Transition of Mental Health Services from Institutional to Community-Based Care Abroad and Its Context for Slovenia—Advantages and Risks
Abstract
1. Introduction
2. Materials and Methods
3. Results
3.1. Literature Review
3.2. Current Mental Health Services in Slovenia
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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N. | Title | Authors | Journal | Study Design | The Main Findings |
---|---|---|---|---|---|
1 | A brief history of the criminalization of mental illness. | Dvoskin et al., 2020 [25] | CNS Spectrums | Narrative review. | Although mental illness accounts for a small percentage of violent crime, deinstitutionalization and inadequately funded community care have contributed to homelessness and imprisonment. To prevent inappropriate incarceration, police officers and first responders need to be trained in recognizing mental disorders or emotional crises. Additionally, sufficient hospital beds must be made available for short-term hospitalization and crisis stabilization. Mental health services should also be accessible within jails and prisons. |
2 | The fiftieth anniversary of the article that shook up psychiatry. | Rybakowski J., 2023 [26] | Psychiatria Polska | Narrative review. | Poland faces a lack of available psychiatric beds after implementing the National Program of Mental Health 2011–2015. A significant correlation has been observed between the reduction in psychiatric beds and an increase in suicides. As a result, patients are often left with only two options: homelessness or imprisonment. In 2022 in the USA, a phenomenon transinstitutionalization was noted, with ten times more psychiatric patients placed in prisons than in psychiatric hospitals. |
3 | Organization of Community Psychiatric Services in Finland. | Korkeila J., 2021 [27] | Consortium Psychiatricum | Narrative review. | Mental health services in Finland are mostly outpatient-oriented, with the number of available beds reduced to just one fifth of what was available four decades ago. Deinstitutionalization has not resulted in a rise in the mortality rate or homelessness of individuals with mental health issues. As in Denmark, patients with schizophrenia, who are more challenging to treat, are increasingly referred to state mental hospitals, which are the only psychiatric facilities where the number of wards and beds has increased. |
4 | Through the Cracks: The Disposition of Patients with Schizophrenia Spectrum Disorders in the Post-Asylum Era. | Tillman, et al., 2022 [28] | HCA Healthcare Journal of Medicine | Narrative review. | Improving access to affordable housing for patients discharged from psychiatric facilities could help disrupt the “revolving door” cycle between shelters, jails, and hospitals. While community care can be a better treatment option for many individuals with psychotic illness, a significant portion of these patients would still benefit most from long-term psychiatric care facilities. |
5 | Deinstitutionalization does not increase imprisonment or homelessness. | Taylor Salisbury T., Thornicroft G., 2016 [29] | The British Journal of Psychiatry | Narrative review. | Most studies on deinstitutionalization report no cases of homelessness, incarceration, or suicide following discharge from the hospital. As outcomes are closely connected to the level of funding of community care services, it is essential to define an appropriate balance of hospital and community-based care across low-, middle-, and high-income countries. |
6 | Deinstitutionalized patients, homelessness and imprisonment: Systematic review. | Winkler, et al., 2018 [30] | The British Journal of Psychiatry | Systematic review. | Cohort studies that followed deinstitutionalized patients showed that they benefited from the transfer to the community care, with serious behavioral issues, such as homelessness, imprisonment, or suicide, occurring only sporadically. |
7 | Hospital Utilization Outcomes Following Assignment to Outpatient Commitment. | Segal S.P., 2022 [31] | Administration and Policy in Mental Health and Mental Health Services Research | Systematic literature review. | Outpatient civil commitment, also known as a community treatment order, requires noncompliant patients to receive necessary treatment, addressing threats to health and safety. This treatment is community-based and a less restrictive alternative to psychiatric hospitalization. It helps limit hospitalization, while also ensuring that patients in mental health crises are referred to necessary treatment in a hospital. Additionally, rapid discharges are associated with a higher likelihood of readmission, particularly in hospitals operating under fixed-fee per admission models. |
8 | Deinstitutionalization and other factors in the criminalization of persons with serious mental illness and how it is being addressed. | Lamb H.R., Weinberger L.E., 2019 [32] | CNS Spectrums | Narrative review. | Deinstitutionalization is one of the contributing factors to incarceration of individuals with mental illness. Family members are often left to manage the patient’s symptoms while also coping with their own emotional responses and deciding whether to involve the police, particularly in situations involving violence. While community care can be an appropriate treatment option for individuals with a history of incarceration, those with severe mental health disorders and a history of violence require specialized, highly structured, and adequately secured clinics. |
9 | Advances and challenges of the Back Home Program as a deinstitutionalization strategy: An integrative review. | De Pádua Lima H., et al., 2022 [33] | Ciencia & Saude Coletiva | Integrative literature review. | Between 2002 and 2015, more than 58% of psychiatric hospital beds in Brazil were closed, accompanied by the implementation of various substitute services. However, the availability of community care is unevenly distributed across the country and is heavily influenced by the current political climate. |
10 | Community mental health care worldwide: Current status and further developments. | Thornicroft G., et al., 2016 [34] | World Psychiatry | Narrative review. | The balanced care model is proposed as a conceptual framework for providing both hospital and community-based services, to ensure access to care during mental health crises and maintain continuity of follow-up. This model must be adapted to the economic level of each country. |
11 | Deinstitutionalization and network of mental health services: A new scene in health care. | Medeiros Lima A., et al., 2020 [35] | Revista Brasileira de Enfermagem | Qualitative study. | The process of deinstitutionalization at the hospital studied in Brazil took longer than initially estimated. It required multisectoral involvement, including managers, healthcare professionals, and service users. Most patients were referred to therapeutic or transinstitutionalized residences, while only a small portion returned to live with their families. |
12 | Improving Care for Deinstitutionalized People with Mental Disorders: Experiences of the Use of Knowledge Translation Tools. | Fulone I., et al., 2021 [36] | Frontiers in Psychiatry | Systematic literature review. | The available evidence from fifteen systematic reviews identifies six types of strategies (psychoeducation, anti-stigma programs, intensive case management, community mental health teams, assisted living, and interventions for acute psychiatric episodes) that can improve the care for deinstitutionalized people with mental disorders and their health outcomes. More rigorous systematic reviews are needed to support evidence-based policymaking. |
13 | Deinstitutionalization and autonomy: Outcomes from a Brazilian mental health policy. | Andrade da Silva G., et al., 2022 [37] | Ciencia & Saude Coletiva | Multi-methodological research. | Research supports the effectiveness of diverse deinstitutionalization strategies in Brazil, but their operationalization could be further improved. |
14 | Mental health care in Italy: Basaglia’s ashes in the wind of the crisis of the last decade. | Carta M.G., et al., 2020 [38] | International Journal of Social Psychiatry | Narrative review. | The closure of psychiatric hospitals in Italy did not lead to an increase in crime; in fact, suicide rates have decreased since their closure. However, there are a few challenges in Italy’s community care, including a lack of scientific documentation regarding the deinstitutionalization process and insufficient funding. Furthermore, there are regional disparities in care, with a clear risk emerging from the imbalance between limited human resources and the need for mandatory medical treatment. |
15 | Boarding of Mentally Ill Patients in Emergency Departments: American Psychiatric Association Resource Document. | Nordstrom K., et al., 2019 [39] | The Western Journal of Emergency Medicine | Narrative review. | The article identifies two primary motivations for deinstitutionalization. One is scientific and patient-centered, driven by improved differentiation between acute and subacute risk, innovations in outpatient and crisis care, advancements of psychopharmacology, and growing recognition of the negative effects of coercive hospitalization. The other motivation is budgetary in nature. Due to the lack of appropriate services, the phenomenon of boarding has emerged, wherein patients seek care in medical emergency departments, settings not designed for the needs of individuals with mental illness, and wait there for hours or days before receiving appropriate treatment. The article suggests recommendations to improve care, both within medical emergency departments and at the broader community level. |
16 | Psychiatric beds and prison populations in 17 Latin American countries between 1991 and 2017: Rates, trends and an inverse relationship between the two indicators. | Siebenförcher M., et al., 2022 [40] | Psychological Medicine | Longitudinal ecological study. | The decrease in the availability of psychiatric beds in Latin America has been associated with an increase in incarceration rates. Policies establishing minimum standards for hospital bed availability and promoting the further development of community-based services should be implemented. |
17 | Aging of severely mentally ill patients first admitted before or after the reorganization of psychiatric care in Sweden. | Bülow P.H., et al., 2022 [41] | International Journal of Mental Health Systems | Pre-post-observational study. | Sweden restructured its psychiatric care through sectorization, i.e., different regions organized inpatient and outpatient care independently. This reform led to shorter hospital stays, a reduction in the number of hospital beds, and improved access to psychiatric care. Compared with the post-sectorization group, the patients of the pre-sectorization period demonstrated lower levels of functioning and had more unmet needs, even when controlling for diagnosis. |
18 | Psychiatric reform and counter-reform: An analysis of a socio-political and sanitary crisis at national and regional level. | De Oliveira Nunes M., et al., 2019 [42] | Ciencia & Saude Coletiva | Narrative review. | This article addresses the uncertain political situation in Brazil regarding mental health. While psychiatric counter-reform is underway, marked by the reemergence of asylums, a paradoxical counter-counter-reform has emerged in the state of Bahia. The authors call for advocacy to prevent human rights violations. |
19 | The Effectiveness of Mental Health Rehabilitation Services: A Systematic Review and Narrative Synthesis. | Dalton-Locke C., et al., 2021 [43] | Frontiers in Psychiatry | Systematic literature review. | A systematic review shows that most patients can be successfully discharged from long-stay psychiatric hospitals into community settings without clinical deterioration. A substantial proportion of these individuals transition to more independent living arrangements, although some continue to require long-term support accommodation. A longer stay in hospital is associated with less favorable outcomes. |
20 | The transition towards community-based mental health care in the European Union: Current realities and prospects. | Vandoni M., et al., 2024 [44] | Health Policy | Narrative review. | The transition to community-based services has been implemented differentially across the European Union. Mental hospitals remain the prominent model of care in most countries, with a few countries endorsing a balanced care model that combines hospital and community care. Better data reporting is key to advancing research, policies, and practices. |
21 | Finding Common Ground for Diverging Policies for Persons with Severe Mental Illness. | Solomon P., Petros R., 2020 [45] | The Psychiatric Quarterly | Narrative review. | Violent incidents involving individuals with mental illness are estimated to account for approximately 4% of all violence in the US, with family members most often being the targets. People with mental health illness are significantly more likely to harm themselves than to harm others. The authors suggest policies that balance risk management with risk opportunity by investing in voluntary treatment approaches that emphasize shared decision-making. |
22 | The relationship between deinstitutionalization and quality of care in longer-term psychiatric and social care facilities in Europe: A cross-sectional study. | Taylor Salisbury T., et al., 2022 [46] | European Psychiatry | Cross-sectional study. | Although deinstitutionalization is associated with higher quality of care, particularly in five key domains—promotion of self-management and autonomy, incorporation of recovery-based practice, availability of treatments and interventions, and better built and therapeutic environments—it has not been significantly linked to better quality of life or care experiences. Transition to community care shows improvements in treatment and outcomes, regardless of the country’s current level of deinstitutionalization. |
23 | Owning our madness: Contributions of Jamaican psychiatry to decolonizing Global Mental Health. | Hickling F.W., 2019 [47] | Transcultural Psychiatry | Narrative review. | Deinstitutionalization in Jamaica was influenced by the country’s history of colonization. Jamaica successfully implemented the gradual downsizing and dismantling of mental hospitals, alongside the establishment of community-based mental health care. The article highlights several successful interventions, including the integration of mental health into general medicine, the Diversion at the Point of Arrest Program, and the reduction in mental health stigma. |
24 | Evolution of forensic psychiatry in Italy over the past 40 years (1978–2018). | Ferracuti S., et al., 2019 [48] | The International Journal of Law and Psychiatry | Narrative review. | The infamous Mental Health Reform in 1978 (Law 180) in Italy failed to address the area of forensic psychiatry. Under the new legislation, inpatient forensic psychiatric hospitals have been replaced by community structures led by psychiatrists and supported by public security staff, with a focus on rehabilitation. The article illustrates the discrepancy between civic and penal law: civic law permits compulsory treatment only when there is a medical need, while penal law allows for security measures if there is a perceived risk of criminal recidivism. This misalignment can result in psychiatric treatment of individuals who may not require it and, in some cases, may even feign illness in order to receive certain benefits. |
25 | Caregiving burden in family caregivers of patients with schizophrenia: A qualitative study. | Tamizi Z., et al., 2020 [49] | Journal of Education and Health Promotion | Qualitative study. | Caring for a patient with schizophrenia places a significant burden on family caregivers. The burden is influenced by factors such as the duration of contact with the patient, the demands of long-term caregiving, the caregiver’s knowledge about the disease, and the degree of integration between the family and the medical team. Proposed future strategies include identifying high-risk caregivers; designing appropriate family-based intervention; and encouraging the active involvement of family members in shaping community care policies and services, such as post-discharge surveillance and home visits. |
26 | Sociodemographic, clinical and criminological characteristics of a sample of Italian Volterra REMS patients. | Lombardi V., et al., 2019 [50] | International Journal of Law and Psychiatry | Cross-sectional study. | Since the closure of forensic psychiatric hospitals in Italy, a new care structure for mental health patients with a history of criminal offenses has been established. This system is based on community residential units. The patient’s population is demographically similar to that of the former forensic psychiatric hospitals, with schizophrenia being the most common primary diagnosis and substance-related disorders the most frequent comorbidity. Due to the high turnover of patients, the authors anticipate future changes in certain sociodemographic, clinical, and criminological characteristics of this population. |
27 | A Comparison of Mental Health Care Systems in Northern and Southern Europe: A Service Mapping Study. | Sadeniemi M. et al., 2018 [51] | International Journal of Environmental Research and Public Health | Service mapping study. | The study compares deinstitutionalization between regions in Finland and Spain. A more structured community care service is associated with a lower suicide rate. In Finland, inpatient hospital days decreased by 54% between 1994 and 2015, accompanied by a 41% reduction in suicide rate. In Spain, the majority of patients with schizophrenia live with their families and are unemployed, whereas in Finland, only half as many patients live with their parents. The difference has contributed to a higher rate of transinstitutionalization into residential services in Finland. |
28 | Coercion in Outpatients under Community Treatment Orders: A Matched Comparison Study. | Nakhost A., et al., 2018 [52] | The Canadian Journal of Psychiatry | Matched comparison study. | Patients with serious mental illness who lack insight may be treated under mandated community treatment orders. Service users treated under such order reported significantly higher levels of perceived coercion compared with those in the control group. However, the perception of coercion was directly correlated with their previous experience with probation and inversely linked with the sense of procedural justice in their treatment. |
29 | Quality of care and its determinants in longer term mental health facilities across Europe; a cross-sectional analysis. | Killaspy H. et al., 2016 [53] | Consortium Psychiatricum | Cross-sectional analysis. | The Quality Indicator for Rehabilitative Care (QuIRC) is an international, standardized quality tool for the evaluation of long-term mental health facilities. In the ten European countries included in the study, the overall quality of care in units for long-term patients was found to be reasonable, although some units still require improvement. Higher quality scores were observed in smaller, community-based units; those serving patients with varying levels of disability; and mixed gender facilities. |
30 | The effects of national mental health plans on mental health services development in Chile: Retrospective interrupted time series analyses of national databases between 1990 and 2017. | Mundt A.P., et al., 2022 [19] | International Journal of Mental Health Systems | Retrospective, quasi-experimental, observational study. | Deinstitutionalization in Chile has been largely successful, with a significant reduction in both short- and long-stay psychiatric hospital beds, as well as a shift in funding away from psychiatric hospitals toward community care between 1990 and 2017. In recent years, however, there has been an increase in the number of psychiatric beds in general hospitals, forensic psychiatric hospitals, and short-stay units within psychiatric hospitals, despite the absence of formal policy supporting this trend. This effect may be attributed to the conversion of long- and medium-stay beds into acute and short stays within the same facility. |
31 | Community Engagement Mental Health Model for Home Treatment of Psychosis in Jamaica. | Nelson D., et al., 2020 [54] | Psychiatric Services | Narrative review. | Evidence suggests that Jamaican’s community-based treatment of patients with acute psychotic disorder is a viable strategy, demonstrating high levels of satisfaction among both service users and providers, as well as favorable clinical outcomes. Lower-income countries must adapt mental health care models developed in high-income countries to suit their own resources and contexts. |
32 | Challenges of Providing Home Care for a Family Member with Serious Chronic Mental Illness: A Qualitative Enquiry. | Mokwena K.E., Ngoveni A., 2020 [55] | International Journal of Environmental Research and Public Health | Qualitative study. | Following deinstitutionalization in South Africa, patients are sometimes discharged home to be cared for by their families, often with only medication and no support. Families have reported experiencing violence perpetrated by the patients, safety concerns, financial strain, emotional distress, and a desire for patients to remain in institutional care. Community-based outreach teams should extend their services to both patients and families, ensuring appropriate follow up and ongoing support. |
33 | An Innovative Approach to the Dismantlement of a Forensic Psychiatric Hospital in Italy: A Ten-year Impact Evaluation. | Leone L., et al., 2023 [56] | Clinical Practice & Epidemiology in Mental Health | Pre-post-study design. | The closure of forensic psychiatric hospitals in Italy and the subsequent opening of community care centers for forensic patients have led to improvements in patients’ mental health during the follow-up period, even among those with a history of long institutionalization and serious mental illness. The need for high control structures during the first two years post-discharge has decreased, and a high rate of workplace integration has been observed. There was a reduction in health care costs, and mental health professionals report the highest level of job satisfaction among health care workers in Italy regarding the quality of care they provide. On the other hand, the study showed high mortality rate from among the initial group of discharges (18.2% of the sample) with an average age of death of just 49 years. |
34 | The Quality of Care Provided by Outpatient Mental Health Services in Georgia. | Chkonia E., et al., 2021 [57] | Consortium Psychiatricum | Cross-sectional observational study. | The transition to community-based care in Georgia, supported by an increased budget, the introduction of new standards, and development of mobile teams, has led to improved medication supply, a more integrated biopsychosocial treatment approach, and training and employment of more mental health professionals. The study also identified the remaining challenges, such as disturbances in redistribution of funding and personnel. |
35 | Psychiatric Reform in Rio de Janeiro: The current situation and future perspectives. | Fagundes Júnior H.M., et al., 2016 [58] | Ciencia & Saude Coletiva | Narrative review. | Deinstitutionalization in Rio de Janeiro has led to a progressive reduction in the number of beds in psychiatric hospitals and an increased role for community-based facilities. While both forms of mental health care still coexist, hospitalization often disrupts continuity of care, leading to repeated admissions. Many individuals seek urgent or emergency psychiatric services. Remaining challenges include the integration of psychiatric beds in general hospitals; the deinstitutionalization of individuals with prolonged hospital stays; and the need for more residential facilities and expanded community services, particularly for people with substance use disorders. |
36 | The Revolving Door Phenomenon in the Romanian Mental Health System. | Păun R-M, et al., 2025 [59] | Alpha Psychiatry | Cross-sectional study. | Deinstitutionalization without sufficiently developed community care often leads to the “revolving door” phenomenon, characterized by at least three hospitalizations in a two-year period. In the Romanian mental health system, the most likely explanation for this pattern is the higher concentration of resources in inpatient units, leaving patients with low socioeconomic status without viable community-based alternatives for ongoing monitoring and treatment. |
37 | Forty years of the Law 180: The aspirations of a great reform, its successes and continuing need. | Mezzina R., 2018 [60] | Epidemiology and Psychiatric Sciences | Narrative review. | Italy implemented the most progressive mental health law, which resulted in the closure of psychiatric hospitals. The law was centered around patients’ needs and rights; however, 40 years later, some drawbacks can be seen. One of them is the lack of protections around involuntary treatment, as there is no consistent, time-limited review of such admissions by independent bodies, as recommended by the World Health Organization. There is a regional variation in the quality of care, with some areas failing to provide adequate crisis services and long-term support. |
38 | Shifting Trends in Admission Patterns of an Acute Inpatient Psychiatric Unit in the State of New York. | Shah B., et al., 2020 [61] | The Cureus Journal of Medical Science | Retrospective observational study. | In the State of New York, there has been a decline in the number of depressive disorder cases treated in emergency settings, which may be linked to improvements in community-based care. In contrast, admissions related to substance use disorders, personality disorders, trauma-related disorders, and neurodevelopment disorders have higher numbers of admissions, which can be explained by their common comorbidities and complex issues, including violence, that require inpatient care. A significant upward trend in the use of restraints has also been observed, which could be mitigated with additional de-escalation training and the implementation of larger units with single rooms to reduce aggression. A decrease in the length of stay has been noted, possibly attributable to both the improvement in treatment options and cost-cutting efforts, as well as the availability of effective community-based options. |
39 | Factors associated with the revolving door phenomenon in patients with schizophrenia: Results from an acute psychiatric hospital in Romania. | Dionisie V., et al., 2025 [62] | Frontiers in Psychiatry | Observational and retrospective cohort study. | The “revolving door” phenomenon, characterized by frequent hospital readmissions, emerged following deinstitutionalization in Romania. Risk factors influencing this phenomenon among patients with schizophrenia include male sex, younger age, comorbid substance or alcohol use disorders, and tendencies toward physical or verbal aggression. |
40 | Accommodation and Health Costs of Deinstitutionalized People with Mental Illness Living in Residential Services in Brazil. | Razzouk D., 2019 [63] | PharmacoEconomics-Open | Cross-sectional study. | Accommodation costs were not significantly influenced by patient profile variables; rather, the region and duration of the hospital stay or the stay in residential care were the main cost predictors. Some residents living more autonomously in independent housing occasionally returned to fully staffed homes. Both health and non-health community services were underutilized. Despite the expectations of deinstitutionalization, findings indicated that patients continued to experience a poor quality of life. The main contributing factors to this were symptom severity, limited social skills, reduced self-care abilities, and poor education. |
41 | An international comparison of the deinstitutionalization of mental health care: Development and findings of the Mental Health Services Deinstitutionalization Measure (MENDit). | Taylor Salisbury T., et al., 2016 [64] | BMC Psychiatry | Instrument development and validation study. | The MENDit is a tool used to assess a country’s level of deinstitutionalization. It evaluated factors such as the existence of specific mental health legislation, dedicated policies and budgets, and the integration of mental and physical health care systems, ideally structured around service users’ needs and focused on promoting autonomy. Inpatient psychiatric units continue to operate in all countries in Europe except Italy and Iceland, while 63% of countries report offering some degree of community residential care. Some authors argue that the rising numbers of psychiatric beds outside of traditional psychiatric hospitals reflect reinstitutionalization, but the article suggests that a truly deinstitutionalized system is the one that provides the most appropriate setting and level of support based on users’ needs. Furthermore, the number of psychiatric beds per capita does not strongly correlate with deinstitutionalization. One of the key challenges to effective deinstitutionalization remains the shortage of trained mental health professionals. |
42 | Observed Outcomes: An Approach to Calculate the Optimum Number of Psychiatric Beds. | O’Reilly R., et al., 2019 [65] | Administration and Policy in Mental Health and Mental Health | Literature review. | In most high-income countries, the numbers of psychiatric beds per capita has decreased. This shortage of available psychiatric beds is having serious consequences for the quality and safety of patient care. The authors argue that there is a threshold for the safe minimal number of psychiatric beds and examine the relationship between bed availability and key hospital performance indicators, as well as population-level patient outcomes, in order to estimate the minimum and optimal bed requirements. The identified factors include out-of-area placements, boarding, involuntary admission, bed occupancy rates, reduction in length of stay, acuity levels in inpatient units, readmission rates, homelessness, suicide rates, all-cause mortality, violent crime and incarceration rates, and caregiver burden. To accurately determine the threshold, comprehensive data on hospitalizations across countries is required. |
43 | How mental health service systems are organized may affect the rate of acute admissions to specialized care: Report from a natural experiment involving 5338 admissions. | Myklebust L.H., et al., 2017 [66] | Sage Open Medicine | Observational study. | Locally integrated services, including the availability of local psychiatric beds, may be more responsive to patients’ needs and can help reduce the need for acute admissions to specialized psychiatric services. Patient characteristics, such as diagnoses and the use of coercion measures, are important predictors of acute admission. |
44 | Investigating the influence of contextual factors in the coordination of chronic mental illness care in a district health system. | Mandlenkosi Phehlukwayo S., Mahlako Tsoka-Gwegweni J., 2018 [67] | African Health Sciences | Qualitative multiple case study. | The research in a region of South Africa indicates deinstitutionalization of patients with chronic mental health illness was poorly planned and accompanied by insufficient outpatient care. This has resulted in fragmented services, reduced quality of care, and decreased safety of staff. |
45 | From asylums to deinstitutionalization and after: An analytic review. | Balbuena Rivera F., 2024 [68] | International Journal of Social Psychiatry | Analytic review. | The dismantling of asylums and the introduction of community-based care—although partly driven by economic factors and overly optimistic expectations of pharmacological treatments—led to significant changes in the care of mental health patients, including improvements in institutional conditions. However, this shift has failed to adequately support patients with the most severe forms of chronic mental illness and their families. Residential units and hospitals serve essential functions that cannot be easily eliminated, as evidenced by current challenges in forensic care, incarceration rates, and acute inpatient admissions. |
46 | On a long, narrow road: The mental health law in Turkey. | Artvinli, F., Uslu, M.K.B., 2023 [69] | International Journal of Law and Psychiatry | Narrative review. | The current legal framework, namely, the Turkish Civil Code, lacks comprehensive framework for involuntary treatment or compulsory hospitalization. In comparison, involuntary hospitalization rates across European countries range from 3.2% to 21.6%, while studies indicate that in Turkey, up to 85% of psychiatric hospitalizations may be involuntary. The article highlights the urgent need for legislation that protects individuals from stigmatization, discrimination, social exclusion, and human rights violations. |
47 | The impact of the Mental Health Act revision for deinstitutionalization in Korea on the crime rate of people with schizophrenia. | Kim A.M., Sohn J.H., 2023 [70] | Psychiatry Research | Quasi-experimental study. | Following the enactment of the Mental Health and Welfare Act in Korea in 2016, a decrease in hospital admissions and the number of psychiatric beds was observed, along with a slight decline in involuntary admissions. Compared with the general population, patients with paranoid schizophrenia had lower rates of rape, violence, intellectual crimes, and public order offenses but a higher rate of robbery. In 2021, the rates of murder, attempted murder, and arson committed by this patient group were 5.3, 6.5, and 11.4 times higher, respectively, than those in the general population. After the implementation of the law, crime rates among individuals with paranoid schizophrenia initially increased and then decreased. No statistically significant effect on the murder rate was observed following deinstitutionalization; however, the findings suggest positive association between deinstitutionalization and crime rate, which may be attributed to underdeveloped community-based care services. |
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Horvat Golob, K.; Temeljotov Salaj, A.; Novak Šarotar, B. Transition of Mental Health Services from Institutional to Community-Based Care Abroad and Its Context for Slovenia—Advantages and Risks. Int. J. Environ. Res. Public Health 2025, 22, 1066. https://doi.org/10.3390/ijerph22071066
Horvat Golob K, Temeljotov Salaj A, Novak Šarotar B. Transition of Mental Health Services from Institutional to Community-Based Care Abroad and Its Context for Slovenia—Advantages and Risks. International Journal of Environmental Research and Public Health. 2025; 22(7):1066. https://doi.org/10.3390/ijerph22071066
Chicago/Turabian StyleHorvat Golob, Katja, Alenka Temeljotov Salaj, and Brigita Novak Šarotar. 2025. "Transition of Mental Health Services from Institutional to Community-Based Care Abroad and Its Context for Slovenia—Advantages and Risks" International Journal of Environmental Research and Public Health 22, no. 7: 1066. https://doi.org/10.3390/ijerph22071066
APA StyleHorvat Golob, K., Temeljotov Salaj, A., & Novak Šarotar, B. (2025). Transition of Mental Health Services from Institutional to Community-Based Care Abroad and Its Context for Slovenia—Advantages and Risks. International Journal of Environmental Research and Public Health, 22(7), 1066. https://doi.org/10.3390/ijerph22071066