This largely unnoticed process requires debate and evaluation

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 …