Global mental health and psychiatric institutions in the 21st century.

In the 19th century, psychiatric institutions were the focus of thousands of articles in the leading English-language medical and psychiatric journals. This area of concern remained important through the first half of the 20th century, with some decline in the number of published articles in the second half of the 20th century as de-institutionalisation gathered pace. The number of articles about this topic has declined sharply in the past 25 years, and psychiatric institutions are not the focus of any of the Grand Challenges in Global Mental Health even though psychiatric institutions of all kinds are widely acknowledged to be the among the main sites of human rights abuses. In this commentary we present examples of impressive transformations of institutions in Sri Lanka and Vietnam, and suggest that the field of global mental health should devote more of its efforts to improving the lives of persons with mental disorders who have been incarcerated in a variety of settings, often under the care of mental health specialists.