This study aimed to review and synthesize the need estimates for psychiatric beds, explore how they changed over time and compare them against the prevalence of actually existing beds. We searched PubMed, Embase classic and Embase, PsycINFO and PsycIndex, Open Grey, Google Scholar, Global Health EBSCO and Proquest Dissertations, from inception to September 13, 2022. Publications providing estimates for the required number of psychiatric inpatient beds were included. Need estimates, length of stay, and year of the estimate were extracted. Need estimates were synthesized using medians and interquartile ranges (IQRs). We also computed prevalence ratios of the need estimates and the existing bed capacities at the same time and place. Sixty-five publications with 98 estimates were identified. Estimates for bed needs were trending lower until 2000, after which they stabilized. The twenty-six most recent estimates after 2000 were submitted to data synthesis (n = 15 for beds with unspecified length of stay, n = 7 for short-stay, and n = 4 for long-stay beds). Median estimates per 100 000 population were 47 (IQR: 39 to 50) beds with unspecified length of stay, 28 (IQR: 23 to 31) beds for short-stay, and 10 (IQR: 8 to 11) for long-stay beds. The median prevalence ratio of need estimates and the actual bed prevalence was 1.8 (IQR: 1.3 to 2.3) from 2000 onwards. Historically, the need estimates for psychiatric beds have decreased until about 2000. In the past two decades, they were stable over time and consistently higher than the actual bed numbers provided.

This article casts a critical eye over the development of American psychiatry from 1980 to the present. It notes the rapid decline of psychoanalysis that followed the publication of DSM III; the rising influence of genetics and neuroscience; the re-emphasis on the biology of mental illness; and the collapse of public psychiatry that accompanied deinstitutionalization. It argues that while genetics and neuroscience have made scientific progress, the clinical utility of their findings to date has been very limited. The fifth edition of the DSM was supposed to base itself on this new science but that proved impossible. Diagnosis remains purely phenomenological and controversial. One of the ironies of research on psychiatric genetics is that has failed to find either a Mendelian origin of schizophrenia and depression or to validate the importance of hypothesized candidate genes. Genome-wide association studies have instead uncovered risk factors for major mental illnesses, but these overlap considerably, and the genetic associations are not dispositive. Most of those who carry these genetic variants do not develop mental illness. The status of psychopharmacology since the mid-1950s is scrutinized, as is the influence of the pharmaceutical industry on contemporary psychiatry, and the implications of its recent decision to abandon work in this arena. The paper concludes with an assessment of the crisis that it contends confronts contemporary American psychiatry: its overemphasis on biology; the urgent questions that persist about diagnosis and therapeutics; concerns about the directions of future research; and its inability to reduce the excess mortality that plagues the mentally ill.

This article traces the history of the way in which mental disorders were viewed and treated, from before the birth of Christ to the present day. Special attention is paid to the process of deinstitutionalization in the United States and the failure to create an adequately robust community mental health system to care for the people who, in a previous era, might have experienced lifelong hospitalization. As a result, far too many people with serious mental illnesses are living in jails and prisons that are ill-suited and unprepared to meet their needs.

One of the major concerns in present-day psychiatry is the criminalization of persons with serious mental illness (SMI). This trend began in the late 1960s when deinstitutionalization was implemented throughout the United States. The intent was to release patients in state hospitals and place them into the community where they and other persons with SMI would be treated. Although community treatment was effective for many, there was a large minority who did not adapt successfully and who presented challenges in treatment. Consequently, some of these individuals’ mental condition and behavior brought them to the attention of law enforcement personnel, whereupon they would be subsequently arrested and incarcerated. The failure of the mental health system to provide a sufficient range of treatment interventions, including an adequate number of psychiatric inpatient beds, has contributed greatly to persons with SMI entering the criminal justice system. A discussion of the many issues and factors related to the criminalization of persons with SMI as well as how the mental health and criminal justice systems are developing strategies and programs to address them is presented.

The deinstitutionalization of individuals with serious mental illness was driven by 4 factors: public revelations regarding the state of public mental hospitals, the introduction of antipsychotic medications, the introduction of federal programs to fund patients who had been discharged, and civil libertarian lawyers. The result is approximately 3.2 million individuals with untreated serious mental illness living in the community. Beginning in the 1970s in the United States, there began to be reported increasing incidents of violent behavior, including homicides, committed by these untreated individuals. Such incidents became more numerous in the 1980s and 1990s, and have further increased since the turn of the century. Existing studies suggest that individuals with untreated severe mental illness are responsible for at least 10% of all homicides and approximately half of all mass killings. Studies have also shown that when these individuals are treated, the incidence of violent behavior decreases significantly. Examples of treatment mechanisms that have proven effective include assisted outpatient treatment (AOT), conditional release, and mental health courts.

This paper explores how corporations, through their Corporate Social Responsibility (CSR) activities, can help to effect positive developmental change. We use research on institutional change, deinstitutionalization, and institutional work to develop our central theoretical framework. This framework allows us to suggest more explicitly how CSR can potentially be mobilized as a purposive form of institutional work aimed at disrupting existing institutions in favor of positive change. We take the gender institution in the Arab Middle East as a case in point. Our suggestion is that the current context of the Arab Spring, which combined with increasingly obvious endogenous institutional contradictions, has created a fertile ground for shaping change processes within the gender institution. Finally, we provide concrete examples of CSR initiatives that regional corporate actors can engage in for positive developmental change supporting women.

An evaluation is currently underway concerning the changes which have taken place in Italy in the twenty years following the reform law. The qualitative and quantitative changes are being analyzed based on a possible shared definition of the processes of deinstitutionalization. This theme is generally the object of misundestandings and cliches. The need for change in clinical and istitutional psychiatry is the indispensable premise for the development of community psychiatry and the growth of a culture of public psychiatry in general. In this framework, an attempt is being made to define the meaning of change through the growth of the active participation of persona affected with mental disorders and their families in treatment, the participation of ordinary citizens, the spread of services in the community and the quantitative increase of the number of personnel involved in public community services. Emblematic of this change is the increase in the number of psychiatrists working in the public sector, from 700 to 7,000, over this twenty year period. The changes which must take place in psychiatric practice must also be emphasized: the heirarchies, the relationships, the search for non-health resources and enhancing the value of operators as subjects outside of their institutional role. The various forms of resistence which have retarded, and continue to retard, the process of change are also considered: the persistence of clinical cultural models, administrative inertia, the defense of acquired privileges by medical and nursing lobbies, the interests of the private, commercial and religious sectors and political manipulation. In any case, the beginning of a process of change which contains all the potential of a real project for prevention is judged positively.

Background: There is large cross-national variation in the characteristics of small, domestic-style care settings which emphasize normalized living. However, a systematic overview of existing types is lacking. This study provides an international comparison of the care concepts which have adopted a homelike philosophy in a small-scale context. Insight into their characteristics is vital for theory, planning and implementation of such dementia care settings.

Method: A literature search was performed using various electronic databases, including PubMed, Medline, CINAHL and PsycINFO. In addition, “gray” literature was identified on the internet. Concepts were analyzed according to five main characteristics: physical setting, number of residents, residents' characteristics, domestic characteristics and care concept.

Results: 75 papers were included covering 11 different concept types in various countries. Similarities among concepts reflected a focus on meaningful activities centered around the daily household. Staff have integrated tasks and are part of the household, and archetypical home-style features, such as kitchens, are incorporated in the buildings. Differences among concepts were found mainly in the physical settings, numbers of residents and residents' characteristics. Some concepts have become regular dementia care settings, while others are smaller initiatives.

Conclusion: The care concepts are implemented in various ways with a changing staff role. However, many aspects of these small, homelike facilities remain unclear. Future research is needed, focusing on residents' characteristics, family, staff and costs.

This study examines the changes in behaviour following residential relocation in 2 groups of adults with mental handicap. Both groups were transferred (one from the community and one from psychiatric hospitals) to small bungalow dwellings in a village type setting at a centre for persons with mental handicap. Relocation had a major impact on a number of behaviours, most prominently, ‘domestic activities’. The impact of the transfer on both groups, the relevance of the findings for future transfer projects and suggestions for future research are discussed.