‘Living in the community’ the pros and cons: A systematic literature review of the impact of deinstitutionalisation on people with intellectual and psychiatric disabilities

Abstract

Summary How did deinstitutionalisation affect the lives of people with intellectual disabilities and people with a psychiatric background? This paper contains a systematic literature review on the consequences of deinstitutionalisation for the target groups, their social network and society at large. PubMed and Online Contents were searched from 2004 till February 2016. Inclusion criteria were (1) article describes (a) consequence(s) of deinstitutionalisation, (2) in Western countries and (3) the target group(s) include people with psychiatric or intellectual disabilities. Sixty-one papers were found and analysed to establish positive, negative or mixed results. Findings The positive effects pertain to the quality of life of people with disabilities after deinstitutionalisation. They learned adaptive skills and receive better care. Negative effects relate to more criminal behaviour by the target groups, victimisation of the target groups and physical health issues. Life for the most severely afflicted people with disabilities deteriorated when they moved to smaller group homes in the community. Mixed effects were also found. It is not clear whether deinstitutionalisation leads to real inclusion in the community. It is equally unclear whether it is cheaper than large-scale institutional care. Only a few studies investigate the effects on family members but some show they are overburdened. Applications Social workers catering for people with disabilities should pay attention to risks for their health and safety and keep an eye on family members. Those who are asked to advise on deinstitutionalisation should consider that this may not benefit the most severely afflicted.