Finding Common Ground for Diverging Policies for Persons with Severe Mental Illness

Psychiatr Q. 2020 Dec;91(4):1193-1208. doi: 10.1007/s11126-020-09821-7.


Two diametrically opposed positions predominate discourse for the care and treatment of persons with severe mental illness: anti-deinstitutionalization and anti-institutionalization. Both share the same goal of ensuring best quality of life for those with severe psychiatric disorders, but pathways to achieving this goal are very different and have resulted in much contention. Supporters of each position espouse a different belief system regarding people with psychiatric disorders and their presumed capabilities, placing varying emphasis on maximizing protection of the community versus protection of individual rights, and result in contrasting mental health policies and practice orientations. The authors delineate the history from which these positions evolved, consequent views, and policies and practices that emerged from these differing attitudes. The article culminates in a proposed practice approach that offers a more balanced approach to serving adults with mental illness -navigating risk management by preserving freedom and opportunities of risk while affording mutually satisfactory "risk control."

Keywords: Coercion; Recovery; Risk management; Severe mental illness.

Publication types

  • Review

MeSH terms

  • Health Policy
  • Humans
  • Institutionalization*
  • Mental Disorders / diagnosis*
  • Mental Disorders / psychology
  • Mental Disorders / therapy*
  • Quality of Life*