Transition of Mental Health Services from Institutional to Community-Based Care Abroad and Its Context for Slovenia—Advantages and Risks

TL;DR

This paper reviews the shift from institutional to community-based mental health care abroad and its implications for Slovenia, highlighting both benefits and risks.

Contribution

The study integrates international literature and Slovenian mental health policies to evaluate deinstitutionalization's context and consequences.

Findings

Community-based care improves quality and outcomes for mental health patients.

Institutional care remains necessary in some cases for safety and treatment during disorder exacerbations.

Deinstitutionalization can lead to unintended consequences like the revolving door phenomenon.

Abstract

Deinstitutionalization is a transition from psychiatric hospitals and other mental health institutions as the primary setting for treatment of individuals with chronic mental health disorders to a range of services, including psychiatric care, that support independent functioning of an individual within the community. The transition has been encouraged by guidelines from the European Expert Group and further specified in the Slovenian Resolution on the National Programme of Mental Health 2018–2028. This integrated systematic and narrative literature review includes 47 international articles from PubMed, along with information on Slovenian mental health legislation and its implementation, to provide insights into deinstitutionalization abroad and its relevance for Slovenia. Although the transition to community-based care is welcomed for promoting independence and respecting individuals’ wants, there are cases where institutional care remains necessary to ensure safety and treatment during the exacerbation of chronic mental health disorders. The quality of care and outcomes generally improve with community-based care. However, the closure of institutions can lead to many unintended consequences, such as the revolving door phenomenon and transinstitutionalization. Both the advantages of community-based care and the important roles of mental health hospitals and other institutions are emphasized.

Figures