There was a time when people experiencing mental health conditions were often misunderstood and labelled “insane”. Rather than being recognised as people who needed care and support, many were shut away in psychiatric institutions. Some were even chained or physically restrained, as though keeping them away from society was the answer to their condition.
Our understanding of mental health has evolved considerably, but questions about how people with mental health conditions are treated remain. Across the world, some still spend months or years in psychiatric hospitals, sometimes against their will.
The World Health Organization (WHO) wants countries to address this. In its guide on mental health services, the organisation called for a move away from long-term institutional care towards mental health services that allow people to receive the support they need while living in their communities.
What does community-based mental healthcare mean?
Community-based care allows people to receive mental health support while living in their homes or other community settings, rather than staying in psychiatric hospitals for long periods. This could include regular appointments with mental health professionals, access to medication, support groups and help with everyday activities.
For example, someone who has received treatment in a psychiatric hospital may be ready to return home but still need regular support. Community-based services can help them continue their treatment and manage daily life without remaining in the hospital.
This approach is part of what WHO calls deinstitutionalisation. It involves helping people who have spent six months or longer in psychiatric hospitals return to community life with the support they need. It also means reducing unnecessary hospital admissions and long stays.
However, this does not mean that all psychiatric hospitals should close or that hospital treatment should end. People experiencing severe mental health difficulties may still need inpatient care. The concern is about keeping people in institutions longer than necessary when they could receive appropriate support elsewhere.
Why is WHO concerned?
Spending a long time away from family, friends and familiar surroundings can affect a person’s independence and quality of life.
People living in institutions may also have limited control over their daily activities and decisions about their treatment. WHO wants mental healthcare systems to respect people’s rights.
The organisation also points to the slow progress many countries have made in changing how mental healthcare is provided. In some places, long-term hospital care is still the main option for people with serious mental health conditions, and community-based services remain limited or hard to reach. As a result, people who could be supported at home sometimes stay in hospital simply because there is nowhere else for them to get the help they need.
What needs to change?
Moving people out of psychiatric hospitals is only one part of the process. They still need somewhere safe to live and access to healthcare professionals who can help them continue their treatment.
Returning home after several years in a psychiatric hospital can bring its own challenges. A person may have to adjust to everyday responsibilities and find ways to reconnect with the community. Access to continued treatment and support is essential during this period. Without it, returning home may not be sustainable, and another hospital admission could become necessary.
This is why community-based mental healthcare needs to go beyond opening clinics or making appointments available. People also need access to housing, social support and opportunities to return to school or work. These things can make a real difference to how well someone settles back into everyday life.
Families also need support. Caring for someone who has spent a long time in hospital can be overwhelming, especially if relatives are unsure how to help or where to turn for professional care. They should not be left to manage everything on their own.
WHO’s guide encourages countries to make these services available and involve people with lived experience in decisions about their care. Their experiences can help shape services that respond to what people actually need.
Recovery does not have to mean being away from home. With the right support in place, many people can rebuild their lives within their communities, and families and neighbours have a part to play in making that possible.
