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

ObjectivesIt has been suggested that since 1990, de-institutionalisation of mental healthcare in Western Europe has been reversed into re-institutionalisation with more forensic beds, places in protected housing services and people with mental disorders in prisons. This study aimed to identify changes in the numbers of places in built institutions providing mental healthcare in Western Europe from 1990 to 2012, and to explore the association between changes in psychiatric bed numbers and changes in other institutions.Settings and dataData were identified from 11 countries on psychiatric hospital beds, forensic beds, protected housing places and prison populations. Fixed effects regression models tested the associations between psychiatric hospital beds with other institutions.ResultsThe number of psychiatric hospital beds decreased, while forensic beds, places in protected housing and prison populations increased. Overall, the number of reduced beds exceeded additional places in other institutions. There was no evidence for an association of changes in bed numbers with changes in forensic beds and protected housing places. Panel data regression analysis showed that changes in psychiatric bed numbers were negatively associated with rising prison populations, but the significant association disappeared once adjusted for gross domestic product as a potential covariate.ConclusionsInstitutional mental healthcare has substantially changed across Western Europe since 1990. There are ongoing overall trends of a decrease in the number of psychiatric hospital beds and an increase in the number of places in other institutions, including prisons. The exact association between these trends and their drivers remains unclear. More reliable data, information on the characteristics of patients in different institutions, long-term pathway analyses and effectiveness studies are required to arrive at evidence-based policies for the provision of institutional mental healthcare.

Hunt’s (AMS Rev, 10, 189–198, 2020 ) notion of the re-institutionalization of marketing as a discipline provides the background for this commentary. This forward-looking context is used to address issues the marketing discipline is facing to reconcile problems we identify. Academic marketing research has become fragmented and polarized into narrow areas that do not provide holistic contributions to knowledge. Doctoral programs are focusing less on core marketing knowledge and theory and more on methodology. This brings into question the culture of both our doctoral programs and the culture of the discipline to provide high-impact research valuable to practitioners and society, as well as the firm. An agenda for change addresses hiring practices, projects, methods, and oversight on the importance of impact. It is suggested the marketing discipline engage in the study of marketing practice to find important problems to investigate.

Commentaries on the status of the marketing discipline conclude that it is significantly troubled, which raises the question: Do the troubles identified portend a de-institutionalization of the discipline in marketing’s Era IV (1980–2020) and its potential re-institutionalization in Era V (2020-?)? This article examines (1) the marketing discipline’s founding in Era I (1900–1920), (2) how the discipline became institutionalized in Era II (1920–1950), (3) how marketing was re-institutionalized in Era III (1950–1980), and (4) how the discipline’s fragmentation in Era IV (1980–2020) portends its de-institutionalization. The article concludes by arguing for the marketing discipline’s re-institutionalization in Era V (2020-?).

In this paper, we question a very deep-rooted bias in the economic literature with regard to conflict and revolution. Conflict in general and revolution in particular are not necessarily the “dark side of self-interest” or bad things. They may be sources of political and economic efficiency depending on their impact on institutional change. Revolution escapes Hirschman’s dichotomous corrective mechanisms of “voice” versus “exit.” We consider revolution as a scream leading to a rejection of existing rules and the suggestion of new rules. Our theoretical framework suggests that revolutions are a source of institutional innovation characterized by a process of de-institutionalization and re-institutionalization. The Veblenian “selective adaptation” on the basis of differentiation, inheritance, and selection through a struggle for survival provides an endogenous explanation of these different stages. We explore the impact of revolutions on institutional change by focusing on two major types of revolutions, namely the elite revolution and the mass revolution. The former is led by some members of the group of former elites, while the latter is driven by social groups and classes that were previously non-dominant. The Glorious Revolution of 1688 in Britain and the 1789 French Revolution are emblematic examples of these two types of revolutions. Both revolutions resulted in a demarcation between property and sovereignty, but through different patterns of institutional innovation. Our references to the Glorious Revolution are exclusively limited to old and neo-institutionalist authors to show the consistency between their theoretical framework and a conception of conflict as a means of bargaining. By contrast, our analysis of the French Revolution attempts to test the consistency of our theoretical framework in light of empirical evidence.

Purpose – The purpose of this paper is to give an account by a rehabilitation psychiatrist of many years of involvement in shared housing for former long-stay hospital residents and other long-term mental health service users. Design/methodology/approach – The paper offers a personal view based on developments in one locality of East London, blending case study narrative with cited earlier published papers that confirm and/or give greater detail on specific aspects of the experience gained. Findings – Long-term mental health service users, given the opportunity via shared housing to develop more lasting and natural relationships, proved to have social and interactive capacity that was obscured by both the conditions of hospital wards and by isolating accommodation “in the community”. The experience provides lessons for a better understanding of patients’ problems. Practical implications – Shared housing is often seen as simply a poor substitute for independent living; but the experience recounted here suggests that shared living may have particular value for some client groups. Originality/value – The housing developments and the associated research remain unusual and of potential value for planners of long-term services.

Background Since 1990, the provision of mental healthcare has changed substantially across Western Europe. There are fewer psychiatric hospital beds and more places in forensic psychiatric hospitals and residential facilities. However, little research has investigated the drivers behind these changes. This study explored qualitatively the perspectives of mental health professional experts on what has driven the changes in Western Europe. Methods In-depth interviews were conducted with twenty-four mental health experts in England, Germany and Italy, who as professionals had personal experiences of the changes in their country. Interviewees were asked about drivers of changes in institutionalised mental health care from 1990 to 2010. The accounts were subjected to a thematic analysis. Results Four broad themes were revealed: the overall philosophy of de-institutionalisation, with the aim to overcome old-fashioned asylum style care; finances, with a pressure to limit expenditure and an interest of provider organisations to increase income; limitations of community mental health care in which most severely ill patients may be neglected; and emphasis on risk containment so that patients posing a risk may be cared for in institutions. Whilst all themes were mentioned in all three countries, there were also differences in emphasis and detail. Conclusions Distinct factors appear to have influenced changes in mental health care. Their precise influence may vary from country to country, and they have to be considered in the context of each country. The drivers may be influenced by professional groups to some extent, but also depend on the overall interest and attitudes in the society at large.

Denmark, internationally known for its high level of welfare and solidarity with vulnerable groups, has been in the forefront promoting the 'normalisation principle' regarding people with intellectual disability (ID). Formulated in the 1950s by Niels Erik Bank-Mikkelsen to ensure people with ID have equal rights to live and participate in the community, social policy has since shifted toward individual rights, self-determination and active citizenship. However, these ideals and social policy goals have proved difficult to realise in practice. Drawing on two empirical studies of professional practice in Danish accommodation units for people with ID, this article investigates how care is practised vis-a-vis people with ID, who - for different reasons - depend on daily interaction with professionals for care, support or treatment. Finally, the article discusses current conditions for providing individualised care and support and how autonomy and active citizenship can be in opposition to empowerment through individual care and support. Keywords: re-institutionalisation, intellectual disability, social pedagogy, individualised care, practice