|Fact sheet No 219: Strengthening Community Mental Health Services and Primary Care - April 1999 (WHO, 1999, 2 p.)|
During the past 20 years there have been radical changes in psychiatric care in Europe as a result of "deinstitutionalisation" of psychiatric patients. That is to say, those previously kept in large public mental hospitals were now discharged and reintegrated into the community where they received treatment and care. It had become clear that these institutions caused long-term damage to individuals' health and ability to function in society.
Deinstitutionalisation means (1) avoiding mental hospital admissions through the provision of community treatment alternatives, (2) the release into the community of all institutionalised patients who have been given adequate preparation for such a change, and (3) the establishment and maintenance of community support systems for non-institutionalised people.
Whilst the deinstitutionalisation process is much more advanced in Western Europe than in Eastern Europe, the issue of strengthening community mental health services is relevant for all European countries.
There is broad scientific support for the belief that an approach to treatment and care based on deinstitutionalisation and its replacement by community treatment and care leads to better results in respect to (1) global symptoms of mental illness, (2) psycho-social adjustment, (3) admission and readmission rates to mental hospitals, (4) length of hospital stay, (5) employment and (6) reduced burden for the family.
Clinical trials have shown that the important elements of an effective response to mental health and neurological problems are psychological and social intervention (independent living skills, training in social skills, vocational training, social support networks, family intervention) and pharmacotherapy (neuroleptics, lithium, antidepressants and anxiolytics).
For most disorders it is essential that pharmacotherapy be used in combination with other specific psychological and social interventions.
The efficacy of these treatments will be reduced substantially if they are not delivered within the context of a comprehensive and coordinated delivery service.
Requirements of a comprehensive community mental health service include:
· crisis intervention
· beds for acute episodes of severe and acute illness in general hospitals
· long-stay accommodation with a 24-hour staff in home-like units, for people with enduring mental illness who need regular supervision of medication and daily monitoring of their mental state but who do not require the continuous presence of medical staff
· day care programmes
· concerted outreach efforts
· supported housing
· home services
· occupational rehabilitation programmes
· patient and family support services
· multidisciplinary health care teams.
Requirements of primary health care are (1) an adequately trained staff to assess, diagnose and manage mental problems, (2) availability of essential drugs for the treatment of mental disorders, (3) establishment of effective links with more specialist care, including well developed criteria for referral, methods of shared care, adequate information systems and communication, and (4) creation of appropriate links with other community and social services.
WHO is supporting the creation of a number of demonstration projects in 14 countries to strengthen community mental health services and primary health care. The major themes include (1) increasing the awareness of the community and educating it about mental health, (2) deinstitutionalisation, (3) reorganisation of mental health services, (4) creation of community mental health services and outreach programs, (5) training of primary care providers, (6) training of psychiatrists, and (7) psycho-social rehabilitation.
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© WHO/OMS, 2000