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Understanding psychiatric institutionalization: a conceptual review

Winnie S Chow* and Stefan Priebe

Author Affiliations

Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Newham Centre for Mental Health, Queen Mary University of London, London E13 8SP, UK

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BMC Psychiatry 2013, 13:169  doi:10.1186/1471-244X-13-169

Published: 18 June 2013



Since Goffman’s seminal work on psychiatric institutions, deinstitutionalization has become a leading term in the psychiatric debate. It described the process of closure or downsizing of large psychiatric hospitals and the establishment of alternative services in the community. Yet, there is a lack of clarity on what exactly the concept of institutionalization means in present-day psychiatry. This review aims to identify the meaning of psychiatric institutionalization since the early 1960s to present-day.


A conceptual review of institutionalization in psychiatry was conducted. Thematic analysis was used to synthesize the findings.


Four main themes were identified in conceptualizing institutionalization: bricks and mortar of care institutions; policy and legal frameworks regulating care; clinical responsibility and paternalism in clinician-patient relationships; and patients’ adaptive behavior to institutionalized care.


The concept of institutionalization in psychiatry reflects four distinct themes. All themes have some relevance for the contemporary debate on how psychiatric care should develop and on the role of institutional care in psychiatry.

Psychiatric Institutionalization; De-institutionalization; Re-institutionalization; Mental Health Care