Mainstreaming Mental Health Care in 42 Countries

Area of Science:

• Global Health
• Mental Health Services Research
• Implementation Science

Background:

• Global consensus and national policies advocate for deinstitutionalization, shifting mental health care from institutions to communities.
• Despite policy emphasis, psychiatric hospitals often receive the majority of mental health funding, contradicting evidence favoring community-based services.
• Understanding the factors influencing deinstitutionalization's international uptake is crucial for effective mental health care reform.

Purpose of the Study:

• To investigate the norms, actors, and strategies influencing the international adoption of deinstitutionalization in mental health care.
• To identify challenges and facilitators in implementing community-based mental health care and downsizing institution-based care.
• To analyze how national contexts shape the implementation of deinstitutionalization strategies.

Main Methods:

• A survey of 78 experts across 42 countries was conducted.
• Experts shared knowledge and experiences regarding community-based mental health care expansion and institution-based care downsizing.
• Data on implementation contexts and strategies were collected.

Main Results:

• Mental health care delivery is not standardized across countries, regardless of setting (institutional or community).
• Advancing deinstitutionalization necessitates the active engagement of government officials, healthcare professionals, and local experts.
• Partnerships among these actors and with stakeholders are vital for resource mobilization and scaling up successful pilot projects.

Conclusions:

• Countries adapt deinstitutionalization strategies to unique situational and population needs.
• Effective management and implementation strategies are essential for augmenting both treatment and preventive mental health services.
• Further research should focus on optimizing these strategies for successful deinstitutionalization.