Current Psychiatry Reports

, Volume 14, Issue 3, pp 259–269 | Cite as

Deinstitutionalization? Where Have All the People Gone?

  • Lisa Davis
  • Anthony Fulginiti
  • Liat Kriegel
  • John S. Brekke


Although there is broad consensus that the state psychiatric hospital population drastically declined over the past five decades, the destination and well-being of people with serious mental illness (SMI) have been in greater doubt. In this article, we examine the aftermath of the deinstitutionalization movement. We begin with a brief historical overview of the move away from state hospitals, followed by an examination of where people with SMI currently reside and receive treatment. Next, we review recent trends reflecting access to treatment and level of community integration among this population. Evidence suggests the current decentralized mental health care system has generally benefited middle-class individuals with less severe disorders; those with serious and persistent mental illness, with the greatest need, often fare the worst. We conclude with several questions warranting further attention, including how deinstitutionalization can be defined and how barriers to community integration may be addressed.


Deinstitutionalization Serious mental illness Incarceration Mental health services Mental health spending Community integration Homeless Nursing homes Institutional Institutionalization 



No potential conflicts of interest relevant to this article were reported.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Lisa Davis
    • 1
  • Anthony Fulginiti
    • 1
  • Liat Kriegel
    • 1
  • John S. Brekke
    • 1
  1. 1.American Academy of Social Work and Social Welfare School of Social Work University of Southern CaliforniaLos AngelesUSA

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