Deinstitutionalization in the United Kingdom

The TAPS Project. 13: Clinical and Social Outcomes of Long-Stay Psychiatric Patients After One Year in the Community

“…The features of institutionalism can occur in community facilities as well as psychiatric hospitals (Lamb, 1979;Bennett & Morris, 1983;Kunze, 1985). This was not the case in the community facilities studied here.…”

Reconstructing the eclectic psychiatry of Thomas Ferguson Rodger

“…Yet Rodger’s rhetoric perhaps belies the complexity of de-institutionalization. Bennett and Morris (1982: 5) write that the decrease in inhabitants of ‘British mental hospitals’ since the 1950s was ‘less the expression of a single process and coherent philosophy than the outcome of … different objectives, emphases, and intellectual foundations’, some of which are summarized here. Early steps in the provision of alternative psychiatric care followed the realization of the reality of mental breakdown in World War I (Freeman, 1996: 55).…”

“…In this period ‘“[p]hysical” and “social” models of psychiatric treatment … contested not only the aetiology of mental illness but also the nature of care, treatment and cure’ (p. 223). Bennett and Morris (1982: 8) articulate a similar antagonism between the contrasting psychiatric sensibility underlying the initial motivations for de-institutionalization in the 1930s and the later move towards ‘community care’ in the 1960s: while the employment of ‘outpatient clinics’ and incorporation of psychiatry into ‘the general medical community’ was at first impelled by the ‘“medicalization” of psychiatric care’, the later community-oriented treatment of mental illness was driven by ‘social models of care’ and a minimization of hospital-based treatment. Yet, as Long (2011: 233) notes, this opposition between ‘physical’ and ‘social’ frameworks was to a degree a ‘false dichotomy’, since ‘[i]n practice physical and social approaches to treatment frequently co-existed within hospitals’.…”

“…It positions Rodger’s eclecticism as both a modification of the biopsychosocial or dynamic model of Adolf Meyer and Henderson, and a response precipitated by psychiatry’s new position within the general hospital. With the post-war establishment of the British National Health Service (NHS) and the gradual process of de-institutionalizing psychiatry which followed, antagonisms have been identified in relation to the advocacy of physical treatments, psychiatry’s alliance with general medicine, and the use of social approaches in psychiatry (Bennett and Morris, 1982: 8; Long, 2011). Towards the end of the 1940s and 1950s, prominent psychiatrists sidelined social/psychological insights and methods, advocating new physical treatments as a means of re-orienting psychiatry in relation to general medicine (Long, 2011: 228).…”

Rehabilitation in psychiatric conditions: 1--Community and residential care.

“…A study of day hospital patients in Cardiff, less well provided with varied community services, showed a lower prevalence of long term patients using the services, and high rates of mental and physical symptoms. 2 Day care is said to be of uneven distribution and quality and inadequately evaluated, and its opportunities are not sufficiently exploited. '4 Day services'5 are provided by health and local authorities and also by voluntary bodies, day hospitals being in theory more devoted to treatment, including occupational therapy, and day centres having more of a social and recreational and sometimes work function, though they often overlap considerably; both have many long term attenders (Edwards and Carter'7).…”