Dr. Gordon Shen, professor at CUNY Graduate School of Public Health and Health Policy, along with colleagues recently completed a study examining the deinstitutionalization of mental health care. Their findings were published in the journal Health Systems & Reform.
Global consensus and national policies have emphasized deinstitutionalization, or a shift in providing mental health care from institutional to community settings. Yet, psychiatric hospitals and asylums receive the majority of mental health funding in many countries, at odds with research evidence that suggests that services should be delivered in the community.
In this study, the researchers aimed to investigate the norms, actors, and strategies that influence the uptake of deinstitutionalization internationally. The study is informed by prior literature on management and implementation science. The success and failure of mental health care operations depend on identifying and overcoming challenges related to implementing innovations within national contexts. “Our paper is at the nexus of three subfields of public health: mental health, health care management, and implementation science,” explains Dr. Shen.
The researchers surveyed 78 experts spanning 42 countries on their knowledge and experiences in expanding community-based mental health care and/or downsizing institution-based care. The experts were asked about the contexts in which said methods were implemented in a country.
The findings showed that mental health care, whether it is provided in institutions or in the community, does not seem to be standardized across countries. Analysis also showed that moving deinstitutionalization forward requires meaningful engagement of three types of actors: government officials, health care professionals, and local experts. Progress toward deinstitutionalization depends on the partnerships formed among these actors and with diverse stakeholders, which have the potential to garner resources and to scale-up pilot projects.
Discussing the results of the study, Dr. Shen explains, “Our findings provide a comprehensive understanding of the state of deinstitutionalization across 42 low and middle income countries. More specifically, the 78 experts we surveyed pointed us to three key themes: disagreements about the means to deinstitutionalization; engagement of three sets of actors; and partnership.”
In conclusion, different countries have adapted deinstitutionalization in ways to meet idiosyncratic situations and population needs. More attention should be given to the management and implementation strategies that are used to augment treatment and preventive services.