The future of community psychiatry and community mental health services

Abstract

Purpose of review The aim of this article is to provide a framework and analysis of a series of critical components to inform the future design, development, sustaining, and monitoring of community mental health services. Recent findings Many mental health services remain too hospital-centric, often without adequate outreach services. On the basis of outcome evidence, we need to shift the balance of mental health services from hospital-centered with community outreach when convenient for staff, to community-centered and mobile, with in-reach to hospital only when necessary. Too few training programs emphasize the macroskills of public advocacy, working with service users, families, social movements, and the media to improve mental health and wellbeing of regional and local communities. Summary We should adopt a health ecosystems approach to mental healthcare and training, encompassing nano to macrolevels of service in every region. Catchment mental health services should be rebuilt as community-centric mental health services, integrating all community and inpatient components, but led and integrated from community sites. Community psychiatrists and mental health professionals of the future will need to be well trained in the nano to macroskills required to take responsibility for the mental health and wellbeing of their catchment communities and to provide leadership in service-planning, management, and continuing revision on the basis of rigorous evaluation. These approaches should be the core of all training in psychiatry and all mental health professions prior to any subspecialization.

The interpretation of beds: More bedtime stories, or maybe they’re dreaming?

“…Local, state and national indicators can only be usefully understood within an interactive healthcare ecosystem approach (Rock and Cross, 2020; Rosen et al, 2020). Only using aggregate figures may lead to an ‘ecological fallacy’ (assuming population means and national averages apply directly to individuals or local services).…”

“…Even taking into account this limitation, Allison’s tacit dismissal of the participation of experts in the development of NMHSPF as just ‘opinion’ disregards the relevance of expert and experiential knowledge in decision-support systems. A healthcare ecosystems approach formalises expert input as essential to develop decision-support tools (Rosen et al, 2020), and NMHSPF is based on extensive consultation with mental health domain experts, including clinicians.…”

International experiences of the active period of COVID-19 - Mental health care

“…Worldwide, and even before COVID-19, mental health was recognised as one of the most fragile elements of the health system, due to its complexity, chronic under-resourcing, inequity, and poor access and service gaps [1] , [2] , [3] , [4] , [5] . Major changes in mental health systems had been suggested and were already underway before 2020 with notable examples in Europe [6] , such as the full-scale national reform enacted in Belgium [7] ; and Latin America [8] .…”

Health Patterns Reveal Interdependent Needs of Dutch Homeless Service Users

“…Recently, Rosen, Gill, and Salvador-Carulla addressed the failure of mental healthcare systems to meet complex multisectoral care needs, such as in homeless populations (52). They revised the literature on critical elements at the individual and regional/national level.…”