Trevor Turner

Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries

Abstract Objective To establish whether reinstitutionalisation is occurring in mental health care and, if so, with what variations between western European countries. Design Comparison of data on changes in service provision. Setting Six European countries with different traditions of mental health care that have all experienced deinstitutionalisation since the 1970s—England, Germany, Italy, the Netherlands, Spain, and Sweden. Outcome measures Changes in the number of forensic hospital beds, involuntary hospital admissions, places in supported housing, general psychiatric hospital beds, and general prison population between 1990-1 and 2002-3. Results Forensic beds and places in supported housing have increased in all countries, whereas changes in involuntary hospital admissions have been inconsistent. The number of psychiatric hospital beds has been reduced in five countries, but only in two countries does this reduction outweigh the number of additional places in forensic institutions and supported housing. The general prison population has substantially increased in all countries. Conclusions Reinstitutionalisation is taking place in European countries with different traditions of health care, although with significant variation between the six countries studied. The precise reasons for the phenomenon remain unclear. General attitudes to risk containment in a society, as indicated by the size of the prison population, may be more important than changing morbidity and new methods of mental healthcare delivery.

Reinstitutionalisation in mental health care

Since the 1950s mental health care in most industrialised countries has been characterised by deinstitutionalisation, with national reforms varying in their pace, fashion, and exact results. 1 2 The development of comprehensive community mental health care is widely regarded as not yet complete. In England the national service framework and NHS Plan aim at establishing new community based services—for example, for home treatment, assertive outreach, and early intervention. Yet despite the apparent evidence of ongoing deinstitutionalisation, we argue that a new era in mental health care has already started—reinstitutionalisation. It is displaying a synonymous pattern across Europe, as with deinstitutionalisation, but this time it has been occurring largely unnoticed by the scientific community and unscrutinised by politicians and the media. What are the signs of reinstitutionalisation? Firstly, the number of forensic beds is rising, in the United Kingdom, with dramatic increases in the private sector. Plans to increase this number further are in hand. Secure units are extremely costly, with no evidence …

ABC of mental health. Schizophrenia.

Schizophrenia is a relatively common form of psychotic disorder (severe mental illness). Its lifetime prevalence is nearly 1%, its annual incidence is about 10-15 per 100 000, and the average general practitioner cares for 10-20 schizophrenic patients depending on the location and social surroundings of the practice. It is a syndrome with various presentations and a variable, often relapsing, long term course. ![][1] Although schizophrenia is publicly misconceived as “split personality,” the diagnosis has good reliability, even across ages and cultures, though there is no biochemical marker. Onset before the age of 30 is the norm, with men tending to present some four years younger than women. Clues as to aetiology are tantalising, and management remains endearingly clinical. Evidence for a genetic cause grows stronger: up to 50% of identical (monozygotic) twins will share a diagnosis, compared with about 15% of non-identical (dizygotic) twins. The strength of genetic factors varies across families, but some 10% of a patients first degree relatives (parents, siblings, and children) will also be schizophrenic, as will 50% of the children of two schizophrenic parents. Premorbid abnormalities of speech and behaviour may be present during childhood. The role of obstetric complications and viral infection in utero remains unproved. Enlarged ventricles and abnormalities of the temporal lobes are not uncommon findings from computed tomography of the brain. Thus, a picture is emerging of a genetic brain disorder, enhanced or brought out by subtle forms of environmental damage. Symptoms are characterised most usefully as positive or negative, although the traditional diagnostic subcategories (hebephrenic, paranoid, catatonic, and simple) have mixtures of both ### Positive symptoms and signs #### Clinical features suggesting diagnosis of schizophrenia Running commentary on persons actions Two or more voices discussing the person Voices speaking the persons thoughts [1]: /embed/graphic-1.gif

Long term outcome of treating schizophrenia

Antipsychotics probably help—but we badly need more long term studies

When is an emergency department not an emergency department

EDITOR—Recently, a young couple, equipped with backpacks and bedrolls, walked into our local accident and emergency department at about 11 pm, climbed into sleeping bags, and set their alarm clock. Early next morning, roused by their alarm, the couple rolled up their bags and left. What was the explanation for this behaviour? It was not careful preparation for attending a department in which the waiting time can often be eight hours …

Improving mental health services in England

Their current fragmentation points up the oxymoronic nature of government’s latest initiative

Invasion of the Body Snatchers (Don Siegel, 1955) – psychiatry in the movies

‘A strange neurosis... evidently contagious... people worrying about what’s going on in the world’, that is how the contented, pipe-smoking, 1950s Californian small town psychiatrist explains what is happening in Santa Mira. Ten or more patients referred complaining of their relatives somehow

Madness at the Globe

The first female playwright to write for the Globe in 400 years sets her play in the 18th century, when people commonly paid a penny to see lunatics. Trevor Turner saw this raucous show

Being Human: Reflections on Mental Distress in Society

[⇓][1] ![Figure][2] This is a bravely written book. Deriving from a series of seminars presented under the auspices of the HUMAN Research Project at Nottingham University, it consists of 13 chapters reflecting on ‘the interface between mental health, mental distress, and the humanities

Clinical excellence awards

Having once more been through the annual awards process of reviewing citations and CVs, within both trust and College systems, we are writing to express our sense of disillusionment and distaste at the whole rigmarole. Not only is it extremely time-consuming for all involved, especially the