Reorganization of mental health services: from institutional to community-based models of care

Abstract

Mental health services in the Eastern Mediterranean Region are predominantly centralized and institutionalized, relying on scarce specialist manpower. This creates a major treatment gap for patients with common and disabling mental disorders and places an unnecessary burden on the individual, their family and society. Six steps for reorganization of mental health services in the Region can be outlined: (1) integrate delivery of interventions for priority mental disorders into primary health care and existing priority programmes; (2) systematically strengthen the capacity of non-specialized health personnel for providing mental health care; (3) scale up community-based services (community outreach teams for defined catchment, supported residential facilities, supported employment and family support); (4) establish mental health services in general hospitals for outpatient and acute inpatient care; (5) progressively reduce the number of long-stay beds in mental hospitals through restricting new admissions; and (6) provide transitional/bridge funding over a period of time to scale up community-based services and downsize mental institutions in parallel.

Scaling up action for mental health in the Eastern Mediterranean Region: an overview

“…There is a strong consensus, supported by evidence reviewed by Saraceno et al, that a balanced approach to secondary mental health services incorporating both community and hospital services offers the best model for a modern mental health service (20). The components of this balanced approach are detailed here.…”

Mental health legislation

“…Mental health-related legislation plays an important role in promoting health equity and access to good quality care by encouraging the development of integrated, community-based mental health care; promoting autonomy and liberty; and preventing marginalization. This consistently shows better outcomes for adherence to treatment, clinical symptoms, quality of life, housing stability, and vocational rehabilitation (8)(9)(10)(11) [see (12)].…”

Global Mental Health: A Call for Increased Awareness and Action for Family Therapists

“…The World Health Organization Pyramid for the optimal mix of services can be used as a guiding framework for service delivery and help increase access to services (see Figure S1; Saraceno et al., ). The base of the pyramid is comprised of a community's natural strengths and resources, which are self‐care and informal community care.…”