The Case for Shifting Mental Health Care From Institutions to Communities

Decades of progress in community-based mental health services have demonstrated that individuals with mental health conditions can thrive when provided with appropriate support. However, many people with mental health conditions still reside in psychiatric hospitals and social care institutions, some for extended periods or even decades.

According to the World Health Organization's Mental Health Atlas, approximately half of these individuals have been admitted involuntarily, stripped of basic choices in their daily lives, and isolated from the outside world.

Institutional mental health care, while having been a prevalent model, is not merely obsolete; it is also a pressing human rights concern. Across the globe, the majority of public mental health funding is allocated towards maintaining these large facilities, leaving millions of people without adequate access to community-based mental health care.

Sri Lanka's mental health system has undergone significant transformation in recent years, moving away from isolated institutions to a decentralized network of district and community services. This shift has been guided by the country's mental health policies over the last two decades, focusing on delivering care through various settings such as inpatient and outpatient units in general hospitals, outreach clinics, rehabilitation units, and child mental health clinics.

Deinstitutionalization is not merely about reducing hospital beds; it encompasses creating an environment where people can live independently and engage fully in society. This requires access to appropriate housing, education, employment, social protection, and person-centered mental and physical health care. Scaling back psychiatric hospital beds must be accompanied by the development of local services and practical supports, including housing, community mental health care, peer support, social connection, education, employment, legal aid, and family support.

No one should be discharged without a guarantee of continuous care, welcomed into supportive environments that are prepared to receive them.

The transition to deinstitutionalization is a cultural shift that necessitates the active engagement of individuals with lived experience, healthcare providers, and the entire community. The World Health Organization has provided practical guidance to assist health leaders in navigating this process, emphasizing the importance of tailoring actions to each country's unique context.

Governments and healthcare systems are urged to prioritize this transition, ensuring that support is provided in settings that foster dignity, autonomy, relationships, and inclusion. People with lived experience should be integral partners throughout this transformation, advocating for their rights and well-being.