WHO Seeks Community Mental Healthcare Over Institutions

The World Health Organisation (WHO)  has released guidelines highlighting the need for community care instead of long-term psychiatric institutionalisation. This is to ensure a rights-based care system for those with mental illness. It stressed the need to maintain individual rights by providing care, support and opportunities in their own communities. Prolonged stay in an institution can isolate and cut them off from the outside world, whereas the new shift urges a person-centred care approach.  

Deinstitutionalisation (DI) is the process where people who have spent extremely long periods in psychiatric institutions are helped to return to their communities. The UN stated that people must not be deprived of their rights, like freedom and dignity, just for the sake of receiving care. It urged countries to move away from the practice of long-term institutional care with a shift towards rights-based mental health care and support in communities.

The WHO Guidelines

The guidelines focus on maintaining the rights and dignity of an individual who may require mental health care without having to surrender basic access to freedom, community and the world outside. The guidelines offer practical approaches for leaders of psychiatric hospitals to implement DI and urge them to reduce psychiatric hospital admissions.

It also urges reform in existing institutional practices to a rights-based approach while also including those who have experienced institutionalisation in community-care decision-making. The whole initiative requires a systemic reform including policy changes, evidence-based interventions and a redesign of existing services. The WHO released the following data on resources used by institutions.

• 81% of countries still provide mental health services in psychiatric hospitals
• 47% of mental health funds go to psychiatric hospitals
• 28% of people admitted to psychiatric hospitals stay over six months
• 16% of people admitted to psychiatric hospitals stay for more than a year
• 49% of admissions to psychiatric hospitals and units are involuntary (decided by someone else)
• More than half of mental health in-patient beds are in Psychiatric hospitals
• 49% of countries possess a registry for isolation and restraint

The Benefits Of Community-based Care

Oftentimes institutionalisation can cause further isolation and worsen conditions in individuals by confining them to a closed environment where they are not included in decision-making or policy changes. The WHO guidelines ensure that such individuals will no longer be left out of policy or decisions that involve their own welfare. A community-based approach aims to help them live a dignified life while also ensuring that they are in touch with the outside world. The main focus and aim for this new structure is to provide basic and accessible care.

• Care that is closer to home and familiar environments
• Safeguard against abuse and neglect
• Support care in familiar settings, including private space and personal belongings
• Offers a choice in daily activities, care and living arrangements
• Maintains inclusion and agency, relationships and jobs
• Better mental and physical health outcomes
• Reduces exclusion and stigma while promoting acceptance and help-seeking
• Opportunity for better skill development and enhanced therapeutic relationships

Need for collaborative efforts

While the responsibility for prevention does fall on hospital leaders and management, a meaningful shift requires senior policy-and-decision-makers with authority to oversee these changes. The guide aims to reach such officials, including health system planners, national and sub-national mental health program managers who will create the conditions that initiate changes at a hospital level. The guidelines also target community partners who work closely with hospital management to help create such an ecosystem and ensure continuity and accountability. Deinstutionalization will require coordinated efforts across many sectors and transparency and dignity in the work done.

Conclusion

In countries like India, where stigma still exists around mental healthcare, such a move could take a long time and will require honest and strict implementation and supervision. Mental healthcare facilities in India often neglect their residents, leaving them to live in horrific conditions. A recent visit by the High Court of Kerala to its three Mental Health Centres found shocking truths.

This urged the Kerala HC to seek immediate answers from those responsible, as well as issue a directive to implement immediate solutions to better it. Several other states still operate mental healthcare and psychiatric facilities with no transparency whatsoever. Hopefully, the WHO guidelines encourage the country to shift towards community care and ensure a better chance at healing and support for those who cannot ask for it themselves.