In recent decades, many countries have made meaningful progress in developing community-based mental health services.
asserted
countries → make → services
Moreover, rights-based approaches have gained traction as people with lived experience increasingly have a voice in shaping mental health policy and services.
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people → base → policy
These developments have shown that people living with mental health conditions can flourish in their communities when given the right support.
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people → show → support
Yet, around the world, very large numbers of people with mental health conditions live behind closed doors in psychiatric hospitals and social care institutions.
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numbers → live → hospitals
According to the World Health Organization’s Mental Health Atlas, about half were brought in against their will, stripped of basic daily choices like what to wear or when to eat, and cut off from the outside world.
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half → accord → world
We think of institutional mental health care as an outdated model.
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We → think → model
It is a human rights issue hiding in plain sight.
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It → hide → sight
Many countries still rely heavily on standalone psychiatric institutions.
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countries → rely → institutions
Across the world, we estimate that nearly half of all public mental health funding is spent on maintaining these large facilities, while access to community-based mental health care, including in general hospitals, for millions of people remains underfunded and overlooked.
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access → estimate → people
Sri Lanka embraced mental healthcare reform by replacing isolated institutions with community-based services.
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Lanka → embrace → services
Guided by the country’s mental health policies over the past 20 years, Sri Lanka has made significant progress in transforming the mental health system from an asylum-based model to a decentralized network of district and community services.
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Lanka → guide → services
Today, mental health care in Sri Lanka is delivered through inpatient and outpatient units in general hospitals, outreach clinics, intermediate rehabilitation units, and child mental health clinics throughout the country.
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care → deliver → country
Facilities that uphold human rights, dignity, and personal autonomy promote recovery.
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that → uphold → recovery
However, when care is characterized by coercion, rigid control, or social isolation, it risks becoming a form of confinement rather than care.
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it → characterize → care
Deinstitutionalization is not simply about reducing hospital beds.
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Deinstitutionalization → reduce → beds
It is about creating the conditions for people to live independently and participate fully in society, with access to appropriate housing, education, employment, social protection, and person-centered mental and physical health care.
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people → create → housing
This is the foundation of recovery, inclusion and human rights-based mental health care.
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This → base → recovery
Scaling back psychiatric hospital beds must go hand in hand with building up local services and practical supports—housing, community mental health care, peer support, social connection, education and employment, legal support, and support for families.
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Scaling → scale → families
No one should be discharged without continuity of care.
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one → discharge → care
People should be welcomed into services and communities that are ready for them.
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that → welcome → them
Countries worldwide are proving that advancing deinstitutionalization is achievable across all income levels, from changing care practices and expanding alternatives to psychiatric hospitals to establishing comprehensive networks of community-based services.
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advancing → prove → services
Deinstitutionalization is a cultural shift that requires the meaningful involvement of people with lived experience, health service providers, and the whole of society.
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that → require → society
To support this transition, the World Health Organization has released new, practical guidance to help health leaders navigate each step.
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leaders → support → step
Every country begins from a different position, with different resources, laws, service systems and community networks.
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country → begin → resources
Implementers need to identify feasible, high-impact actions that are appropriate to their own context.
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that → need → context
We must ensure that people receive the support they need in environments that promote dignity, autonomy, relationships and inclusion.
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that → ensure → dignity
We call on governments, health and social care systems to make this a priority, with people with lived experience as partners throughout the transition.
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this → call → transition
The Aporia
