Community Mental Health Services

Community mental health services deliver assessment, treatment, support, and rehabilitation to people with mental illness in local, non-hospital settings — homes, clinics, day centres, and community teams — rather than in long-stay institutions. They are the organisational backbone of contemporary mental health care and a primary setting for mental health nursing practice.

Definition

Community mental health services are mental health diagnostic, treatment, and rehabilitative services provided to people living in the community, organised to deliver accessible, continuous, and locally based care as an alternative or complement to institutional care.

Scope

This entry covers the rationale for community-based mental health care, common service models such as community mental health teams and assertive community treatment, the balanced care model that integrates community and hospital components, and the global treatment gap. It is a reference overview of how services are organised, not guidance on individual service planning or treatment.

Core questions

• What service models deliver mental health care in the community?
• How does the balanced care model combine community and hospital components?
• What is assertive community treatment and whom is it intended to serve?
• Why does a large mental health treatment gap persist worldwide?

Key concepts

• Deinstitutionalisation
• Community mental health team
• Assertive community treatment (ACT)
• Balanced care model
• Continuity of care
• Treatment gap
• Task-sharing in low-resource settings

Key theories

Balanced care model

Thornicroft and colleagues describe a balanced care model in which community-based services are the core of provision, supplemented by hospital care for those who need it, with the mix calibrated to a setting's resources; this frames the international move away from purely institutional care.

Mechanisms

Community services are typically organised as multidisciplinary teams that provide care close to where people live, aiming for accessibility, continuity, and integration with primary care and social services. Assertive community treatment offers intensive, team-based, assertive outreach for people with severe mental illness and high needs; a Cochrane review found it can reduce hospital admission and improve engagement compared with standard care for this group (Marshall 2000). The balanced care model frames how community and hospital components are combined according to available resources (Thornicroft 2016).

Clinical relevance

Community mental health services are a central setting in which mental health nurses assess, support, and coordinate care for people living with mental illness. This entry describes how such services are configured at a system level and does not direct the care of any individual.

Epidemiology

A substantial proportion of people with mental disorders receive no treatment, a gap that is largest in low- and middle-income countries where specialist resources are scarce and barriers to service development are considerable (Saraceno 2007; Patel 2018). Strengthening community-based care and task-sharing with non-specialist workers are widely proposed responses.

Evidence & guidelines

International policy favours balanced, community-based mental health systems (Thornicroft 2016). Systematic review evidence supports assertive community treatment for reducing admissions among people with severe mental illness and high service use (Marshall 2000), and global mental health analyses set out priorities for scaling up community care, especially in lower-resource settings (Saraceno 2007; Patel 2018).

History

From the mid-twentieth century, deinstitutionalisation in many high-income countries shifted care from large psychiatric hospitals to community settings, prompting the development of community mental health teams and models such as assertive community treatment. More recently, the global mental health movement has extended attention to the treatment gap and to building community-based services in low- and middle-income countries.

Debates

Adequacy of community provision after deinstitutionalisation

Where hospital closures outpaced investment in community services, concerns arose about unmet need; debate continues over the right balance of community and hospital components and the resourcing required to make community care effective.

Key figures

• Graham Thornicroft
• Michele Tansella
• Benedetto Saraceno
• Vikram Patel

Seminal works

• thornicroft-2016-cmhc
• marshall-2000
• patel-2018

Frequently asked questions

What is assertive community treatment?

Assertive community treatment is an intensive, multidisciplinary, team-based model that provides assertive outreach and continuous support to people with severe mental illness and high needs; systematic review evidence suggests it can reduce hospital admissions and improve engagement for this group.

What is the mental health treatment gap?

It refers to the difference between the number of people who have a mental disorder and the number who actually receive care; this gap is large worldwide and widest in low- and middle-income countries.