sealy-whitehead-2004-forty-years-of-deinstitutionalization-of-psychiatric-services-in-canada-an-empirical-assessment

Introduction

• Deinstitutionalization: The process of transitioning psychiatric patients from hospitals to community settings.

• Context: Often associated with the late 1960s and 1970s, but has been ongoing for 40 years.

• Misconception: That deinstitutionalization is complete; the reality is ongoing policy adjustments and implementations occurred.

Objectives

• Aim: Analyze the empirical implementation of deinstitutionalization in Canada over the last 40 years.

• Components Evaluated:

  • Population-based psychiatric beds.

  • Days of care in psychiatric hospitals.

  • Days of care in psychiatric units in general hospitals.

  • Per capita expenditures on psychiatric services.

Key Findings

• Significant closure of psychiatric beds in the 1970s and 1980s, but an increase in care days within general hospitals leading to transinstitutionalization.

• A notable decrease in overall inpatient care days began in the 1990s.

• Per capita expenditures on community psychiatric services rose consistently.

• Variation: Significant differences across provinces in terms of timing and intensity of deinstitutionalization.

Clinical Implications

• Importance of identifying the stage of deinstitutionalization in research to gauge impacts effectively.

• Need for research to define the optimal level of community services that should not be expanded further.

• Emphasizes that inpatient services should not be entirely eliminated.

Methodology

• Data Sources: Utilized Statistics Canada and Canadian Institute for Health Information data, including:

  • Inpatient psychiatric bed-days (1960-1990).

  • Total days of care and expenditures from the mid-1990s.

• Analyzed two primary time periods:

  • 1960-1980: Insight into bed closures and early deinstitutionalization.

  • 1981-1999: Deeper examination of community service development and care patterns.

Results

1960-1980

• Driven largely by fiscal and legal factors leading to a rapid closure of over 62% of psychiatric beds in Canada within specific years.

• Different provinces showed varied rates of deinstitutionalization (e.g., Alberta had the largest bed closure).

• The onset of community health services increased due to bed closures.

1981-1999

• Continued decrease in admissions and lengths of stay in psychiatric settings.

• Changes in admission patterns noted, with many experiencing shorter and multiple admissions.

• Significant shifts from long-term institutional care to various community models.

Analysis

• Days of Care:

  • Decrease in psychiatric hospital stay days over time, with notable provincial differences.

  • Manitoba reported high rates of days of care in psychiatric hospitals in 1994-1995, contrasting with lower rates elsewhere.

Expenditures

• Focused on inpatient vs. community-based service funding:

  • Overall inpatient costs decreased while expenditures for community services rose steeply.

  • From the late 1980s to 1998-1999, expenditures for community services increased over 1261%.

Conclusion

• Deinstitutionalization is an ongoing process. The variations across regions suggest that no universal standard or endpoint exists for determining when deinstitutionalization is complete.

• Acknowledgment that an increase in community services should occur alongside the closure of inpatient facilities.

Acknowledgments

• The authors express gratitude towards the Canadian Institute of Health Information and various provincial health ministries for assistance with data collection.