Designing care together with and centred around people: July’s story

It is a grey and drizzly day in northern Belgium. Sharon Vandemaele drives up to her client July’s home, is met with a smile and invited into the living room, where a warm fire is blazing. On some days, July may choose to sit in her favourite corner on the sofa for this meeting. But today, July prefers to sit at her table, where, over a cup of coffee, they talk about how July is feeling, her health needs and any adjustments to her current care plan.

Sharon is a psychiatric care nurse and July – one of 3 clients she is visiting on this day – is a person with mental health care needs. July’s consultations have not always taken place in the comfort of her home. In fact, she was often hospitalized before Belgium transformed its mental health care system to a community-based one.

In the past, 6 months was the longest stretch that July spent in the hospital. “At the time, Helena – my daughter – was very small and my mother took care of her. The fact that I couldn’t go home felt like a living hell. It was a very harsh period in our lives, a dark time for my family,” remembers July. The introduction of mobile mental health care teams has significantly changed July’s experience and that of many others.

Care co-designed with patients and provided close to their homes

“With the mobile team, there is more shared decision-making compared to the hospital, where doctors and nurses made decisions without involving me,” explains July. “The mobile team takes into account my preferences, and in case I have to be hospitalized, they also take care of my daughter and husband,” she adds.

Gerrit Vanhee is the leader and coordinator of the mobile team providing long-term care in the region. His multidisciplinary team of 10 includes 2 psychiatrists, an occupational therapist, social workers and a psychiatric nurse. “As a mobile team, we provide added value for people who have difficulty leaving their houses, since we take care of them in their own environment,” says Gerrit.

The mobile team also involves family doctors, as well as social services, in the care of their clients. Furthermore, the team teaches primary health care nurses, family physicians and home-help assistants the skills needed to support vulnerable people with mental health care needs. “We are complementary to primary care and work closely together,” adds Gerrit.

The inspiring example of Belgium’s transformation of its mental health care system

Mobile teams providing long-term and emergency mental health care are a central element of Belgium’s multisectoral mental health networks, offering outreach services, prevention, in- and outpatient services, primary care, day care, and vocational, housing and social care services.

These are a result of Belgium’s successful nationwide reform of the mental health sector, in response to the need for more people-centred approaches. The reform aimed to strengthen community-based care and to reduce the number of beds needed in psychiatric hospitals.

The reform improved the delivery of integrated care, social rehabilitation and recovery. Perhaps most significantly, it also improved the quality of life for people with mental health care needs and their families.