Reorganization of mental health services: from institutional to community-based models of care

Mental health services in the Eastern Mediterranean Region are predominantly centralized and institutionalized, relying on scarce specialist manpower. This creates a major treatment gap for patients with common and disabling mental disorders and places an unnecessary burden on the individual, their family and society. Six steps for reorganization of mental health services in the Region can be outlined: [1] integrate delivery of interventions for priority mental disorders into primary health care and existing priority programmes; [2] systematically strengthen the capacity of non-specialized health personnel for providing mental health care; [3] scale up community-based services [community outreach teams for defined catchment, supported residential facilities, supported employment and family support]; [4] establish mental health services in general hospitals for outpatient and acute inpatient care; [5] progressively reduce the number of long-stay beds in mental hospitals through restricting new admissions; and [6] provide transitional/bridge funding over a period of time to scale up community-based services and downsize mental institutions in parallel

Mental health surveillance and information systems

Routine information systems for mental health in many Eastern Mediterranean Region countries are rudimentary or absent, making it difficult to understand the needs of local populations and to plan accordingly. Key components for mental health surveillance and information systems are: national commitment and leadership to ensure that relevant high quality information is collected and reported; a minimum data set of key mental health indicators; intersectoral collaboration with appropriate data sharing; routine data collection supplemented with periodic surveys; quality control and confidentiality; and technology and skills to support data collection, sharing and dissemination. Priority strategic interventions include: [1] periodically assessing and reporting the mental health resources and capacities available using standardized methodologies; [2] routine collection of information and reporting on service availability, coverage and continuity, for priority mental disorders disaggregated by age, sex and diagnosis; and [3] mandatory recording and reporting of suicides at the national level [using relevant ICD codes]