International trends in community-oriented mental health services
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Four national accounts of community-oriented mental health reforms and services are presented as national case studies. These include community crisis and early intervention services, community residential respite and rehabilitation/recovery services, interventions for prevention of suicide and deliberate self-harm, community care management and assertive community care services, community-based day programs, and vocational services. We also review government policy impacting CMHSs and reform of mental health services. There is widespread and increasingly consistent international recognition that: institutional hospitalization does not offer adequate therapeutic support or care; there is a widespread movement toward provision of mental health services in the community; innovation in community care is progressing and becoming increasingly evidence based, including day and night home based care, supported community housing, social inclusion and access to meaningful activity, especially paid work. This shift requires strong support via legislative reform upholding human rights and enabling more community living; committed leadership, adequate funding, and stigma reduction; and the replenishment and retooling the mental health workforce and enhancing its skill set. This should include training and supervision in evidence-based interventions, and a culture of active-response, interdisciplinary teamwork with peer workers, while encouraging recovery-oriented and trauma-informed treatment and care.