Stages, Strategies, and Policies of Deinstitutionalization for People with Mental Disorders: A Scoping Review
DOI:
https://doi.org/10.37287/ijghr.v7i6.392Keywords:
community-based mental health, deinstitutionalization, mental disorders, policy, scoping reviewAbstract
Deinstitutionalization represents a major global reform in mental health care, shifting from long-term psychiatric hospitalization toward community-based services. While widely promoted by the World Health Organization (WHO), the processes, strategies, and policies underpinning this transition vary substantially across contexts. This scoping review aimed to map the stages, strategies, and policy frameworks of psychiatric deinstitutionalization worldwide, with particular attention to Indonesia’s evolving experience. Guided by Arksey and O’Malley’s scoping review framework, we searched PubMed, Scopus, ProQuest, Science Direct, Google scholar and WHO grey literature for studies published between 2005-2025. Keywords included deinstitutionalization, community mental health, rehabilitation, mental disorders, policy. Eligible studies examined deinstitutionalization in relation to people with mental disorders, focusing on stages, strategies, or policies. Data were charted by country/region and synthesized thematically. Seventeen studies were selected for inclusion from 983 articles screened. Globally, deinstitutionalization follows a continuum: (1) reducing psychiatric bed, (2) transition to community care, (3) strengthening of community-based services, (4) consolidation of integrated systems, and (5) implementing advanced model (e.g., Trieste, Italy). Strategies include community integration, therapeutic residential services, civic engagement, and multisectoral collaboration. Policy range from limited reforms to comprehensive laws institutionalizing community mental health.: Deinstitutionalization is a complex. In Indonesia remains in a transitional stage, with community engagement compensating for policy gaps. Strengthening legal enforcement, expanding community services, and promoting multisectoral integration are key to achieving a rights-based mental health system.
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