Deinstitutionalization in the UK and Ireland: Outcomes for service users

The UK research literature on the effects of deinstitutionalization, published between 1980 and 1994, was reviewed. The results from 71 publications arising from 46 studies indicated that smaller, community-based residential services were generally, though not inevitably, associated with: (1) increased user engagement in ongoing activities; (2) increased contact from care staff; (3) increased use of community facilities; (4) increases in adaptive behaviours; (5) reductions in observed challenging behaviour; (6) increased opportunities for choice; (7) increased contact with family and friends; (8) a better material standard of living; and (9) increased acceptance by the community. No differences were found with regard to reported challenging behaviour. In addition to these differences between institutions and community-based residential services, there were also large differences in service quality within community-based residential services, with some community-based services providing a quality of life similar to institutions. The limitations and implications of the evidence are discussed.