Putting mental health deinstitutionalisation back on track: a scoping review of what empirically hinders and drives deinstitutionalisation of adults who experience mental illness.

backgroundMental health deinstitutionalisation continues to be a global human rights priority. After over half a century, the discharge to the community often means the transition to smaller-scale institutions, segregation environments, and limited opportunities for community inclusion. This scoping review aims to identify what hinders and drives the deinstitutionalisation process of adults experiencing mental health challenges.

methodA scoping review was conducted following the Joanna Briggs Institute methodology and reported under the PRISMA extension for scoping reviews (PRISMA-ScR). A systematic search of four electronic databases, PubMed, APA PsycINFO, Web of Science, and Scopus, was undertaken between January and March 2024. Only empirical studies focusing on the deinstitutionalisation process of adults with mental health challenges, published in English, from 1991 to 2024 were eligible for inclusion. A template in Microsoft Excel was created for data extraction. Results were descriptively synthesised and organised into the system change framework's four fundamental dimensions (norms, resources, regulations, and operations).

resultsA total of 57 studies were included. Most of those included studies, 53% were qualitative (n = 30), 60% were published from 2014 to 2024 (n = 34), 26% were from North Americas (n = 15), and 25% were from Europe (n = 14). Factors that hindered mental health deinstitutionalisation included the exclusiveness of the medical model, social discrimination, insufficient community services, transinstitutionalisation, lack of support for community inclusion, most funds allocated to institutionalisation, economic incentives for institutionalisation, institutional policies, inefficient governance, professional control, and limited advocacy. Drivers included a model for community inclusion, an inclusive society, resourcing community alternatives, independent housing, individualised context-oriented support, economic pressures, policy and legal reform, consumer participation in services, and consumer advocacy.

conclusionsThe study findings constitute an important basis to inform the ongoing or future deinstitutionalisation processes of adults with mental illness diagnoses.