The Case for Shifting Mental Health Care From Institutions to Communities

In recent decades, many countries have made meaningful progress in developing community-based mental health services. Moreover, rights-based approaches have gained traction as people with lived experience increasingly have a voice in shaping mental health policy and services. These developments have shown that people living with mental health conditions can flourish in their communities when given the right support. Yet, around the world, very large numbers of people with mental health conditions live behind closed doors in psychiatric hospitals and social care institutions. Some have been there for months; others for decades. According to the World Health Organization’s Mental Health Atlas, about half were brought in against their will, stripped of basic daily choices like what to wear or when to eat, and cut off from the outside world. We think of institutional mental health care as an outdated model. But it is far more than that. It is a human rights issue hiding in plain sight. Many countries still rely heavily on standalone psychiatric institutions. Across the world, we estimate that nearly half of all public mental health funding is spent on maintaining these large facilities...