The Role of Deinstitutionalization in Experience-Based Quality of Psychiatric Treatment: Results of a Mixed Methods Study

Abstract Background Since the mid-twentieth century, many Western European countries have shifted the focus of mental health care from hospital-based to community-based settings. While the impact of deinstitutionalization on various quality indicators has been widely studied, its effects on patient-experienced quality of care remain underexplored. This study aims to identify deinstitutionalization-related conditions that are necessary and/or sufficient for achieving a high level of experience-based quality in psychiatric treatment. Methods We employed a mixed-methods design following a qual→quan→QUAL sequence. Our analysis drew on quantified interview data and routine data from a precursor study involving nine hospitals implementing flexible and integrative psychiatric treatment (FIT64b) and five control hospitals in Germany. We conducted a crisp-set Qualitative Comparative Analysis (QCA) to identify necessary and sufficient conditions associated with deinstitutionalization that could—individually or in combination—lead to higher or lower patient-reported quality of care. To further interpret the QCA results, we performed a Grounded Theory-inspired qualitative re-analysis of the original interview material. Results FIT64b with a reduced number of hospital beds was identified as a necessary condition for a higher experience-based quality of psychiatric treatment. Surprisingly, a longer average hospital length of stay was a sufficient condition for this outcome, while a shorter hospital length of stay was found to be a necessary one for a lower experience-based treatment quality. The interview re-analysis showed that inpatient treatment of adequate length can potentially be a deeply transformative experience that requires a suitable amount of time to make use of a multitude of occasions for processes of learning, reflection and behavioural changes. Conclusions Deinstitutionalization can play an important role in achieving higher experience-based quality in mental healthcare if certain conditions are fulfilled. Modern psychiatric services with a reduced number of hospital beds and well-developed outpatient care like FIT64b are necessary but have to be combined with an appropriate hospital length of stay. Trial registration: This study was part of the multi-center controlled PsychCare trial (German Clinical Trials Register No. DRKS00022535; Date of registration: 2020–10 − 02).