Deinstitutionalization today : person-centered focus and system change toward community mental health

english

2025

volume 64, issue 1/2

community-based care   human rights   psychiatric institutions   recovery   social inclusion

Univerza v Ljubljani, Fakulteta za socialno delo

Long term institutions have been for many years considered as relics of the past, but they still absorb the ma- jority of economic resources of mental healthcare and are vehemently resisting to change. Most reforms in Europe are now trying to develop community services, which are integrated within welfare systems and so- cial networks, but they are loosely coupled with a radical institutional transformation. Deinstitutionalization is mentioned in many international charters and documents, as the WHO Report and the UN Committee for Convention on the Rights of Persons with Disabilities. While there is a substantial agreement on the basic defi- nition as far as it is referred to patients (e.g., the release from the institution), nonetheless the process is widely misunderstood. It regards not just the downsizing, and final closure of total institutions, or the discharge of their patients, but a whole system change and moreover a full transformation of psychiatry towards community mental health. Deinstitutionalization must be seen as the main strategy to overturn old forms of oppression of people with mental health conditions and disabilities and to mobilize resources and supports for their recovery and social integration. Community-based services can promote the response to needs and the fulfillment of ci- tizenship rights by catalyzing resources and opportunities. The Italian experience, and especially the one in Tri- este, is a demonstration that this is possible, by acting in a way that fosters subjectivity, empowerment, recovery and social inclusion, while embracing a human rights approach (e.g. principles of open door, no restraint). To complete deinstitutionalization of mental healthcare, we thus need the convergence of human rights, person- -centered and recovery approaches with comprehensive, strong, and responsive community-centric services

26.11.2025