title: Reorganization of mental health services: from institutional to community-based models of care.
abstract: Mental health services in the Eastern Mediterranean Region are predominantly centralized and institutionalized, relying on scarce specialist manpower. This creates a major treatment gap for patients with common and disabling mental disorders and places an unnecessary burden on the individual, their family and society. Six steps for reorganization of mental health services in the Region can be outlined: (1) integrate delivery of interventions for priority mental disorders into primary health care and existing priority programmes; (2) systematically strengthen the capacity of non-specialized health personnel for providing mental health care; (3) scale up community-based services (community outreach teams for defined catchment, supported residential facilities, supported employment and family support); (4) establish mental health services in general hospitals for outpatient and acute inpatient care; (5) progressively reduce the number of long-stay beds in mental hospitals through restricting new admissions; and (6) provide transitional/bridge funding over a period of time to scale up community-based services and downsize mental institutions in parallel.
authors.affiliation: Faculdade de Ciências Médicas, UniversidadeNova de Lisboa, Lisbon, Portugal.
authors.forename: B
authors.initials: B
authors.lastname: Saraceno
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, and Lancashire Care NHS Foundation Trust, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Gater
authors.affiliation: Department of Psychological Sciences, University of Liverpool; Child Mental Health Unit, Royal Liverpool Children's Hospital, Liverpool, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Rahman
authors.affiliation: Mental Health and Substance Abuse Department, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt.
authors.forename: K
authors.initials: K
authors.lastname: Saeed
authors.affiliation: CBM International, West Africa Regional Office, Lomé, Togo.
authors.forename: J
authors.initials: J
authors.lastname: Eaton
authors.affiliation: World Federation for Mental Health, London, United Kingdom.
authors.forename: G
authors.initials: G
authors.lastname: Ivbijaro
authors.affiliation: World Organization of Family Doctors, Sydney; Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Kidd
authors.affiliation: Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Dowrick
authors.affiliation: Research Action on Mental and Brain Disorders, World Health Organization Headquarters, Geneva, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Servili
authors.affiliation: Mental Health and Substance Abuse Department, World Health Organization Headquarters, Geneva, Switzerland.
authors.forename: M K
authors.initials: MK
authors.lastname: Funk
authors.affiliation: Basic Needs, Leamington Spa, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Underhill
mesh_terms: D057191:Capacity Building; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D006291:Health Policy; D006292:Health Priorities; D006778:Hospitals, Psychiatric / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D019083:Mediterranean Region; D008605:Mental Health Services / Q000191:economics / Q000458:organization & administration*; D009937:Organizational Objectives; D016730:Program Development; D058996:Quality Improvement; D014944:World Health Organization