Advocating for Community-Based Mental Health Care Over Institutionalization

However, a significant number of people with mental health conditions still reside in psychiatric hospitals and social care institutions worldwide. The World Health Organization’s Mental Health Atlas reveals that many of these individuals have been confined for months, or even decades, often against their will, deprived of basic choices such as clothing and meal times, and isolated from the outside world.

Institutional mental health care is increasingly viewed as an outdated model, but it also represents a pressing human rights concern. A considerable amount of public mental health funding, nearly half, is still allocated to sustaining large psychiatric facilities, while community-based mental health care remains dangerously underfunded and overlooked.

Sri Lanka has taken notable steps toward mental health reform by dismantling isolated institutions and implementing community-based services. Over the past 20 years, the country has transitioned from an asylum-based model to a decentralized system of district and community services, which include inpatient and outpatient units in general hospitals, outreach clinics, and specialized mental health facilities.

Facilities that promote human rights, dignity, and personal autonomy are essential for recovery. Conversely, care defined by coercion or social isolation can lead to more confinement than care. Deinstitutionalization involves more than simply reducing hospital beds; it focuses on creating conditions for individuals to live independently and engage fully in society. This includes access to housing, education, employment, social protection, and comprehensive health care tailored to individual needs.

The process requires scaling back psychiatric hospital beds while simultaneously enhancing local services, such as housing support, community mental health care, social connections, and educational and legal services. Continuity of care is crucial; individuals should not be discharged without a clear plan for ongoing support.

Countries around the globe are demonstrating that deinstitutionalization is achievable across various income levels. This includes evolving care practices, expanding alternatives to psychiatric institutions, and establishing robust community-based service networks. Achieving this cultural shift necessitates the active participation of individuals with lived experience, health service providers, and society at large.

To facilitate this transition, the World Health Organization has introduced new practical guidance for health leaders to navigate the process effectively. Recognizing that each country has unique resources, laws, and service systems, implementers are encouraged to identify feasible, impactful actions suited to their specific contexts.

It is imperative that support systems are prioritized to ensure individuals receive care in environments that uphold dignity, autonomy, and inclusion. We urge governments and health care systems to prioritize this transition, actively involving individuals with lived experience as partners throughout the process.