In others, bed numbers actually increased despite this introduction. The drugs also have been used on a variety of populations that were not deemed to be mentally ill (such as people with learning difficulties and older people). The drugs were only relevant in giving psychiatric staff more confidence in dealing with community-based patients; they do not explain the policy of deinstitutionalization. At the end of the twentieth century deinstitutionalization has become a dominant mental health policy goal in most Western democracies (Sax, 1984). Conclusion

However, this formal goal has become clouded by evidence that the gradual reduction of large institutions has been replaced by a scattering of smaller ones 'in the community' (Roe, 1976). Also, most countries still have legal statutes to coercively remove madness from community set- tings. The extent of this continued coercive control varies from one country to another. For example, more conformist or authoritarian cultures such as Japan or Russia have higher rates of involuntary detention...

What is clear at the time of writing is that a policy of deinstitutionalization and one of genuine community care are not the same. Currently, it may be more accurate to talk of 'reinstitutionalization' as the actual outcome of large hospital closures rather than 'community care.'
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