Mental health policy in Quebec: challenges for an integrated system

Forty years of deinstitutionalization of psychiatric services in Canada: an empirical assessment

OBJECTIVE

To empirically analyze the implementation of the policy of deinstitutionalization of psychiatric services over a 40-year period.

METHOD

We assessed the policy of deinstitutionalization in terms of the following components: 1) population-based psychiatric beds, days of care in psychiatric hospitals (PHs); 2) days of care in psychiatric units in general hospitals (GHs); and 3) per capita expenditures on psychiatric services.

RESULTS

There was a rapid closure of beds in PHs in the 1970s and 1980s, but this was associated with an increasing rate of days of care in psychiatric units in GHs (that is, transinstitutionalization). It was not until the 1990s that the overall days of inpatient care began to decrease. Per capita expenditures on community-based psychiatric services increased throughout this period.

CONCLUSIONS

Standardized rates reveal tremendous variation among the provinces in the timing and intensity of deinstitutionalization.