (depending on the perspective of the time period, historical actors, and historians). But the story for children's mental institutions was different. At the time when adult institutions were in decline, children's mental hospitals were expanding. Parents and advocates clamoured for more beds and more services. The decrease in facilities for children was more due to economic factors than ideological opposition. This paper explores a case study of a hospital in Michigan as a window into the different characteristics of the discussion of psychiatric care for children.

The segregation and isolation of people with disabilities are global problems, rooted in legislation and policy, social norms and traditional practices. The right to live independently and be included in the community, contained in article 19 of the United Nations Convention on the Rights of Persons with Disabilities, was created to combat the phenomenon of institutionalization and to spur efforts towards its eventual eradication. This essay offers a commentary on article 19, drawing on its drafting history, on the interpretation provided by the responsible UN body and on the efforts by that body to monitor and encourage compliance. It emphasizes the extent of the transformation required to realize the full ambition of the article and the need for cooperation across UN treaty bodies., (Copyright © 2019. Published by Elsevier Ltd.)

Introduction : This study examines the humanization movement at the Saint-Jean-de-Dieu psychiatric hospital between the 1960s and the 1990s.Context : Conducting a historiography of psychiatric deinstitutionalization in Quebec during the twentieth century shows that the institution was a place of social control and, above all else, a place where psychiatric patients were neglected and dehumanized.Objective : While the historiography since the 1960s has focused on a largely one-dimensional and critical reading of the way in which deinstitutionalization took place in Quebec, I have instead chosen to focus on the changes that took place within the Quebec hospital's walls.Method : In addition to the medical records of the patients who were interned in 1961, I conducted interviews to examine the experiences and emotions of nurses who worked in the psychiatric hospital between the 1960s and 1990s.Results : The examination of medical records revealed patients' reluctance and resistance to reintegrate into society. The interviews with nurses revealed that they often felt close to their patients.Discussion : The words and memories of nurses enrich and deepen the complexity of the history of psychiatric nursing practices, extend the existing historiography, and open new avenues for research in the field.Conclusion : The deinstitutionalization movement promoted mental health policies that transformed the old psychiatric hospital. This new analytical approach contributed to renewing the history of psychiatric nursing practices.

In April 1962, a new mental hospital was inaugurated in Belville, a town near Cape Town, South Africa. Stikland Mental Hospital was planned as mental health care was changing with the introduction of psychotropic drugs and renewed debates about deinstitutionalization-and as the South African legislature formalized the system known as "apartheid." This article focuses on this hospital, which embodied many global ideas about treatment and management of the mentally ill but which also incorporated the local politics of strict racial segregation. It had been planned in response to overcrowded mental hospitals in the 1950s, but by the time it opened, new forms of treatment had produced a surplus of beds for White patients. Architecturally, the hospital was conceived with the general principles of the villa plan in mind, although utilitarian aspects, such as patient and staff numbers, gardens, and budgets, dominated the design of the buildings. The public relations exercises undertaken highlight the negotiations involved in building a mental hospital in 1960s South Africa, but the example of Stikland also showcases new plans for research and training in mental health professions in the 1960s and 1970s. Disciplines such as clinical psychology benefited from the professional training opportunities provided. Overall, Stikland Mental Hospital therefore provides an important perspective on deinstitutionalization outside its familiar settings and historical accounts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

There is a rich literature on the deinstitutionalization movement in the US but few, if any, parallel histories of state mental hospitals. Under attack from the 1950s on, state hospitals dwindled in size and importance. Yet, their budgets remained large. This paper offers a case study of one such facility, Indiana's Central State Hospital, between 1968 and 1994. During these years, local newspapers published multiple stories of patient abuse and neglect. Internal hospital materials also acknowledged problems but offered few solutions. In 1984, the US Department of Justice intervened, charging Central State with having violated patients' civil rights, the first such action filed under the 1980 Civil Rights of Institutionalized Persons Act. Although Indiana signed a consent decree promising major reform, long-lasting change proved elusive. Civil and criminal lawsuits proliferated. In 1992, as Central State continued to attract negative attention, Indiana Governor Evan Bayh ordered the troubled hospital closed. His decision promised to save the state millions of dollars and won plaudits from many, but not all, mental health advocates. Even as the last patients left in 1994, some families continued to challenge the wisdom of eliminating Indiana's only large urban mental hospital, but to no effect.

This paper proposes a historiographical discussion based on the article « Les contrecoups de la déshospitalisation psychiatrique. L'exemple du parcours transinstitutionel de Françoise ». Françoise's transinstitutional journey presented in the collective publication La fin de l'asile ? Histoire de la déshospitalisation psychiatrique dans l'espace francophone au XX e siècle , gives me the opportunity to reveal the subtext of this article, and to describe the method and the historical reasoning that gave life to the psychiatric journey of an anonymous person named Françoise. This process is organized around three main points: my positioning as a researcher, the issues related to my narrative approach, and a statement on my historical reasoning in an interdisciplinary perspective. Influenced and inspired by the work of Alain Corbin, George Duby, Roy Porter, Natalie Zemon Davis and Arlette Farge, my approach focusses on the feelings and emotions hidden in historical sources. I remain connected to a subjective intuition, and stay away from positivist reflexes. Based on my research experience with psychiatric records, my conclusion explores the renewal of historical writing , in which I suggest that it is possible to write the history of ordinary people while telling stories with sensitivity.

In Italy, following the closure of psychiatric hospitals in 1978 and the release of psychiatric patients into community care, there was a mismatch between common psychiatric patients and the convicted mentally ill who were sentenced to serve in state forensic psychiatric hospitals. The recent closure of such structures following the Prime Minister's Decree of April 1, 2008, fostered the need to create new structures. These are called "REMS," and they are based in the community and led by psychiatrists and healthcare staff who may rely on the collaboration of public security staff. This act completed a course of progressive deinstitutionalization of all psychiatric patients. However, some problems remain, and persons regarded as "partially mentally disabled" at the time of crime perpetration must serve part of their sentence in prison and the rest in the aforementioned structures or in psychiatric rehabilitation communities, depending on their claimed "social dangerousness." Psychiatric services now face the ambiguity of treating persons who are considered dangerous by court orders, while the civil law criteria for involuntary hospitalization is based only on the need of care. The complete closure of forensic hospitals may be considered a decisive step forward in the humanization of society, but there are still some issues to address to make it work better. The implementation of multidisciplinary teams and effective psychotherapy, psychoeducational, and rehabilitation interventions can help., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Aim: Asylums comprises the main focus of historical research on early 20th century psychiatry. To assess the characteristic of asylum transfers in a clinical population, we analyzed newly found clinical records from University of Pisa Clinic for Mental and Nervous Illness. We focused on the early years of this structure’s activities considering all admissions from 24th April 1907 to 31st January 1913., Methods: We collected demographic and clinical data from 1,068 patients performing Chi-Square Tests to study correlation between asylum transfer and diagnosis and gender difference; independent sample Student’s t-tests were also performed to compare mean Age, mean number of Days of Hospitalization and mean number of Subsequent Admissions to the Clinic observed in patients transferred to an asylum versus those who had been discharged. Multiple logistic regression model was employed to identify the best predictors of asylum transfers., Results: Most patient were discharged, and only a third of the hospitalization led to asylum confinement. Our data outlines a peculiar discharge rationale, suggesting that the Clinic acted like a “sieve-institution” to prevent asylum overcrowding from treatable, non-chronic conditions., Discussion: These data suggest that our historical view of psychiatric care is probably not complete, and that a different approach to source materials could provide new research paradigms.

This article examines Scottish provision of psychiatric care in the 1960s and 1970s. It demonstrates that institutional services did not rapidly disappear across the UK following the Ministry of Health's decision to shut down psychiatric hospitals in 1961, and highlights Scotland's distinctive trajectory. Furthermore, it contends that psychiatric hospitals developed new approaches to assist patients in this era, thereby contributing towards the transformation of post-war psychiatric practice. Connecting a discussion of policy with an analysis of provision, it examines the Department of Health for Scotland's cautious response to the Ministry's embrace of deinstitutionalization, before analysing Glasgow's psychiatric provision in the 1970s. At this point the city boasted virtually no community-based services, and relied heavily on its under-resourced and overburdened hospitals. Closer analysis dispels any impression of stagnation, revealing how ideologies of deinstitutionalization transformed institutional care.

This article provides a brief history on the evolution of child mental health services. From 1961 when modern day mental health programming began with the Joint Commission on Mental Health and Illness to key developments in children's mental health services and prevention in modern day., ((c) 2015 APA, all rights reserved).)

If one thinks medicine, madness and the past, one image immediately pops into mind: that of the mental asylum. Following the famous work by Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason, many historians have thus considered that the medicalization of insanity in the modern age had mostly led to a "great confinement" and a greater segregation of all individuals deemed mentally unfit during the "asylum era': However, new research demonstrates that this classic narrative of the psychiatric past needs to be revised. It discloses that, ever since the 191h century, a whole other medical culture existed as a challenge to asylums, a culture that advocated the integration of the mad and fought to disassociate psychiatry from the dominant model of confinement all throughout the occidental world. This article aims at presenting the results of these historical works that depict another aspect of the psychiatric history, exploring "boarding out" practices, instead of asylum ones.

The deinstitutionalization of individuals with serious mental illness was driven by 4 factors: public revelations regarding the state of public mental hospitals, the introduction of antipsychotic medications, the introduction of federal programs to fund patients who had been discharged, and civil libertarian lawyers. The result is approximately 3.2 million individuals with untreated serious mental illness living in the community. Beginning in the 1970s in the United States, there began to be reported increasing incidents of violent behavior, including homicides, committed by these untreated individuals. Such incidents became more numerous in the 1980s and 1990s, and have further increased since the turn of the century. Existing studies suggest that individuals with untreated severe mental illness are responsible for at least 10% of all homicides and approximately half of all mass killings. Studies have also shown that when these individuals are treated, the incidence of violent behavior decreases significantly. Examples of treatment mechanisms that have proven effective include assisted outpatient treatment (AOT), conditional release, and mental health courts.

Unlabelled: POLICY POINTS: A retrospective analysis of federally funded homeless research in the 1980s serves as a case study of how politics can influence social and behavioral science research agendas today in the United States. These studies of homeless populations, the first funded by the National Institute of Mental Health, demonstrated that only about a third of the homeless population was mentally ill and that a diverse group of people experienced homelessness. This groundbreaking research program set the mold for a generation of research and policy characterizing homelessness as primarily an individual-level problem rather than a problem with the social safety net., Context: A decade after the nation's Skid Rows were razed, homelessness reemerged in the early 1980s as a health policy issue in the United States. While activists advocated for government-funded programs to address homelessness, officials of the Reagan administration questioned the need for a federal response to the problem. In this climate, the National Institute of Mental Health (NIMH) launched a seminal program to investigate mental illness and substance abuse among homeless individuals. This program serves as a key case study of the social and behavioral sciences' role in the policy response to homelessness and how politics has shaped the federal research agenda., Methods: Drawing on interviews with former government officials, researchers, social activists, and others, along with archival material, news reports, scientific literature, and government publications, this article examines the emergence and impact of social and behavioral science research on homelessness., Findings: Research sponsored by the NIMH and other federal research bodies during the 1980s produced a rough picture of mental illness and substance abuse prevalence among the US homeless population, and private foundations supported projects that looked at this group's health care needs. The Reagan administration's opposition to funding "social research," together with the lack of private-sector support for such research, meant that few studies examined the relationship between homelessness and structural factors such as housing, employment, and social services., Conclusions: The NIMH's homelessness research program led to improved understanding of substance abuse and mental illness in homeless populations. Its primary research focus on behavioral disorders nevertheless unwittingly reinforced the erroneous notion that homelessness was rooted solely in individual pathology. These distortions, shaped by the Reagan administration's policies and reflecting social and behavioral scientists' long-standing tendencies to emphasize individual and cultural rather than structural aspects of poverty, fragmented homelessness research and policy in enduring ways., (© 2015 Milbank Memorial Fund.)

This article analyses the illness experiences of male patients from the Heidelberg University Psychiatric Hospital during the protests against Psychiatry in the year 1973. Protest is one of the most important expressions of masculinity in socially disadvantaged men, such as men with mental disorders. The analysis of 100 medical records shows that some patients tried to construct themselves as men in a way that was explicitly motivated by antipsychiatric ideas: They questioned psychiatric authority, behaved "sexually inappropriate", or used drugs. On the eve of psychiatric reform in West Germany those patients were well aware that the alternative--complying with the treatment--would put them at considerable risk. In addition to the usual inference of hegemonic or normative masculinities as risk-factors, the behavior of those ,,rebellious patients" has to be interpreted as individual coping strategies.

The thinking of Franco Basaglia helps to improve understanding of the complexity of the relationships between theory and practice. Medicine must be thought out on the basis of the political organisation where it is situated and the psychiatric institution reflects an organisation founded on exclusion. It is essential to re-establish a place for an individual's difference in psychiatric practice. The challenge is to enable the patient to emerge as a subject.

In 2013 at the Rodewisch Clinic for Psychiatry, four folders were found that contain original documents from the office of former head of the clinic Rolf Walther. These original sources provide new insights into the organisational background of the International Symposium on Psychiatric Rehabilitation of 1963, as a result of which the groundbreaking Rodewisch Propositions were framed. The documents founds reveal that, apart from the persons already identified, Halle/Saale - based hygienist Karlheinz Renker was deeply involved in the preparation of this event. They also show that for ideological reasons the GDR Ministry of Health restricted the number of participants from non-socialist countries, in particular Western Germany, to be admitted. Finally, the sources suggest that a volume compiling all talks given at the symposium as one publication and as such making its content and resolutions known to a wider public failed, among other reasons, due to the fact that Karl Leonhard, then head of the GDR Association for Psychiatry and Neurology, was "not interested" in it., (© Georg Thieme Verlag KG Stuttgart · New York.)

The reform of psychiatry in Germany has seen the conversion of numerous psychiatric hospitals into general hospitals with a psychiatric department. With regard to nursing care, a two-year additional training is offered to professionals wishing to work in psychiatry. Finally, there exists within the population a marginalisation of psychotic patients or of those suffering from an addiction.

Purpose of Review: The purpose of this review is to highlight recent English-language literature on the history of psychiatric institutions. It considers work published since 2010, as well as a few important older articles that have not yet been reviewed in these pages., Recent Findings: Developments in the last half of the 20th century suggest that psychiatric historiography might finally be able to put the mental asylum behind it. Deinstitutionalization and the diffusion of professional jurisdictions seem to have consigned institutional histories to the methodological dustbin. But these transformations have also opened new perspectives on the institutional history of psychiatry and its methodologies. This review reflects on some of the enduring historiographic potential and importance of evidence drawn from institutional settings., Summary: As carceral narratives have begun to lose their paradigmatic status within psychiatric historiography, a much more nuanced picture of asylum culture is becoming visible. The history of psychiatric institutions remains an integral and productive part of psychiatric historiography.

In the early 1960s, Canada's provinces began radically to reduce the in-patient populations of their psychiatric services. This was part of a wider project of trans-institutionalization through which vulnerable people and those who cared for them were shifted across institutional contexts within Canada's evolving welfare state apparatus. This article draws on interviews with Psychiatric Nurses who worked through the transformative mental health reforms of the 1960s and 1970s, and it makes a case for practitioner history. Practitioner narratives offer a window on the vital tensions between the manifest and the latent functions of welfare institutions, between the impulse to support and the impulse to control, and between paternalism and respect for the rights of the mentally ill. It draws upon the authority of practitioners who, retrospectively, have gained insight into their involvement with prior regimes of caring and control and have come to discern institutional logics previously so hegemonic as to have been largely invisible to them.

Community mental health nurses had a central role in the construction of new rehabilitative practices and community mental health services in the 1960s and 1970s. The purpose of this article is, first, to explore how nurses understood and created their new role and identity in the turbulent context of deinstitutionalization. The development of after care services for patients discharged from Alberta Hospital in Ponoka (AH-Ponoka), a large mental institution in Calgary, in the Canadian province of Alberta, will be used as a case study. I specifically focus on the establishment of outpatient services in a new psychiatric department at Foothills General Hospital in Calgary. Second, I examine how deinstitutionalization itself shaped community mental health nurses' work. Oral history interviews with nurses and other mental health professionals, who had a central role in this transformation process, provide a unique lens through which to explore this social change. The article concludes that new rehabilitative, community-based mental health services can better be understood as a transformation of former institutional practices rather than as a definite break with them.

This article on the first initiatives of social integration of the mentally ill, using the example of Saint-Jean-de-Dieu Hospital, explores the implementation of dehopsitalization (the transition between hospital and community care) in the early decades of the 20th century. Our study is part of the recent historiographical stream that offers a reinterpretation of the period just prior to the Quiet Revolution in Quebec. We aim to contribute to this research by showing that the policies, strategies, and practices of the Sisters of Providence and the psychiatrists of Saint-Jean-de-Dieu already comprised a deinstitutionalization system that was reintegrating patients into their families as early as the 1910s--half a century before the first wave of deinstitutionalization of the 1960s was orchestrated by the authors of the Bédard Report.

This article develops an analytical framework of processes of institutional reform in psychiatry in Western countries during the last century. It discusses explanations of social change based on deinstitutionalization and proposes instead to put reform practices themselves at the centre of the analysis. Thus, central to this framework is the historicity of the idea of reform itself. Taking the case of France as an example, the article shows how the diffusion of a reformist ethos within psychiatry in the post-World War II period can be accounted for by a change in medical expertise during the first half of the century. It concludes with a discussion of the changing relationship between psychiatrists and the State in the twentieth century.

While contemporary mental health services have been marked by the burgeoning of outpatient and preventive care, the historiography of psychiatry remains largely tied to the study of custodial and palliative treatment.The work in which contemporary psychiatry has been involved cannot be adequately understood as a singular, autonomous enterprise based in a residential facility. It has become a technoscience that operates in numerous settings and alongside multiple sciences, technologies and decision-makers. This paper explores what it might mean to 'deinstitutionalize' the history of contemporary psychiatry by examining the case of social therapy for sex offenders in West Germany.

This article on the first initiatives of social integration of the mentally ill, using the example of the Hôpital St-Jean-de-Dieu, explores the implementation of a period of deinstitutionalization in the early decades of the 20th century. Our study is situated in the recent historiography that offers a rereading of the period just prior to the Quiet Revolution in Quebec. We intend to contribute by demonstrating that the policies, strategies and practices of the Sisters of Providence and the psychiatrists of St-Jean-de-Dieu developed a system of deinstitutionalization that reintegrated patients into their family as early as the 1910s, half a century before the first wave of deinstitutionalization of the 1960s was orchestrated by the authors of the Bédard report.

Using demographics on admission to, and discharge from, mental hospitals in Alberta and British Columbia, this paper analyzes the social process commonly framed as deinstitutionalization between 1950 and 1980. A focus on the two most western Canadian provinces permits an exploration of these changes in these regional contexts. Pressured by new funding arrangements, a shift towards community care, and growing criticism of the alleged oppressive nature of large institutions, the three main mental hospitals scaled down as of the 1950s. This trend did not mean, however, that the overall number of hospitalized patients decreased during this time period. The total number of hospitalizations, particularly short-term admissions, actually expanded, while trans-institutionalization also occurred. This case study mirrors larger trends of postwar mental health care, illustrating the social, political, and cultural challenges experienced in the reconstruction of institutional care.

Defined as a set of distinct processes that included the declining use of large psychiatric institutions and the increasing use of outpatient services and general hospitals, deinstitutionalization occurred earlier in Saskatchewan than other provinces in Canada. It was led by a CCF government dedicated to major change across a number of sectors including mental health, assisted by one of the most influential and well-organized social movement organizations of the 1950s, the Saskatchewan Division of the Canadian Mental Health Association (SCMHA). However, by the late 1950s and early 1960s, the SCMHA opposed the CCF government's policy priority on medicare which it felt came at the expense of mental health care, in particular the implementation of a regional psychiatric hospital system called the Saskatchewan Plan. As a consequence, the SCMHA, once such a powerful ally of the CCF government in health reform, formed a strategic and temporary coalition with the anti-medicare forces in the province. Given the fact that a number of medical staff within the government's department of public health were prominent members of the SCMHA, the CCF government found that it occupied an increasingly divided house at the very time it was struggling to introduce medicare in the midst of civil unrest and a doctors' strike.

During late 1951 and early 1952, married couple, social biologist Elaine Cumming and psychiatrist John Cumming, led a mental health education experiment in Indian Head, Saskatchewan. The study, which was intended to inform strategies toward deinstitutionalization, sought to determine if attitudes regarding mental illness could be changed through commonly used educational practices. It was shaped by the shared interests of powerful philanthropic, charitable, psychiatric, academic and governmental bodies to create healthier citizens and a stronger democratic nation through expert knowledge. However, in addition to the disappointing findings indicating that attitudes remained unchanged, the town appeared to close ranks against the research team. Nonetheless, the Cummings' later association with sociologists at Harvard University enabled them to interpret the results in a way that lent the study credibility and themselves legitimacy, thus opening the door to their careers as very successful researchers and policy-makers.

Never is the fraught relationship between the state-run custodial mental hospital and its host community clearer than during the period of rapid deinstitutionalization, when communities, facing the closure of their mental health facilities, inserted themselves into debates about the proper configuration of the mental health care system. Using the case of Weyburn, Saskatchewan, site in the 1960s of one of Canada's earliest and most radical experiments in rapid institutional depopulation, this article explores the government of Saskatchewan's management of the conflict between the latent functions of the old-line mental hospital as a community institution, an employer, and a generator of economic activity with its manifest function as a site of care made obsolete by the shift to community models of care.

This article offers a glimpse into the lives and activities of some of the patients, volunteers and staff in the Saskatchewan mental health system during the period of deinstitutionalization. Drawing on her own experience as a patient in psychiatric wards as well as ongoing research in the history of mental health, it features the role of Regina Volunteer Visitors in Saskatchewan Hospital, Weyburn and examines the importance of occupational and recreational therapies and activities in improving the lives of the patients in that institution. It emphasizes the perspectives of patients and volunteers who actively worked to develop recreational activities, with the intention of helping individuals connect with the surrounding communities. The views and perspectives presented here are drawn from a variety of historical and oral interview sources, including views from visitors to the asylum and patients who lived within its walls. The author has also been a consumer of mental health services, and spent time in the Provincial Mental Hospital in North Battleford. The article therefore makes an important contribution to enhancing our understanding of the social history of deinstitutionalization, not only for its unique source base, but also because those sources have been examined and explained to readers through the perspectives of a former patient herself. This article draws significant attention to the changing opportunities for patients as they interacted with the women's volunteer groups, as well as to how the changes brought about by the encroaching deinstitutionalization, care in the community, and decisions from "above" affected the individuals on the ground.

Psychiatry opens to the world at a time when the very basis of psychiatric practice, namely the asylum, is called into question. Studies appear in Quebec and Canadian journals concurrent to the introduction of new formulas for care, such as the delivery of psychiatric services in general hospitals and clinics, that allow patients to be treated outside the walls of psychiatric hospitals. In addition, postwar psychiatry takes an optimistic view toward the future of children with impairments through the creation of specialized schools and workshops. From the mid-20th century onward, the thinking in psychiatry centres on the open door.

In this paper we explore the broader policy determinants of the de-hospitalization of mental patients in Nova Scotia between the 1950s and 1980s and trace the background to the development of occupational rehabilitation programs in the community. For employment programs, the government chose to rely on non-profit NGOs as the suppliers of services. As a case study of such an organization, we examine the evolution of LakeCity Employment Services Association as a resource for people living with mental disabilities.

On the eve of deinstitutionalization, a group of professionals, including an architect, a psychiatrist, and a psychologist, joined together in pursuit of a middle ground between outright closure of long-stay hospitals and the introduction of out-patient services in general hospitals. Augmented by the use of the hallucinogenic drug LSD, these men produced a trenchant critique of modern psychiatry and the changing mental health system without subscribing to antipsychiatry. Caught among shifting psychiatric paradigms, fiscal constraints, and political pressure to situate mental health within an encroaching system of publicly funded health care reforms, their proposed mental hospital designs failed to stem the tidal wave of post-World War II changes in mental health care.

This paper examines the history of care in modern society and seeks to expose how deep transformations in care arise from wider social relations. From historical survey we may discern a series of transitional points, where the practice and the experience of care was greatly, sometimes suddenly, redefined. Each betrayed deeper political and ethical struggles that went to the core of social relations, and which weren't merely therapeutic in nature. This paper explores two such 'moments'. I first examine the emergence of a new institutional landscape during the middle industrial era, in the wake of a series of legal and political reforms that sought to settle a social order uprooted and distressed by raw modernisation. I provide a composite, yet incomplete view, of how this transformation proceeded in one urban setting, colonial Melbourne. In the second instance, I review the ambitions and process of deinstitutionalisation in the late 20(th) century. Ostensibly, this reform sought, inter alia, to collapse the great division between 'fit' and 'unfit' established in 1834. Again, empirical reference is made to the reconstitution of care in Melbourne, Australia, this time during its late 20th experience of institutional reform. The focus in this case is the process of downscaling and closure for a major congregate facility, Kew Cottages. The major conclusion is that periods of intense transition in the ideology and mode of care are reflective of wider social transformations not merely of therapeutic or institutional shifts.

According to the Penrose's law, outlined on the basis of a comparative study of European statistics, there is an inverse relationship between the number of psychiatric beds and prison population. Based on international data, interrelationship among prison, asylum, psychiatric disease and criminal action are investigated in the present study, paying particular attention to the event of deinstitutionalization. Prevalence of mental and addictive diseases as well as psychological disturbances in prison is characterized by epidemiological data. As proposed by Penrose, an inverse relationship between the number of psychiatric beds and prison population can be observed in Hungary, too. To get a deeper insight into the mainstream of the events, economic, sociological, philosophical, as well as therapeutic aspects initializing deinstitutionalization are highlighted in the course of analysis. On the basis of data, it can be assumed that members the same population are confined to both systems. The author arrives at the conclusion that deinstitutionalization has in fact led to trans-institutionalization, because of, on one hand, the limited capacity of community treatment facilities; on the other hand, the community treatment itself cannot provide adequate treatment options to those suffering from severe, chronic mental diseases or comorbid states. In addition, the rate of financial support and the methods for prevention and treatment are insufficient to protect patients from the effects of revolving door.

It is not possible to work on alternatives to chronic institutionalization without taking into account a reform of the mental health care system. A great deal of experience has been accumulated and a lot of unsolved problems have arisen since the beginning of the deinstitutionalization in USA and Europe in the 60s. The aim was the closing of psychiatric hospitals, and so the accent was put on the physical place of treatment instead on the quality of the treatment or on the actual needs of the people involved. A review of the experiences is made and some clues are given to avoid the major problems and errors that have presented. Political decisions, experienced professionals, a stable and sufficient budget, modification of some laws, the creation of community institutions that fulfill the patient's needs before moving them, postgraduate training in rehabilitation, flexibility and creativity with empirical and scientific grounds are needed for a successful reform of the mental health care system.

Deinstitutionalisation describes the process in which, throughout the western world, psychiatric hospitals discharged most of their patients and most often closed their doors. It coincided with an influential rethinking of the status of the mentally ill as citizens. At Wolston Park Hospital, Queensland's first and major psychiatric facility, opened in 1865, this was an extended process beginning in the 1930s that ended only in 2001. This paper considers how this happened, over what period of time, and with what kinds of impact on the institutional community. It makes use of oral histories collected among those who worked at the hospital as well as those who were its patients and clients.