Forty or fifty years down the line, is the deinstitutionalisation movement (inspired by Foucault) viewed as largely a positive or negative step in the treatment of the mentally ill?

The best evidence regarding outcomes following deinstitutionalization comes from the medical literature. Historians and sociologists have more often addressed the causal factors leading to deinstitutionalization most frequently pointing to the impact of neuroleptics, the antipsychiatric ‘movement’, or hospital closure as a cost-saving measure in the neo-liberal era. As regards outcomes, since 1939 the eponymous ‘Penrose’ or ‘hydraulic’ hypothesis, based upon European figures, has argued that prison numbers increase as psychiatric places decrease. Since the advent of deinstitutionalization, various medical and media publications have promoted this hypothesis while also arguing that discharged patients have joined the ranks of the homeless. Studies supporting this contention have normally been population level ecological studies. However, a recent meta-analysis of cohort studies of discharged patients, looking at individual outcomes, has found that:

Homelessness and imprisonment occurred sporadically; in the majority of studies no single case of homelessness or imprisonment was reported.

It should be borne in mind, that those included in the above study were discharged to community based residential facilities and that one of the factors necessary for successful outcomes in community care models is sufficient investment in alternative services.

With vast changes in the organization of the mental health institutional landscape since the advent of deinstitutionalization, mental health trajectories/careers have changed substantially, with multiple readmissions, shorter stays, and access to a wider range of mental health professionals and services; moreover, in terms of mental health, there’s also been a far greater medicalization of society.