Community care is associated with continuity of care, greater users’ satisfaction, increased adherence to treatment, better protection of human rights, and prevention of stigma.
Overall mental hospitals lost the central role they had but in many countries the number of mental hospitals continue to be high and consume the majority of resources allocated to mental health.
Community-based services enables people with mental disorders to maintain family relationships, friendships and jobs while receiving treatment, which facilitates early treatment and rehabilitation.
Barriers considered to have the highest impact in Europe are lack of cooperation between health and social sectors, difficulties in the MH integration in the health care and lack of clear leadership.
Across Europe, much effort has been made over recent decades to ensure high-quality longer-term care for people with severe mental disorders, which helped to advance mental health care in many countries. These include improvements in the living conditions in psychiatric hospitals, the development of community services, the integration of mental health care within primary care, the development of psychosocial, the protection of the human rights of people with mental disorders and the increasing participation of users and families in the improvement of policies and services.
However, much more has still to be done. The reality is that in many countries, people with these disorders continue to reside in large psychiatric hospitals or social care institutions with poor living conditions, inadequate clinical assistance and frequent human rights violations. In some countries, although progress has been made in the transition from psychiatric hospitals to community care, the resources allocated to the new services are very limited and responses to psychosocial needs are very scarce. The ultimate goal of the Work Package 5 is to develop recommendations for action at EU-level and in Member States that may lead to a more effective implementation of the desired shifting to community-based mental health systems and services.
1 - Situation analysis
Progress made in EU and MS in the transition from the traditional model of mental hospital-based care to community-based care models for people with severe mental disorders was made with the collaboration ofnational and European working groups integrating policy makers and other stakeholders.
The following methods were used:
- A literature review was made in order to review scientific evidence, best practices and available technical resources relevant for the implementation of community-based and socially-inclusive approaches to mental health in Europe.
- To identify the general trends of the transition to community-based mental health care in EU, an analysis of existing data on a selected set of indicators was made.
- To understand in more detail the process of transition to community-based care, three different methods were used in the 9 countries that participated in this Workpackage (Austria, Bulgaria, Estonia, Hungary, Ireland, Italy, Portugal, Spain, UK), which somehow represent the main different kinds of transition process registered in EU:
- New and more extensive data related to this process was collected in these countries, with the support of a Questionnaire specifically developed for this purpose (Transition from hospital based care into community based care Assessment Questionnaire);
- A SWOT analysis (to evaluate achievements, barriers and challenges in MS) was developed in six countries;
- Finally, good practices were identifies and described in each of the participating countries.
2 - Recommendations for action at EU-level and in Member States
A set of recommendations were drafted, covering the main areas that are fundamental to improve the implementation of the transition to community-based care.
3 - Endorsement of the framework for action
Several actions aiming at supporting the engagement and commitment of Member States and other stakeholders in effective action to develop community-based and socially inclusive approaches to mental health in Europe were initiated and will be continued in the second part of the JA.