WHO urges shift from institutional to community-based mental health care

The World Health Organisation (WHO) has released a new guide to help countries shift from institutionalised mental health care, which relies on long-term stays in psychiatric hospitals, to community-based, person-centred services that respect patients' rights and choices.

Many people with mental health conditions are currently living in large psychiatric hospitals and social care institutions. Nearly half are kept in these facilities involuntarily for months, years, or even decades, isolating them from the outside world.

Known as deinstitutionalisation (DI), this process involves helping people who have spent long periods (six months or more) in psychiatric hospitals to return and live in their communities, with the care, support and opportunities they need to lead fulfilling lives.

“People should not have to give up their freedom, dignity or place in their community to receive ongoing mental health support,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Countries must move away from relying on long-term institutional care and accelerate the shift of investments from institutions to rights-based mental health care and support in communities.”

The new guide sets out practical actions for psychiatric hospital leaders to implement DI. It focuses on reducing psychiatric hospital admissions and long stays, changing institutional practices to better protect people’s rights, and helping people leave hospital and return to community life with the support they need.

It also makes clear that DI cannot be achieved by hospitals alone. Access to housing, health care, social support, education, employment opportunities and support for families are essential to helping people live well in their communities.

Many countries are working to strengthen community-based mental health services, but progress remains uneven. WHO’s Mental Health Atlas found that only 9 percent of reporting countries had fully shifted to community-based mental health care, while more than half (53 percent) were still at an early stage of reform. More than one in four (28 percent) people admitted to psychiatric hospitals stayed longer than six months.

The new DI guide aligns with this year’s World Mental Health Day theme, “Lived experiences heard: real voices, real change,” and highlights the importance of ensuring that people with lived experience are active partners in shaping the policies, services and decisions that affect their lives.

WAM