Deinstitutionalization in the UK

Abstract This chapter describes the evolution of deinstitutionalization and community care in the UK for adults suffering from severe mental illness and intellectual disability. Deinstitutionalization was driven by awareness that the impersonal, regimented care in the hospital asylums was as disabling as the disorders they sought to contain. It was encouraged by psychiatric optimism in light of new pharmacological and psychosocial treatments which showed that most patients could be safely managed in the community and so maintain or regain social, occupational, and leisure function. Overall, this has been a successful enterprise with improvements in quality of life and personal satisfaction for many. But it is not a cheaper alternative to hospital care, and services still struggle with the balance between encouraging independence and managing risk. Institutions still exist and, indeed have been growing, for forensic services and in the non-statutory sector.