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    Morrow, Marina 2004. Mental Health Reform, Economic Globalization and the Practice of Citizenship. Canadian Journal of Community Mental Health, Vol. 23, Issue. 2, p. 39.

  • Currently known as: Epidemiology and Psychiatric Sciences Title history
    Epidemiologia e Psichiatria Sociale, Volume 9, Issue 3
  • September 2000, pp. 163-170

Evaluating the closure or downsizing of psychiatric hospitals: social or clinical event?


Objectives – The evaluation matrix recently proposed by Tansella and Thornicroft suggests that the field of social and epidemiological psychiatry has focussed more on the individual/patient level of mental health care services than the system level. Moreover, phenomena such as deinstitutionalisation have been examined more as clinical events than as social ones. The aims here are to deepen our understanding of deinstitutionalisation, particularly as regards the downsizing/closure and role of psychiatric hospitals. Methods – I begin by reviewing the manifest and latent functions of psychiatric hospitals. This is followed by a discussion of how these functions must be met by any comprehensive community-oriented system of mental health care for severely mentally ill patients. Also, in order to reframe the downsizing/closure of psychiatric hospitals as a social event for the field of social psychiatry and psychiatric epidemiology, I posit that the process of deinstitutionalisation is driven today by the same forces that were present at the outset of the movement. Results – I review four recent series of studies addressing primarily the outcomes, but also other aspects, of the downsizing/closure of psychiatric hospitals, with a view to illustrating the methods used, the results obtained and the blind angles missed in this research. Conclusions – Lessons are drawn on how to fill certain vacant cells of the matrix.


Scopo – Secondo la matrice di valutazione recentemente proposta da Tansella e Thornicroft, la disciplina del la psichiatria sociale ed epidemiologica si è concentrata maggiormente a livello di singolo/paziente dei servizi di cura della salute mentale. Inoltre, fenomeni quali la deistituzionalizzazione sono stati esaminati piuttosto come fatti clinici che sociali. Nel tentativo di approfondire la nostra conoscenza della deistituzionalizzazione, si prendono in esame in primo luogo le funzioni palesi e latenti degli ospedali psichiatrici ed in particolare modo le questioni del loro ridimensionamento/chiusura, nonché del loro ruolo. Metodi – Segue una discussione relativa alle modalità con cui tali funzioni devono essere soddisfatte da qualsiasi sistema generale per comunità, che abbia come scopo la cura della salute mentale di pazienti affetti da gravi patologie mentali. Al fine di riconsiderare il ridimensionamento/chiusura degli ospedali psichiatrici in quanto fatto sociale per il campo della psichiatria sociale e l'epidemiologia psichiatrica, si premette, inoltre, che il processo di deistituzionalizzazione viene oggi condotto dalle stesse forze presenti al momento della nascita del movimento. Risultati – Vengono esaminati quattro serie di studi recenti aventi come oggetto principale, unitamente ad altri aspetti, il ridimensionamento o la chiusura degli ospedali psichiatrici, allo scopo d'illustrare i metodi impiegati, i risultati ottenuti, nonché gli aspetti trascurati da questi studi. Conclusioni – Infine, vengono avanzate delle conclusioni sulle modalità con cui riempire talune cellule inutilizzate della matrice.

Corresponding author
Indirizzo per la corrispondenza: Dr. A.D. Lesage, Université de Montréal and Centre de recherche Fernand-Seguin, Hôpital Louis-H. Lafontaine, 7331 Hochelaga, Montréal (Québec). Fax: 514-251.5404. E-mail:
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H. Goldman , J. Morrissey & S. Ridgely (1994). Evaluating the Robert Wood Johnson Foundation Program on chronic mental illness. MilIBank Quarterly 72, 3748.

C. Henderson & G. Thornicroft (1997). L'étet de la désinstitutionnalisation en Grande Bretagne. Santé Mentale au Quebec 22, 88114.

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L.J. Kirmayer & A. Young (1999). Culture and context in the evolutionary concept of mental disorder. Journal of Abnormal Psychology 108(3), 446452.

J.H. McGrew (Ed.) (1999). Special section: multiple perspectives on the closing of a state hospital. Journal of Behavioral Health Services and Research 26, 236328.

A.B. Rothbard , A.B. Schinnar , T.P. Hadley , K.A. Foley & E. Kuno (1998). Cost comparison of state hospital in community based care for seriously mentally ill adults. American Journal of Psychiatry 155, 523529.

M. Tansella & G. Thornicroft (1998). A conceptual framework for mental health services. Psychological Medicine 28, 503508.

G. Thornicroft , T. Baker , F. Hollaway , S. Johnson , M. Leese , P. McCrone , G. Szmukler , R. Teller & T. Wykes (1999). Community mental health teams:fevidence or belief? British Journal of Psychiatry 175, 508513.

T. Wykes & J.K. Wing (1982). A ward in a house: accommodation for «new» long-stay patients. Ada Psychiatrica Scandinavica 65, 315330.

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Epidemiology and Psychiatric Sciences
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