In the late 20th century, the approach to mental disorders evolved towards a more humane model, moving away from the extreme measures previously employed in psychiatric hospitals. This shift marked the beginning of deinstitutionalization, which transitioned patients from long-term psychiatric institutions to a community-based framework. This new environment aimed to facilitate healing and promote better outcomes for patients (Carson, 2025). As a result, a substantial number of psychiatric hospitals were closed, and the population within mental hospitals was significantly reduced, from over half a million individuals in 1950 to approximately 100,000 by the early 1990s (Hooley, 2019).
Why does deinstitutionalization have flaws?
While deinstitutionalization was intended to enhance patient autonomy and decrease instances of institutional abuse, the outcomes have been mixed. One negative consequence of the closure of mental hospitals was the overcrowding of community facilities, which led to an increase in homelessness among individuals with mental illnesses. States that rapidly closed psychiatric beds, such as California and New York, experienced marked increases in homelessness (Torrey, 2014). Many former psychiatric patients found themselves “trans-institutionalized,” moving from hospitals into jails, shelters, or onto the streets due to an absence of adequate community care (Lamb & Weinberger, 2001).
Why long-term hospitalization is still a requirement
However, there remain situations where long-term hospitalization is the most appropriate option for individuals with mental illnesses.
Patients Capable of Committing Criminal Acts
In cases of severe mental illnesses such as extreme psychopathy, anti-social or bipolar disorders, hospitalization may be necessary to ensure the safety of both the individuals and those around them. Hospitalization allows for proper treatment and monitoring, rather than incarceration following a criminal act.
Patients at Risk of Self-Harm
Patients with previous suicide attempts, severe depression, or psychosis face a 5 to 10 times greater risk of dying by suicide without hospitalization (Large, 2018). Those experiencing acute psychosis or intense suicidal ideation tend to stabilize more effectively in inpatient settings compared to outpatient care. Facilities that provide 24/7 monitoring and secure environments can substantially enhance the safety and recovery of these patients.
Patients with Critical Mental Disorders
Psychiatric hospitalization can significantly reduce emergency room visits and improve medication adherence in severe cases. Patients with critical mental health needs require constant medical supervision, specialized units offer structured therapeutic environments conducive to stabilization, and treatment should be followed in a patient-centered approach (Geller, 2012).
Patients in Need of Long-Term Care
Some individuals with chronic mental illnesses, such as treatment-resistant schizophrenia, severe personality disorders, or degenerative conditions like dementia, may require long-term care that supports stabilization, rehabilitation, and an improved quality of life when outpatient services are inadequate.
Patients Resistant to Treatment
For individuals who are resistant to treatment, community care may prove inadequate. This resistance is particularly evident in cases involving addictions, memory, or mental impairments, where patients find it challenging to engage with community support systems. In such situations, families often take on the responsibility of care in the absence of hospitalization alternatives. Patient-centered care within a psychiatric hospital entails constructing, implementing, and monitoring treatment, habilitation, and rehabilitation efforts with continuous and meaningful input from both patients and staff to the greatest extent possible (Geller, 2012).
Proposed Solution
Hospitalization and the community care model should go hand-in-hand for the best treatment approach. The Balanced Care Model (BCM) is recommended for improving psychiatric care comprehensively. This model emphasizes a necessary equilibrium between hospital and community care, as well as among the various service components (e.g., clinical teams) within any healthcare system. There is a pressing need to adopt a balanced approach that integrates community resources with hospitalization facilities for individuals who require them (Thornicroft, G., & Tansella, M., 2013).
References
Carson, S. H. (2025, June 23). Psychopathology [lecture recording], Canvas. https://canvas.harvard.edu/
Hooley, J. M., Butcher, J. N., Nock, M., & Mineka, S. (2019). Abnormal psychology (18th ed.). Pearson.
Thornicroft, G., & Tansella, M. (2013). The balanced care model for global mental health. Psychological Medicine, 43(4), 849–863. https://doi.org/10.1017/S0033291712001420
Geller, J. L. (2012). Patient-Centered, Recovery-Oriented Psychiatric Care and Treatment Are Not Always Voluntary. Psychiatric Services, 63(5), 493–495. https://doi.org/10.1176/appi.ps.201100503
Torrey, Fuller & Zdanowicz, Mary & Kennard, Sheriff & Lamb, Harry. (2014). The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey. https://www.researchgate.net/publication/296333518_The_Treatment_of_Persons_with_Mental_Illness_in_Prisons_and_Jails_A_State_Survey
Lamb, H. R., & Weinberger, L. E. (2001). Persons with severe mental illness in jails and prisons: A review. In H. R. Lamb & L. E. Weinberger (Eds.), Deinstitutionalization: Promise and problems (pp. 29–49). Jossey-Bass/Wiley. https://psycnet.apa.org/record/2001-01558-003
Large MM. The role of prediction in suicide prevention. Dialogues Clin Neurosci. 2018 Sep;20(3):197-205. doi: 10.31887/DCNS.2018.20.3/mlarge. https://pmc.ncbi.nlm.nih.gov/articles/PMC6296389/