International perspectives

This chapter will examine deinstitutionalisation in Italy, the United States, and post-apartheid South Africa. In examining the different drivers and outcomes of policies in these areas, similar themes to the UK experience emerge. These include: the role of scandals in the pressure for change, the role of fiscal considerations in the development of policy, an initial period of optimism and the impact of scandals. In Italy, the work of the psychiatrist, Franco Basaglia was seen as a possible blueprint for wider reforms. Basaglia’s work became very influential amongst radicals and the anti-psychiatry movement. The USA was at the forefront of the deinstitutionalisation policy. The links between the closure of psychiatric facilities and the expansion of the use of imprisonment have been most closely examined in this context. Finally, the chapter examines the total policy failure that led to the deaths of one hundred and forty-four patients in Gauteng Province, South Africa in 2014