2008 issue 4


Volume 17, issue 4

World Psychiatry Forum

Steps, challenges and lessons in developing community mental health care

Graham Thornicroft1, Michele Tansella2, Ann Law1
1. Health Service and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK
2. Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
Postępy Psychiatrii i Neurologii 2008; 17 (4): 273-279
Keywords: community care, community mental health services, psychiatric services


This paper summarises our own accumulated experience from developing community-orientated mental health services in England and Italy over the last 20-30 years. From this we have provisionally concluded that the following issues are central to the development of balanced mental health services: (a) services need to reflect the priorities of service users and carers; (b) evidence supports the need for both hospital and community services; (c) services need to be provided close to home; (d) some services need to be mobile rather than static; (e) interventions need to address both symptoms and disabilities; and (f) treatment has to be specific to individual needs. In this paper we consider ten key challenges that often face those trying to develop community-based mental health services: a) dealing with anxiety and uncertainty; (b) compensating for a possible lack of structure in community services; (c) learning how to initiate new developments; (d) managing opposition to change within the mental health system; e) responding to opposition from neighbours; (f) negotiating financial obstacles; (g) avoiding system rigidities; (h) bridging boundaries and barriers; i) maintaining staff morale; and (j) creating locally relevant ser-vices rather than seeking „the right answer" from elsewhere.