On the sectorization of psychiatric services

Area of Science:

• Public Health Policy
• Mental Healthcare Organization
• Psychiatric Service Delivery

Background:

• Sectorization, a public hospital and outpatient service model, emerged in Europe in the 1950s to reform psychiatric care.
• Established in France in the 1960s and institutionalized by 1985, sectorization aims to enhance service accessibility and continuity.
• The UK developed community psychiatry and mental health trusts concurrently, with sectorization adopted across most European nations.

Discussion:

• In Greece, sectorization was legislated in 1992 and 1999, but deinstitutionalization and inadequate support hampered its practical implementation.
• Deficiencies in service range and coordination within Greek sectors lead to bypassing the system, increased private service use, and higher readmission rates.
• Recent organizational changes, including Law 5129/2024, centralize management and abolish sector-based structures, raising concerns about operational feasibility and continuity.

Key Insights:

• International experience demonstrates sectorization's positive outcomes for users' functioning and met needs, reducing hospitalizations.
• Despite its aims, Greek sectorization faces challenges including underfunding, lack of coordination, and insufficient public services, impacting care continuity.
• The new centralized management framework risks operational issues and undermines the core principles of sector-based organization and effective service delivery.

Outlook:

• Addressing severe shortages in public services, hospital beds, and staffing is crucial for sectorization's completion.
• Enhanced coordination, liaison between units, and a national needs assessment are vital for improving mental health service delivery.
• Substantive amendments and expert contributions are needed to align the new law with the essential principles of sectorization.