Institutionalization is the placing of emotionally disturbed or psychotic people in a therapeutic facility.

Institutionalization refers to committing an individual, or sometimes a group, to a mental or welfare institution. The formal use of institutions for the housing of the mentally ill did not come about until the nineteenth century in some developed countries. Before that time, mentally ill persons were usually seen by others as being possessed by the devil or having been punished for some religious reason. The ancient Egyptians, Greeks, and Romans all wrote about mentally ill people as having religious or personal problems. Superstitions about these people were paramount in these ancient beliefs.

However, not all people felt this way about the mentally ill. For instance, Greek physician Hippocrates (460 BCE–370 BCE) believed that the mentally ill could be helped through a change in their environment or by the administration of certain medications.


It was not until the nineteenth century that these negative attitudes toward the mentally ill began to diminish. In that century, institutionalization of the mentally ill began in 1808 when the British Parliament mandated, through the County Asylums Act, the building of public mental asylums to take care of mentally ill persons. Within four years, the first asylum was opened in Nottinghamshire. Though required by law, many counties failed to build such asylums. The licensing and supervising of private asylums came about 20 years later.

However, it was not until 1845 that the Lunacy/ Lunatics Act made it clear that the mentally ill could not just be housed within such facilities but had to be medically treated for their mental problems. The act required that each facility be regularly inspected and that a qualified physician maintain a residency at each facility. The Lunacy Commission was created to regulate the asylums. Other countries soon followed the lead of Great Britain, with France enacting a law in 1838 to regulate the admissions of its asylums and their services and the United States constructing its first asylum (Utica State Hospital) in New York in 1850.

Activists help to treat the mentally ill

The first U.S. asylum was erected largely because of the efforts of American activist Dorothea Dix (1802– 1887), who had earlier worked diligently to improve the living conditions of the mentally ill. Dix wrote the 1843 report “Memorial to the Legislature of Massachusetts,” about conditions provided for the mentally ill.

In “Memorial,” Dix stated: “I proceed, Gentlemen, briefly to call your attention to the present state of Insane Persons confined within this Commonwealth, in cages, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience.” Dix lobbied the state and the federal government to enact laws to create proper asylums for the mentally ill.


This WHO primary source contains a personal account of living with mental illness in the Czech Republic.

The Czech Republic's plan to pilot community-based mental health services is a welcome development for people with both mild and severe forms of mental illness.

For 34-year-old Jana Stastny things started to fall apart when she broke her leg. Confined to her bed, Stastny started to suffer delusions.

“I had this obsessive feeling that there was a war outside, and that I could easily become a victim,” she says. Stastny called the emergency services and she was admitted to a psychiatric hospital, where she was initially put in a ward with severely agitated patients.

She was diagnosed with bipolar disorder, and released after a few months.

When she returned home her husband was living with another woman. “I tried to kill myself and ended up being re-admitted,” she says. Her second stay in hospital ended when she managed to escape. Back on the outside without support, she soon fell apart. A pattern was being established.

Everything changed when Stastny moved to Prague's District 8 and was admitted to the Bohnice Psychiatric Hospital run by Dr. Martin Holly.

Stastny noticed two differences at Bohnice: first, she was treated as an individual; second, the Bohnice focused on getting her home to live as independently as possible.

“I had visits not just from nurses but also social workers,” she says. “They talked to my doctor about my illness, but they also asked me how I felt and what I needed for a successful return home.”

Once back home, the support continued, with nurses helping her to readjust to everyday life at home. “Without that support I would have quickly ended up homeless again,” she says.

One main reason for slow progress in the Czech Republic has been lack of consultation, according to Dr. Ivan Duskov, head of the Strategic Project Management Office at the Ministry of Health. To improve dialogue, a working group was set up in 2012.

The group spent a year hammering out a reform strategy based on a balanced care model, in which psychiatric hospitals continue to offer care for the severest cases, while people with less severe forms of mental illness are cared for by a network of community establishments called mental health centres.

“The mental health centres are the big news,” says Duškov, who hopes that these will not only increase the number of facilities offering care but also provide mobile teams to support people in their homes.

“The plan is to start with about 20 pilot mental health centres to find the best working model,” he says. “This is not just about identifying the specifics in different settings, but, for example, finding out who will be the best service provider in the mental health centres.”

Stastny knows what it feels like for her life to fall apart, and to be saved. “If I get worse, I'm not afraid to go back to hospital anymore,” she says “because I know that the community nurses will help me recover.”

SOURCE: ” Taking Mental Health into the Community“ Bulletin of the World Health Organization, November 2014.

Benefiting from institutional care

What people believe about mental institutions is often colored by the media's portrayal of them, such as in the popular movie One Flew Over the Cuckoo's Nest (1975) and Girl, Interrupted (1999). With responsible care and effective treatment, the best institutions offer emotionally disturbed people a better chance at life. These individuals can learn skills, improve behavioral and psychological problems, and develop healthier self-esteem.

People with mild emotional or behavior problems often benefit from a short stay at an institution and benefit from a therapy protocol that minimizes the fact of institutionalization. However, severely disturbed people require a longer stay and a highly controlled environment.

Controversy over long-term institutionalization

Psychologists differ widely on the long-term effects of institutionalization. A shortage of research funds means that little solid evidence exists to support one side or the other. Although many improvements have been made in the quality of mental institutions, some civil-rights and patients-rights groups claim that incidences of neglect or below-standard care persist. Of particular concern is the lack of proper staff training. Detractors of institutions also point out that patients are often sedated without given any other form of treatment. They assert that institutions do more harm than good.


A facility or institution used to shelter and provide care to mentally ill persons.
The adjective for someone who is suffering from a psychosis, or an abnormal mental condition that causes losing sense of reality.

Despite the high numbers of mentally ill children, the negative effects the mentally ill have on society as a whole, and the development of effective treatment options for the mentally ill, long delays often occur before these people are helped. Decades sometimes pass after symptoms first appear and treatment is first begun. For the vast majority of emotionally disturbed children and adolescents, the use of institutionalization is not meant to provide long-term treatment. The average stay for young people ranges from several months to two years.

Decade of deinstitutionalization

During the 1980s, the federal government began a program of deinstitutionalizing the mentally ill from psychiatric hospitals. Some returned to their families. Others found themselves in hospitals or community health centers. In the second decade of the twenty-first century, it is not uncommon to see emotionally disturbed or psychotic people living on the streets, along with other homeless people. A portion of them are charged with crimes and sent to jails and prisons.

Local communities have been reluctant to provide alternatives to mental institutions, refusing to allow mental health clinics, halfway houses, or group homes to be established in their neighborhoods. Although deinstitutionalization has been seen as a general benefit for most mental health patients, it also has resulted in many shortcomings, including forcing many mentally ill persons to become homeless and without adequate mental health care. Instead of having continuous care in long-term psychiatric hospitals, they were provided much less care for much smaller periods of time in short-term facilities, often being unprepared for the outside world when discharged.

See also Halfway house .



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Leach, Jonathan. Improving Mental Health Through Social Support: Building Positive and Empowering Relationships. London and Philadelphia: Jessica Kingsley, 2015.

Payne, Christopher. Asylum: Inside the Closed World of State Mental Hospitals. Cambridge, MA: MIT Press, 2009.

Pilgrim, David. Understanding Mental Health: A Critical Realist Exploration. Abingdon, Oxon, England: Routledge, 2015.

Ruggiero, Adriane, editor. Mental Health. Detroit: Greenhaven Press, 2008.


Eisenberg, Leon, and Laurence B. Guttmacher. “Were We All Asleep at the Switch? A Personal Reminiscence of Psychiatry from 1940 to 2010.” Acta Psychiatrica Scandinavica 122,2 (August 2010): 89–102.


Bagenstos, Samuel R., Cardozo Law Review. “The Past and Future of Deinstitutionalization Litigation.” (accessed July 30, 2015).

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Dix, Dorothea L., Internet Archive ( “Memorial to the Legislature of Massachusetts 1843.” (accessed July 29, 2015).

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National Alliance on Mental Illness. “Mental Health By The Numbers.” (accessed July 30, 2015).

Pollack, Harold, Washington Post. “What Happened to U.S. Mental Health Care After Deinstitutionalization?” (accessed July 30, 2015).


Mental Health America, 2000 North Beauregard St., 6th Fl., Alexandria, VA, 22311, (703) 684-7722, Fax: (703) 684-5968, (800) 969-6642, .

National Alliance on Mental Illness, 3803 N. Fairfax Dr., Ste. 100, Arlington, VA, 22203, (703) 524-7600, Fax: (703) 524-9094, (800) 950-6264, .