Table 4. Study Characteristics Of Included Studies.

First Author And Year	Country	Aim of study	Setting	Study Design	Type of end user or participant	Number of participants	Provider Type
ABAS 2003	New Zealand	To describe reasons for admission and alternatives to admission in a government funded acute inpatient unit	Inpatient Unit	Mixed Methods	Adult patients admitted to a psychiatric hospitalization in the South Auckland Health Mental Health Services	255 admissions to an acute psychiatric unit in Auckland	Public
AGGETT 2005	UK	To describe the work of a busy Community Mental Health Team with outreach clients. Barriers to collaborative work and some of the team’s strategies to overcome them are delineated.	CMHC	Case series	Difficult to engage adult clients between 35 and 52 years old of a outreach community mental health team in an East London borough.	4 service users	Public
ALAKESON 2010	USA	To examine a range of innovative self-directed care programs in England, Germany, the Netherlands, and the United States.	CMHC	Narrative style	Home and community-based long-term care service users with physical and cognitive disabilities	Inapplicable	Public
ALLEN 2007	UK	To investigate predictors for out of area placements for people with challenging behaviors and also reports on their costs and basic characteristics.	Mixed	Descriptive Transversal	All people attending to services supporting children and adults with intellectual disability in a large area of South Wales in conjunction with health, education, unitary authority, voluntary and private sector commissioners and providers.	1458 people	Public
ANDERSON 1998	USA	To show the changes over 30 years in state institutional populations, interstate variability, movement of individuals into and out of state institutions, costs of state institutional care, and state institution closure as a result of social policy.	Inpatient Unit	Descriptive Longitudinal	Patients in institutions for mental disabilities and epileptics between 1950 and 1968	Inapplicable	Public
ASH 2015	Australia	To describe the implementation of recovery-based practice into a psychiatric intensive care unit, and report change in seclusion rates over the period when these changes were introduced (2011–2013).	Inpatient Unit	Mixed Methods	Consumers (average age 38 years) detained under the SA Mental Health Act. Eleven percent had been charged with or convicted of an offence with a custodial sentence. Common diagnoses were schizophrenia (32%), drug-induced psychosis (18%) and bipolar disorder (manic) (18%). The average length of stay was 11.5 days.	63 people	Public
BARRY 2002	USA	To examine the relationship between age, the use of health services and level of functioning in patients with schizophrenia across the adult lifespan	Mixed	Descriptive Transversal	Veterans with schizophrenia drawn from the VA National Psychosis Registry who received a diagnosis of schizophrenia during a VA clinical encounter between 1999 and 2000.	102.256	Other: not described
BARTON 1983	USA	To discuss the role of mental hospital in the health care system for the elderly	Inpatient Unit	Narrative style	Inapplicable	Inapplicable	Mixed
BENNETT 1982	UK	To describe factors that fostered the deinstitutionalization process in the UK and its consequences in psychiatric services.	Mixed	Narrative style	Inapplicable	Inapplicable	Public
BREDENBERG 1983	USA	To present available documentation regarding the implications of residential integration of geriatric ex-mental patients and the well elderly and make recommendations for future action.	Residency	Narrative style	elderly discharged mental health service users	Inapplicable	Other: not described
BRYANT 2004	UK	To identify how the experience of attending day services met the needs of people with enduring mental health problems	Day Unit	Thematic analysis	patient population.	39 people	Public
CHAKRABORTY 2011	UK	To compare measures of perceived racism, medication adherence and hospital admission between African- Caribbean and white British patients with psychosis	Mixed	Cohort study	participants aged 18–65 years; with a self-assigned ethnicity of Caribbean origin with either parents or grandparents born in the Caribbean; having a Research Diagnostic Criteria-defined psychotic symptom and in receipt of psychiatric services in north London, UK	110 people	Public
CHAN 2014	Hong Kong	To examine the mediating role of self-stigma and unmet needs in the relationship between psychiatric symptom severity and subjective quality of life.	CMHC	Case series	Adults with schizophrenia spectrum disorders attending community mental health services in Hong Kong	400	Nonprofit organization
CHOPRA 2011	Australia	To assess the long-term outcomes for the original cohort of 18 residents of the Footbridge Community Care Unit (CCU), a residential psychiatric rehabilitation unit at St Vincent’s Mental Health Melbourne.	ED	Cohort study	14 schizophrenic and 4 people with schizoaffective disorder	18	Public
COHEN 1983	USA	To clarify conceptions about mental illness in later life and promote the development of mental health services for the elderly in the community.	Residency	Narrative style	senior people with mental health difficulties living in housing arrangements	Inapplicable	Other: not described
CONWAY 1994	UK	To report outcomes of community mental health services for people with schizophrenia who had shown very low levels of supported housing and structured day activity.	CMHC	Cohort study	patients from West Lambeth, London originally aged 20-65 years who satisfied the research diagnostic criteria for schizophrenia.	51 people	Other: not described
DORWART 1991	USA	To assess the effect of changes in ownership and types of inpatient settings on the structure of the mental health services system.	Inpatient Unit	Analytic transversal	All nonfederal psychiatric hospitals in the United States, including community mental health centers with inpatient units between October 1987 and May 1988	915 hospitals	Mixed
EVANS 2012	USA	To describe the conversion of partial hospitals into recovery-oriented programs as part of system transformation.	CMHC	Narrative style	Stakeholders involved in a transformation of mental health service in a hospital	Inapplicable	Other: not described
FAKHOURY AND PRIEBE 2002	UK	To provide an international overview of deinstitutionalization and review related issues as discussed in the current literature.	Mixed	Narrative style	Inapplicable	Inapplicable	Mixed
FREEDMAN 1984	USA	To identify and discuss the major policy issues related to the care of the chronically mentally ill, specifically the effects and implications of deinstitutionalization for this particular population.	CMHC	Case report	a 32-year-old schizophrenic who has spent more than 10 years in mental health institutions	Inapplicable	Public
GOERING 1984	Canada	To describe the 6-month and 2-year postdischarge outcome in each of five aftercare components for 505 subjects in a traditional system of service delivery.	Inpatient Unit	Cohort study	Adult people discharged from inpatient units in Toronto	505 participants	Public
GRABOWSKI 2009	USA	To estimate the cross-state variation in the proportion of nursing home admissions indicating a mental illness, and the proportion of persons with mental illness admitted to nursing homes.	Residency	Descriptive Transversal	Nursing home admissions in the USA during 2005	1.150.734 new admissions	Private
HUANG 2017	Singapore	To design a general practitioner– partnership programme in an institute in Singapore to facilitate the transition to community services and gauge the impact of the interventions chosen to improve uptake of referrals.	CMHC	Mixed Methods	Stable mental health service users referred to the GP from December 2014 to January 2016 partnership programme in a mental health institute in Singapore	238 service users	Private
JOHN 2010	India	To describe the successful management of a person with schizophrenia in the community through a primary care team in liaison with psychiatrist services.	CMHC	Case report	adult with psychotic symptoms living in an urban area of India	1 person	Public
KAFFMAN 1996	Israel	To report on an alternative community care program that has been developed and implemented in the Kibbutz Clinic for the treatment and rehabilitation of the severely mentally ill.	CMHC	Mixed Methods	adult people with a severe mental illness with poor functioning who participated in the program conducted in Telem, Israel, for at least 18 months and followed up for a minimum of 4 years.	124 patients	Private
KALISOVA 2018	Czech Republic	To assess the effect of the S.U.P.R. psychosocial rehabilitation programme on the quality of care at the longer-term inpatient psychiatric departments	Inpatient Unit	Experimental not randomized (‘before and after’ design)	All Czech psychiatric hospitals focused on longer term inpatients, mainly with a diagnosis of schizophrenia.	14 units for 499 patients with severe mental illness with complex needs	Other: not described
KAM-SHING 2006	China	To review and evaluate the implementation of community mental health in the People’s Republic of China	CMHC	Narrative style	Inapplicable	Inapplicable	Public
KLEINER 1992	USA and Norway	To describe the experiences in the creation of innovative service delivery system which integrates psychiatric services with lay community support systems and patient social networks.	CMHC	Narrative style	Psychotic patients who had more than two years of cumulative hospitalization, and who could not be placed with relatives.	Inapplicable	Other: not described
KRAUDY 1987	Nicaragua	To assess the extent to which the new proposed model had been translated into a different way of delivering psychiatric care in Nicaragua	Primary Care Centre	Descriptive Transversal	children and adult patients attending one of the surveyed services for the first time irrespective of whether or not they had a psychiatric history.	342 patients	Public
LAMB 1977	USA	To assess the career of psychiatrically disabled people in the community	CMHC	Descriptive Transversal	Long-term psychiatrically disable people between 18 and 64 years old who live in the community in California with a psychotic diagnoses	99 people	Private
LAVOIE-TREMBLAY 2012	Canada	To describe how families and decision makers perceive collaboration in the context of a major transformation of mental health services and to identify the factors that facilitate and hinder family collaboration.	CMHC	Thamatic Analysis	family members of users of mental health services and key decision makers on the mental health service	54 family members and 22 decision makers	Public
MALLIK 1998	USA	To identify perceived barriers to community integration in people with psychiatric disabilities, in the areas of skills, environmental support, and community resources.	Inpatient Unit	Case series	People with psychiatric disabilities in the Alliance of Psychiatric Rehabilitation Program in Baltimore County, Maryland	42 people	Public
MANUEL 2012	USA	To explore the experience of women with severe mental illness in transition from psychiatric hospital care to the community.	Residency	Thematic analysis	women living in transitional residences on the grounds of two state-operated psychiatric hospitals in the New York City metropolitan area, awaiting discharge to both supervised and independent housing in New York City.	25 women	Public
MATSEA 2019	South Africa	To explore the views of different stakeholders about their roles as support systems for people with mental illness and their families in a rural setting.	CMHC	Content Analysis	Stakeholders comprising traditional health practitioners (faith and traditional healer), traditional leaders, church members, home-based care team and police officers from Mashashane, a rural setting in Limpopo Province, South Africa	41 stakeholders	Public
MAYSTON 2016	Ethiopia	To engage key stakeholders in participatory planning for a shift to mental health care integrated into primary care, and to explore their perspectives on acceptability and feasibility of the change.	CMHC	Framework analysis	key stakeholders (healthcare administrators and providers, caregivers, service-users and community leaders) living in Butajira town	11 service users, 27 caregivers, 15 health extension worker and 10 health center workers	Public
MCCUBBIN 1994	Canada	To reevaluate the recent tendency to attribute economic causes to deinstitutionalization and its subsequent “treatment in the community” mental health systems	Mixed	Narrative style	Inapplicable	Inapplicable	Mixed
MECHANIC 1990	USA	To provide a comprehensive overview of the causes, nature, and consequences of the practice of deinstitutionalization in the Unites States	Mixed	Narrative style	Inapplicable	Inapplicable	Mixed
O’DOHERTY 2016	Ireland	To document the views of family members of people with an intellectual disability regarding implementation of a personalized model of social support in Ireland.	CMHC	Grounded theory	parent, adult sibling or extended family member of a person receiving full-time residential supports from the agency	40 family members	Public
OSHIMA 2006	Japan	To explore how the introduction of community-based care has changed the role of psychiatric hospitals and families in caring for people with mental illness by examining the different types of living settings of clients treated for schizophrenia in Kawasaki as compared with a similar group of clients nationally	CMHC	Descriptive Transversal	adults with a diagnosis of schizophrenia living in the community and hospitalized in Kawasaki and the rest of Japan	3.845 people living in Kawasaki and 448.000 living in Japan	Private
PAHO 2008	Argentina, Brazil, Chile, Cuba, Jamaica and Mexico	To convey some of the more innovative experiences to reform mental health services implemented in Latin America and the Caribbean	Mixed	Narrative style	Inapplicable	Inapplicable	Public
RIZZARDO 1986	Italy	To analyse the impact of the reform on health care delivery by the general practitioner in an urban district in the Veneto region.	Primary Care Centre	Descriptive Transversal	General practitioners working in a psychiatric service run by the University of Padua by 1983	24 general practitioners	Other: University facilities
ROSE 1979	USA	To analyse deinstitutionalization policy on the sector of community mental health care and review its accomplishments and difficulties.	Mixed	Narrative style	Inapplicable	Inapplicable	Mixed
ROSENHECK 2000	USA	To review the relationship between mental health service delivery and the community in which it is embedded.	CMHC	Narrative style	Inapplicable	Inapplicable	Mixed
SCHMIDT 2000	Canada	To examine how psychiatric rehabilitation fits within a remote First Nations community.	CMHC	Thematic analysis	service providers, consumers and family members of aboriginal people with severe mental illness living in northern British Columbia.	10 stakeholders	Public
SEMKE 1999	USA	To explore system outcomes of interventions that were aimed at lowering high use of long stay state hospitals.	Mixed	Descriptive Transversal	adults living in the Washington state who experienced one psychiatric hospitalization of 30 days or more, or three or more psychiatric hospital admissions during a “pre-reform” period (1988) or after implementation of reform interventions (between 1991 and 1993)	2.646.307 high utilizers of state hospitals	Public
SHEN AND SNOWDEN 2014	USA	To examine whether the institutionalization of deinstitutionalization policy changed the supply of psychiatric beds in 193 countries from 2001 to 2011.	Inpatient Units	Echological study	Mental health systems as units	193 countries	Public
STELOVICH 1979	USA	To describe factors related to deinstitutionalization leading to transfer mental health service delivery from civil mental health hospitals to prison facilities.	Inpatient Unit	Narrative style	Psychiatric patients transferred to prison facilities in Massachusetts	Inapplicable	Public
SWIDLER 1995	USA	To describe the political processes leading to the Community Mental Health Reinvestment Act passage, the obstacle overcome by legislative negotiators and implementation issues.	Mixed	Narrative style	Inapplicable	Inapplicable	Public
SYTEMA 1996	Italy and Netherlands	To compare the treatment of severely mentally ill patients in a community mental health service without the back-up of a mental hospital with the treatment provided in an institution-based system in which mental hospital are still predominant.	Mixed	Cohort study	Patient with schizophrenia that contacted a service at least once in 1988 or in 1989 in Groningen (The Netherlands) or South-Verona (Italy)	812 patients	Mixed
WASYLENKI 1995	Canada	To describe the authors’ involvement in three service delivery projects in Ontario and discuss how, by assuming multiple roles, they were able to ensure that planning and policy development were informed by current knowledge.	Mixed	Narrative style	Inapplicable	Inapplicable	Public
WEISS 1990	USA	To analyze deinstitutionalization policies implemented in 1946 and 1963 in USA	Mixed	Narrative style	Inapplicable	Inapplicable	Public
WHO 2014	Malaysia, Japan, Ethiopia, Brazil, Nigeria, Uganda, UK, Iran, Italy, Portugal, Cambodia, Philippines, Spain, New Zealand, Usa, Sri Lanka, Chile, India, Republic of Korea, The Netherlandands, Zambia, Indonesia, Tanzania, Singapore, Lithuania, Australia, Georgia, Vietnam, South Africa, Ghana, Sweden	To capture lessons learnt from those who have been involved directly with deinstitutionalization and/or expanding community-based services and identify innovative strategies and methods associated with success of this process.	Mixed	Mixed Methods	mental health experts involved directly with deinstitutionalization and/or expanding community-based services	78 people	Public

^*CMHC: Community Mental Health Centre; ED: Emergency Department