The shift of mental health services from institutions to communities has been raised as a global necessity. In recent decades, many countries have made meaningful progress in developing community-based mental health services. These developments have shown that individuals with mental disorders can thrive in their communities with appropriate support.
The Current State of Mental Health Services
However, globally, a large number of individuals with mental disorders live in psychiatric hospitals and social care institutions. Some of them are kept in these centers for months, while others for decades. According to World Health Organization statistics, about half of these individuals have been forcibly admitted to these centers and are deprived of their daily choices.
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The institutional model of mental health care is recognized as an outdated and ineffective model. This situation is not only a treatment model but also a human rights issue. Many countries still heavily rely on independent mental institutions, and nearly half of the public mental health budget is allocated to maintaining these centers, while access to community-based mental health services is not covered for millions.
Sri Lanka's Experience in Reforming Mental Health Services
Sri Lanka has undertaken the reform of mental health services by replacing isolated institutions with community-based services. Over the past two decades, this country has made significant progress in transforming its mental health system from a shelter-based model to a decentralized network of local and regional services. Today, mental health services in Sri Lanka are provided through inpatient and outpatient units in public hospitals, external clinics, rehabilitation units, and child mental health clinics across the country.
Treatment centers that respect human rights, dignity, and individual autonomy help improve the situation of individuals. However, when care is provided through coercion, strict control, or social isolation, it becomes a form of imprisonment.
The Importance of Creating Conditions for Independence and Social Participation
Transforming institutions is not simply about reducing the number of hospital beds. It is about creating conditions where individuals can live independently and fully participate in society. This includes access to adequate housing, education, employment, social support, and physical and mental healthcare. These are the foundations of recovery, inclusion, and human rights-based mental health services.
Reducing hospital beds must be accompanied by strengthening local services and practical supports. No one should leave institutions without continued care. Individuals should be welcomed into services and communities that are ready to accept them.
World Health Organization Guidance for Transitioning to Community-Based Services
Different countries are demonstrating that progress in transforming institutions to community-based services is possible at all income levels. The World Health Organization has published new guidelines to help health leaders navigate each step of this transition. Each country has different positions and resources and needs to identify high-impact actions suitable for its context.
It must be ensured that individuals receive support in environments that promote dignity, autonomy, relationships, and inclusion. Governments and health systems are urged to prioritize this issue and consider individuals with mental disorders as key partners in this transition.
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