Deinstitutionalization and psychiatric reform in Spain

The transformation of psychiatric care which has been carried out in Spain since the 1980s, under the name of "Psychiatric Reform", had produced as it most significant achievements: (i) the development of a new organizational structure for mental health care, (ii) the integration of psychiatric pati ents in the general health care system, (iii) the creation of an extensive community network of mental health centers, and (iv) the adoption by the ge neral public of more positive attitudes towards mental illness and its trea tment and the passing of legislative measures aimed at improving the civil rights of these patients. However, the application of the Psychiatric Refor m has followed an uneven course in Spain as a whole, with marked difference s between the different autonomous communities. The main deficiency has bee n in the development of intermediate community services and programs to reh abilitate and resettle patients in the community. With regard to deinstitut ionalization, the results have also been insufficient and it is still possi ble to observe a strong tendency, within the system, to maintain the old me ntal hospitals for both long-term and short-term illness can. Finally, the analysis of the Spanish experience has revealed that (i) many of the critic isms leveled at deinstitutionalization are not aimed at its "conceptual cor e" but stem from its inadequate implementation, and (ii) it is wrong to equ ate deinstitutionalization and psychiatric reform with closure of psychiatr ic hospitals, without the awareness that this process is far more complex.