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8 - From Deinstitutionalization to Deprescribing and Beyond

from Part III - The Future

Published online by Cambridge University Press:  03 March 2022

By
Rebecca Miller  and
Anthony Pavlo
Edited by
Meaghan Stacy  and
Charlie A. Davidson
Meaghan Stacy
Affiliation:
Yale University, Connecticut
Charlie A. Davidson
Affiliation:
Emory University, Atlanta
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Summary

Deinstitutionalization informs a movement toward a civil rights-informed perspective, and connects to the current trend of deprescribing in psychiatry. This emerging practice is growing. We look at the intersection of scientific evidence, social and cultural trends, and economic influences, then outline potential trajectories for the future, including de-diagnosis and deconstructing. “De-diagnosing” a mental illness is rarely discussed but seems a somewhat natural reordering and recalibration of decades of diagnostic expansion. The uptick in diagnosing in psychiatry reflects broader cultural movements and is impacted by and has influenced the need for deprescribing. The relocation of individual distress from within a person to societal barriers and inequities reflects a progression and decolonization of psychiatry as a vehicle for self-blame. Similarly, deconstructing reflects the necessary step of taking apart current evidence by including lived experience and cocreated stakeholder science, and reapplying them by identifying evidence, or lack thereof, for approaches such as hospitalization.

Keywords

deinstitutionalizationdeprescribingde-diagnosisanti-psychiatry
Type
Chapter
Information
Recovering the US Mental Healthcare System
The Past, Present, and Future of Psychosocial Interventions for Psychosis
 , pp. 183 - 205
Publisher: Cambridge University Press
Print publication year: 2022

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