A Model of Deinstitutionalization of Psychiatric Care across 161 Nations: 2001–2014

:Deinstitutionalization has been ongoing since the 1950s and is a trend that has been molded by diverse sociocultural conditions and competing ideologies. Key questions from the literature include its extent and the drivers motivating it, political and financial dimensions, and consequences in such domains as homelessness, nursing home care, and the criminalization of the mentally ill. This study specifically addresses questions about the extent of deinstitutionalization internationally, and the salience of competing explanations of this trend for understanding the extent of availability of psychiatric beds.This study employs a secondary analysis of data from the four editions of the World Health Organization’s Mental Health Atlas, as well as supplemental international databases. It uses a regression methodology to examine rates of change of psychiatric beds during 2001–2014 in 161 nations. Predictors include key geographic, demographic, socioeconomic, political, cultural, and service system conditions.The study reveals deinstitutionalization of inpatient care is far from universal, characterizing almost a half (45.1%) of the world’s nations. That the overall decline in inpatient beds is close to half of one percent (−0.41%) per year indicates this is a modest reduction, notwithstanding dramatic changes in both directions in subsets of nations. The regression model accounts for 55.7% of the variation of deinstitutionalization, using several significant predictors. Deinstitutionalization is associated with income inequality, racial and ethnic diversity, low population density, a high Human Development Index, psychiatric commitment laws, high incarceration rates, among other conditions.