International Trends in Community Mental Health Services

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Textbook of Community Psychiatry: American Association for Community Psychiatry, Second Edition


This chapter will provide summaries of the state of community mental health in some countries around the world, allowing readers to compare and contrast the nature of services and to further understand the successes and challenges of innovative programing. While certainly not exhaustive, we will describe examples from countries of which we have the most firsthand knowledge and focus on some leading-edge innovations and system reforms. There are consistent themes across these nations: (1) movement away from institutional hospital-centricity; (2) provision of mental health services in the community; (3) provision of supported housing and purposeful and productive activity (e.g., work); (4) emphasis on human rights and facilitating least restrictive care; (5) committed leadership for stigma reduction and advocacy; (6) expansion of the mental health workforce, including peer workers, supporting integrated teamwork; (7) holistic and comprehensive assessment, addressing social determinants; and (8) provision of trauma-informed, recovery-oriented treatment across the life span. Future directions of international of international community psychiatry and mental health services should entail more: completion of de-institutionalization; inclusive interdisciplinary teamwork; voluntary and collaborative care with more individual choice and control; consultation with families; culturally respectful global mental health approaches integrated with primary health care, and optimal balance between face-to-face or home delivery care and telehelath or digitally augmented care.

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