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The European Social Network (ESN) actively contributed to a capacity-building workshop in Budapest, Hungary on 21-24 September of the EU-funded Joint Action on Mental Health and Wellbeing. This workshop was organised by Working Package 5 on Community-based approaches, which focuses on the development of community based services for people with mental health problems.

The workshop addressed a wide range of topics, including the development of mental health policies and plans, the integration of mental health into primary care, and the transition to community-based mental health services. The purpose was to identify areas for policy and practice transfer to the Hungarian context.

ESN has been working for a number of years on the development of community care. Part of that work was a training series for civil servants from the Viségrad countries (Czech Republic, Hungary, Poland, and Slovakia) on Developing Community Care. This training, carried out by ESN between 2011 and 2012, was designed to equip the public sector with the skills and knowledge to initiate and manage changes resulting from deinstitutionalisation. A former participant, Juraj Marendiak from the Public Care Services department of the Bratislava Self-Governing Region, Slovakia, pointed out the fact that mental health services can only be truly community-based if they are separated from clinical environments.

Integration of mental health services into primary care

Attention was given to the link between primary care and mental health services. An example is the training of General Practitioners (GP) to carry out diagnoses of mental health problems and detect signs early.

Terry Madden, an independent consultant working for Dublin City Council (Ireland), gave the Irish perspective on the admissions pathway for people with acute mental health problems who would still be treated in a hospital rather than by their GP. Bringing mental health into GP practices is seen as a step in the right direction. However, in order to make primary care integration more holistic, social workers would need to be actively involved, ideally those with specific mental health qualifications.

Transition to community-based mental health services

Hellen Killaspy, Professor at University College London, gave an overview on the development of community-based mental health services since the 1950s and focused on the outreach role of multidisciplinary teams in England. Furthermore, she analysed how political commitment can generate considerable momentum in rendering mental health services more effective.

ESN Policy Director Alfonso Montero outlined the key elements to make the shift from institutional care to community based care a reality: planning, assessment, choice and quality while the objective must be to ensure people’s social inclusion. He also highlighted the potential of evidence-based methods and called for more social innovation in mental health services. As an example of social innovation, he raised awareness about the importance of research and data on the economics of mental health, notably acknowledging the cost-effectiveness of local mental health services.

Conclusion

The rich discussions outlined the variety of relevant dimensions in the development of community-based mental health services, and cast a spotlight on the different stages of deinstitutionalisation both across and within European countries. Also, the data collection within Working Package 5 revealed that re-institutionalisation developments can challenge the transition. As an overarching element, it was found that the shift in actual policy and services is still lagging behind verbal commitments at political level. The European Social Network (ESN) will continue to support the transition towards community-based services, as it is convinced that it will improve the quality of services and result in a better quality of life for users.