Services and deinstitutionalization

Lumos/Chris Leslie

Across Europe, countries develop strategies to support community-based services. In many countries, community health services have replaced the traditional models of care. Bed numbers have been reduced and institutions closed, but the pace of change is uneven. Although care based in the community has been shown to offer a better quality of life and satisfaction than traditional hospital care in most cases, institutional care still dominates in most parts of the WHO European Region.

Over the last decade attention has focused on the notion of 'scaling up' or increasing the capacity of mental health services. In Europe services and resources in mental health care vary from country to country, with the number of beds ranging from 8 to 152, and of psychiatrists from 1 to 30 per 100,000 people. Also, the treatment gap is still between 35 and 50%. This diversity is not only due to the different resources available, it also relates to the different models of care applied, that are often the result of the challenges of decentralization.

The new policy focus on mental health and deinstitutionalization looks beyond the traditional psychiatric services, to include a public mental health policy and an agenda for social inclusion. This policy of reform aims for an integrated and comprehensive approach, with treatment, promotion and prevention as equally important components. Such a transformation of existing mental health practice requires political and professional leadership, and support through international collaboration.

A balanced partnership among international guidance, national plans and local expertise is the recipe for progress. National action plans should prescribe models of care and identify necessary health resources to ease tension between central planning and local implementation. Universities and training programs should also increase capacity to guarantee a sufficient supply of specialist mental health staff that can work in close partnership with primary care teams.

The WHO European Mental Health Action Plan (2013) reinforces this focus by acknowledging that "the commitment to deinstitutionalization and the development of community-based mental health services have continued, although progress is uneven across the Region. The consensus is that care and treatment should be provided in local settings, since large mental hospitals often lead to neglect and institutionalization".