Intended for healthcare professionals


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

BMJ 2005; 330 doi: (Published 13 January 2005) Cite this as: BMJ 2005;330:123
  1. Stefan Priebe (s.priebe{at}, professor of social and community psychiatry1,
  2. Alli Badesconyi, specialist registrar1,
  3. Angelo Fioritti, medical director2,
  4. Lars Hansson, professor of psychology3,
  5. Reinhold Kilian, senior lecturer4,
  6. Francisco Torres-Gonzales, professor of psychiatry5,
  7. Trevor Turner, honorary senior lecturer1,
  8. Durk Wiersma, professor of psychiatry6
  1. 1 Unit for Social and Community Psychiatry, Queen Mary University of London, Newham Centre for Mental Health, London E13 8SP,
  2. 2 AUSL Rimini, Italy I-47900,
  3. 3 Department of Nursing, University of Lund, Sweden S-22100,
  4. 4 Department of Psychiatry II, University of Ulm, 89312 Günzburg, Germany,
  5. 5 Department of Psychiatry, University of Granada, Spain E-18071,
  6. 6 Department of Psychiatry, University Hospital, 9700 RB Groningen, Netherlands
  1. Correspondence to: S Priebe
  • Accepted 18 October 2004


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.


  • Contributors The study idea originated from SP and was further developed in discussions with TT and specified in communication with all authors. All authors agreed on the study design and are guarantors for data from their country: AF for data from Italy, LH for Sweden, RK for Germany, FT-G for Spain, DW for the Netherlands, and SP for the United Kingdom. AB coordinated the data collection. Data interpretation was agreed among all authors. SP is the overall guarantor for the paper

  • Funding East London and the City Mental Health Trust. The funding was through the R&D budget of the trust. East London and the City Mental Health Trust did not influence the design of the study, data collection, or presentation of the findings in any way

  • Competing interests None declared

  • Ethical approval Not needed

  • Accepted 18 October 2004
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