Developing Community Care

One in four people will experience some form of mental health problems in their lifetime. Even though these conditions are widespread, people suffering from them remain faced with stigma and social exclusion. Often, the only services available to them are in big residential facilities.

Deinstitutionalisation and the development of community based services for people with mental health problems was the theme of the third meeting of the Developing Community Care policy & practice group. Invited by the Veneto Region, a member of ESN, the group met in Venice on 25-26 March to discuss the progress made in closing down psychiatric hospitals and assess the challenges stemming from it. The Veneto, a leading region in this process, organised a visit to community and semi-residential services in Treviso, where group members engaged in discussions with local social and mental health directors while visiting the facilities.

While Italy is one of the countries that has successfully closed down its psychiatric hospitals, Bruno Forti is left unconvinced with its results: “Indeed”, he says, “we do now have these services in place, but how much are we really engaging with the community?” He explains that the fear and stigma forever present in the community still constitute an obstacle for people with mental health problems to be fully accepted and respected. “It is the same in Sweden”, agrees Mikael Johannson, “whereas people with learning disabilities are now welcomed by the locals, mentally ill people are still kept at a slight distance.”

The integration of mentally ill people in the ex-Communist societies is even more difficult. For several decades they were ‘invisible’, hidden away from the population in far away institutions, often in castles or country manors in the aftermath of World War II. The closure of these establishments is further complicated by the general lack of funding and unclear legal status of the buildings.

The accessibility of community care, as well as its sustainability and the challenges it poses to local planners were further issues highlighted in the group’s discussions. On this subject, Guido Verschaeren revealed how Flemish social welfare centres, in cooperation with service users, are constantly improving accessibility on various levels. The group agreed that community care must start from basic and generic services - delivered in the nearby popular places such as cafes or sport centres - while also offering specialised services for more serious interventions.

Aleksandra Čalošević from Serbia brought up the question of how local social planning could be used to promote sustainable and inclusive community based services. She raised the issue of the lack of reliable data and ‘quick fix’ budget cuts which in long-term may affect the lives of those most vulnerable in the community. Aleksandraalso brought attention to EU structural funds for Central Eastern Europe as a means to finance the initial phase of developing community based services. Unfortunately, some national governments are not always committed to securing these funds for community care and allocate the use of funds for (re-)construction of large residential institutions. Zsolt Bugarszki, a co-author of the recent report on the use of EU funds in social care in Hungary, objects to this practice: “It is simply unacceptable to use EU money to perpetuate social exclusion of vulnerable people."