A Mixed-Methods National Study of Deinstitutionalization, Community Mental Health Infrastructure, and Recovery Outcomes Across Nigeria

Deinstitutionalization policies in Nigeria have been advocated for decades, yet community mental health infrastructure remains underdeveloped, raising critical questions about the readiness for and consequences of psychiatric bed reduction. This national mixed-methods study examines the relationship between deinstitutionalization, community mental health infrastructure, and patient recovery outcomes across Nigeria's six geopolitical zones. Phase one conducts a national facility audit of 25 psychiatric hospitals and 120 community mental health units, documenting bed numbers, staffing ratios, outreach coverage, and community rehabilitation programs. Phase two follows a cohort of 400 patients discharged from long-term inpatient care across six facilities over 18 months, assessing recovery outcomes using the Global Assessment of Functioning (GAF) and Camberwell Assessment of Need (CAN). Phase three uses serial qualitative interviews with 60 patients and caregivers to document lived experiences of community reintegration. Multilevel modeling will link facility-level infrastructure data to individual recovery outcomes. This study constitutes the most comprehensive national investigation of deinstitutionalization processes and their outcomes in Nigeria to date, generating original evidence to guide Federal Ministry of Health policy on psychiatric bed management, community care investment, and the National Mental Health Act implementation. Keywords: deinstitutionalization, community mental health, recovery, Nigeria, national study