Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Newham Centre for Mental Health, Queen Mary University of London, London E13 8SP, UK.
BMC Psychiatry. 2013 Jun 18;13:169. doi: 10.1186/1471-244X-13-169.
Since Goffman's seminal work on psychiatric institutions, deinstitutionalization has become a leading term in the psychiatric debate. It described the process of closure or downsizing of large psychiatric hospitals and the establishment of alternative services in the community. Yet, there is a lack of clarity on what exactly the concept of institutionalization means in present-day psychiatry. This review aims to identify the meaning of psychiatric institutionalization since the early 1960s to present-day.
A conceptual review of institutionalization in psychiatry was conducted. Thematic analysis was used to synthesize the findings.
Four main themes were identified in conceptualizing institutionalization: bricks and mortar of care institutions; policy and legal frameworks regulating care; clinical responsibility and paternalism in clinician-patient relationships; and patients' adaptive behavior to institutionalized care.
The concept of institutionalization in psychiatry reflects four distinct themes. All themes have some relevance for the contemporary debate on how psychiatric care should develop and on the role of institutional care in psychiatry.
自戈夫曼（Goffman）关于精神病院的开创性著作以来，“去机构化”已成为精神病学领域的一个主要术语。它描述了大型精神病院的关闭或缩小以及在社区中建立替代服务的过程。然而，目前对于“机构化”在当今精神病学中的确切含义还缺乏明确性。本综述旨在确定自 20 世纪 60 年代初至今精神病学机构化的含义。
对精神病学中的机构化进行了概念性综述。使用主题分析来综合研究结果。
在对机构化进行概念化时确定了四个主要主题：护理机构的实体结构；规范护理的政策和法律框架；医患关系中的临床责任和家长式作风；以及患者对机构化护理的适应行为。
精神病学中的机构化概念反映了四个不同的主题。所有主题都与当前关于精神病学应该如何发展以及机构化护理在精神病学中的作用的争论有关。
