Beyond de-institutionalisation: striking the right balance for mental health

Posted by Gulbenkian

Beyond de-institutionalisation: striking the right balance for mental health


The growing burden of mental ill health and the accompanying costs in terms of reduced quality of life, loss of productivity, and premature mortality, especially for the neglected mild to moderate mental illnesses, makes mental health a priority for all OECD countries.

The over-arching policy direction for mental health systems in OECD countries has been de-institutionalisation: moving away from mental hospitals towards care in the community. While some countries have made significant strides in shifting the locus of care delivery from institutions to community-based settings, in many countries institutions still remain dominant, and the care provided leaves much to desired.

This report argues that even in those OECD countries with a long history of de- institutionalisation, it is rare that this process has been or is being accompanied by sufficient investment in community care to secure high quality mental health care. Furthermore, the disproportionate focus on severe mental illness has meant that mild to moderate mental illness, which makes up the largest burden of disease, has remained overwhelmingly neglected. The large treatment gap for mild to moderate disorders needs to be rectified by developing mental health services in primary care and expanding access to these services. Improving the quality of mental health care requires better outcome indicators for mental health that can be used to drive improved mental health system performance.

Summary of main findings and recommendations of this document:

- Better information is needed on the outputs and outcomes of the mental health system

- Better data on mental health spending is needed to guide policy

- Mental hospitals, de-institutionalisation, and paying for specialist services

- Improving detection and treatment of mental health in primary care

- New approaches to mental health require new approaches to workforce

- Mental Health requires strong governance and leadership to achieve multi-sectoral coordination 

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