New institutionalization as a rebound phenomenon? The case of Israel

Objective: To explore whether the history of significant deinstitutionalization in Western European countries since the 1950s, and in Israel more recently, may have led to the establishment of new alternative institutions as a "rebound" phenomenon. Methods: Data on service provision in Israel are analyzed and compared with published data from Europe. We considered five commonly used indicators of mental health services to reflect trends in institutionalization in psychiatric hospitals, the forensic system and supported housing. Results: In Israel, there has been a substantial increase in placement in supported housing (by 307%), psychiatric treatments in the prison population (by 61%), and a reduction of psychiatric hospital beds (by 42%) between 1991/2 and 2002/3. The changes are consistent with trends observed during the same decade in European countries with a different history of psychiatric institutionalization. However, increases in involuntary admissions in Israel, England, the Netherlands and Germany have not been shared by Spain, Italy and Sweden. Conclusion: The appearance of possible new forms of institutionalization also occurs in Israel and appears not to depend on a history of large asylums and deinstitutionalization since 1950s. Thus, it cannot be explained as a mere "rebound" phenomenon, and may be influenced by other societal factors that are shared by various European countries.