Shifting towards community-oriented mental health care in Belgium
- High burden of disease from mental health conditions.
- Heavy reliance on institutionalization in mental health care provision.
- Limited availability of community mental health services.
- Changes to legislation, policy and care guidelines at the national level guided mental health reform and government funding was made available to promote the implementation of local community mental health projects aligned with the new national vision for mental health.
- Top-down support for bottom-up ideas ensured both the necessary resources and local ownership needed to optimize mental health reform.
- A supportive legislative framework helped solidify a common vision for mental health reform, providing a unified focus for local efforts to align with.
- Space for experimentation in the delivery of mental health care was allowed for, motivating locally-adapted projects and sparking grassroots innovation.
- Increasing the provision of community- and home-based care supported greater consideration of patients’ environments.
Mental health conditions contributed significantly to the burden of disease in Belgium, with one in four people affected during their lifetime. However, patients’ health outcomes and quality of life were negatively impacted by a heavy focus on institutionalized care, evidenced by the high ratio of psychiatric beds per capita, and lack of community-based care alternatives.
A European-wide focus on mental health in the late 2000s pushed mental health up the government agenda in Belgium and a national shift towards community-based mental health care was encouraged through new legislation, care guidelines and financing channels. To further incentivize the adoption of community-based approaches and stimulate local innovation in mental health care, the government issued an open call in 2010 to fund pilot community mental health projects. One example of a project awarded funding by the government was the proposal by the North West Flanders Mental Health Care Network to establish mobile community mental health teams. Mobile teams set up under this initiative are multidisciplinary and consist of a psychiatrist, psychologist and psychiatric nurse. Services offered by the mobile teams aim to holistically treat patients, with teams working to develop personalized care plans, connect with other providers and involve patients’ informal networks. Patients are also empowered to actively participate in their care and patient forums and local support groups have been established. While there were some initial concerns among mental health providers in North West Flanders about their future in a more community-oriented care model, these concerns were eased by project leaders taking the time to explain that the initiative aimed to redefine, but not eliminate, mental health providers’ roles. A uniting focus for providers was their recognition that “it is sometimes better to keep people in their home”. As of June 2012, experimental projects designed to improve the delivery of mental health services, such as the North West Flanders initiative, had been implemented across approximately three quarters of Belgium. Government officials continue to monitor these local initiatives and collect information on the performance and spending of funded projects. Regular monitoring helps confirm responsible use of government funds and continued implementation of projects according to the initial proposals put forward.
The government played a key role in encouraging the shift towards greater provision of community mental health care by issuing an open funding call to stimulate local project proposals, setting clear guidelines to steer the direction of activities and performing ongoing monitoring to ensure accountability. Within this context, a variety of local actors have come together to work on building community mental health. In the example of North West Flanders, two local psychiatric hospitals teamed up with other local mental health care organizations and primary care services to introduce mobile community mental health teams. A multidisciplinary steering committee for the North West Flanders Mental Health Network oversees the project and a project coordinator facilitates activities.
A national-level evaluation of government-funded projects is currently being led by Belgian universities. Government officials continue to monitor the progress of funded projects in order to determine the future for these initiatives.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
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Network Coordinator GGZ Region Nord-West Vlaanderen