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Studentship - Winnie Chow

Centre for Psychiatry

Funding Body: East London NHS Foundation Trust
Project Investigator: Stefan Priebe


Major reforms have changed psychiatric care in Europe over the last five decades. As part of the deinstitutionalisation movement, large asylums were abolished or downsized, and services in the community have been established.

The development of this movement varies greatly across countries. Research suggests that the process of deinstitutionalisation has ended and might have been replaced by a development known as re-institutionalisation, characterized by an increased number of forensic psychiatric beds, and places in residential care and supported housing [1-5]. More research is required to understand this process.

This study aims to examine the potential trend of re-institutionalisation in mental health care where the main objective is to examine how different types of institutionalised psychiatric care, i.e. care provided by institutions that are defined by bricks and mortar, have changed since 1990. Potential driving factors influencing the provision of mental health services will also be explored. Several countries will be taken into account to avoid a false focus on national factors for an international phenomenon.

Activities & Outputs

This study comprises of three parts:

  • a conceptual review on how the term ’institutionalisation’ is conceptualized in modern psychiatry;
  • figures on indicators of institutionalised mental health care and of potential driving factors have been collected; and
  • in-depth interviews with mental health professionals on driving factors influencing provision of mental health services- specifically institutional care were conducted.

Four main themes were identified in conceptualizing institutionalization:

  • bricks and mortar of care institutions;
  • policy and legal frameworks regulating care;
  • clinical responsibility and paternalism in clinician-patient relationships; and d) patients’ adaptive behaviour to institutionalised care [5].
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