World Health Organization's Deinstitutionalization Initiative

Depressed man lying on a psychiatrist's couch with speech bubbles: 'How do you feel?' and 'Why do you feel this way?'

The World Health Organization has been stressing the importance of deinstitutionalized mental health care for a while now. They have called on countries to adopt new models of service and mental health policy, thereby improving the overall standard of mental health treatment.

In this article we will examine what deinstitutionalization of mental health care is, reasons why it is should be seriously considered and the recommended ways to implement changes to mental healthcare.

What is Deinstitutionalization of Mental Health Care?

In a nutshell, it is the process of moving current models of mental health treatment and support from psychiatric institutions over to community-based services. Worldwide emphasis on this shift has been developing momentum for quite a few years, with the ‘Trieste Model’ in Italy taking centre stage.

The ‘Trieste Model’

The Trieste model has been globally influential since its inception in the 1970s. After psychiatric hospital closures in Trieste, Italy, the model was passed in law in 1978, promoting community-based mental health services. It is regarded as one of the best mental health models of practice in the world, gaining widespread recognition, including the support from the WHO.

Why Deinstitutionalize?

Quality of care and availability of mental health services are the fundamental reasons for deinstitutionalization. Too many people around the world cannot afford or even access mental health care that is appropriate for their condition. There are also extensive reports of human rights violations and poor treatment within mental health institutions, ranging from poor living conditions and overcrowding, to lack of resources, ineffective treatment, segregation and discrimination.

The WHO have stated: “To reduce suffering, uphold human rights, improve access and quality, and move towards universal health coverage, we must reimagine mental health systems from the ground up. This means building comprehensive, community-based networks of mental health services and supports for people of all ages”.

It is also a right for ‘people with psychosocial disabilities to live independently in their communities’, in accordance with The Convention on the Rights of Persons with Disabilities.

Community-based mental health care needs to be:

Available
Affordable
Accessible
Equitable
Free from stigma and discrimination
An advancement on current methods to improve overall well-being
Beneficial for society as well as individuals

How Can Deinstitutionalization Be Actioned

Creating communities with beneficial mental health services requires education, professionalism and resources that are central to provide the care necessary. Transitioning from institutions takes careful planning, collaboration, funding and continual monitoring and evaluation.

In 2014, the WHO conducted a survey of 78 mental health experts from 42 countries for the purpose of discovering useful measures that can be taken for community-based mental health services. A key insight gained was the emphasis most of the respondents put on political support and timing.

The main considerations for community-based implementation include:

Full commitment from health professionals.
Collaboration with caregivers and people with lived experience.
Financial support and funding.
Maintaining dedicated mental health centres and mobile teams.
Ensuring continuity of care.
Cooperating with law enforcement, educators and community members.
Integrating mental health into general health care, hospitals and clinics.
Providing mental health services in schools, workplaces and social service departments.
Meeting the needs of all cases, no matter how diverse.