Community mental health care worldwide: current status and further developments

Abstract

This paper aims to give an overview of the key issues facing those who are in a position to influence the planning and provision of mental health systems, and who need to address questions of which staff, services and sectors to invest in, and for which patients. The paper considers in turn: a) definitions of community mental health care; b) a conceptual framework to use when evaluating the need for hospital and community mental health care; c) the potential for wider platforms, outside the health service, for mental health improvement, including schools and the workplace; d) data on how far community mental health services have been developed across different regions of the world; e) the need to develop in more detail models of community mental health services for low- and middle-income countries which are directly based upon evidence for those countries; f) how to incorporate mental health practice within integrated models to identify and treat people with comorbid long-term conditions; g) possible adverse effects of deinstitutionalization. We then present a series of ten recommendations for the future strengthening of health systems to support and treat people with mental illness.

Keywords: Community mental health care; chronic care model; deinstitutionalization; evidence-based interventions; low- and middle-income countries; mental health services; schools; workplace.

Figure 1

Balanced care model in relation to high‐, middle‐ and low‐income countries

Figure 2

Global distribution of mental health expenditure per capita, by health setting (data from the WHO Atlas21)