WHO Calls for Community Based Mental Health Services to Replace Long-Term Institutional Care

GENEVA, Oct 9: The World Health Organization (WHO) has called on countries to accelerate the transition from long-term psychiatric institutional care to community based mental health services, emphasising that people living with mental health conditions should be able to receive appropriate treatment without losing their independence, dignity or connection with society.

In guidance released ahead of World Mental Health Day, observed on October 10, the global health agency outlined practical measures to help governments and psychiatric hospitals develop more accessible, person-centred systems. The recommendations focus on reducing unnecessarily prolonged hospital stays, protecting patients’ rights and providing the support required for people to return to community life.

The WHO said many people with mental health conditions continue to live in large psychiatric hospitals and social care institutions for extended periods. Nearly half of those living in such facilities are held involuntarily for months, years or even decades, according to the agency.

The organisation said this model can isolate individuals from their families, communities and opportunities to participate in everyday life. It called for a fundamental change in how mental health services are organised, financed and delivered.

WHO highlights need for a different care model

The new guidance focuses on deinstitutionalisation, a process that helps people who have spent extended periods in psychiatric hospitals move into community settings with appropriate medical, social and practical support.

Rather than treating discharge from a hospital as the final objective, the WHO recommends creating a complete support system that enables individuals to live safely and independently. This includes access to continuing healthcare, suitable accommodation, social assistance, education and employment opportunities.

WHO Director-General Tedros Adhanom Ghebreyesus said people should not have to sacrifice their freedom, dignity or place in their communities to obtain continuing mental health support.

He urged governments to move away from excessive reliance on long-term institutional arrangements and redirect investment towards community services that respect individual rights.

The approach does not mean eliminating necessary hospital treatment or denying care to people experiencing severe mental health crises. Instead, it seeks to ensure that hospital admission and residential care are appropriate to individual needs, while preventing people from remaining in institutions simply because alternative services are unavailable.

Community-based care can include outpatient psychiatric treatment, psychological counselling, rehabilitation, crisis intervention, supported accommodation and assistance from trained community health workers. The precise combination depends on a person’s condition, circumstances and preferences.

Global progress remains uneven

The WHO’s Mental Health Atlas has identified substantial gaps in the transition towards community-based care. According to figures cited in its October 9 announcement, only 9 per cent of reporting countries had fully shifted to community-based mental health services, while 53 per cent remained at an early stage of reform.

The agency also reported that more than one in four people admitted to psychiatric hospitals stayed for longer than six months.

These findings underline the difficulty of changing established healthcare systems. Moving away from institutional care requires more than revising hospital policies or reducing the number of beds. Governments must establish reliable alternatives so that patients do not lose access to treatment when they leave residential facilities.

Without sufficient community services, premature discharge can expose people to homelessness, interrupted medication, social isolation and repeated hospital admissions. The WHO’s recommendations therefore place equal importance on reducing unnecessary institutional stays and ensuring that patients have the resources to maintain their health outside hospital settings.

For countries with limited mental health funding, the transition may require changes in workforce planning, healthcare budgets and the distribution of services between urban centres and rural communities.

Housing and employment form part of recovery

The WHO emphasised that psychiatric hospitals cannot accomplish deinstitutionalisation on their own. Successful community living depends on coordinated support from health services, housing providers, social welfare agencies, educational institutions and employers.

Suitable accommodation is particularly important for people who have spent years in institutional settings and may no longer have a stable family home. Supported housing arrangements can provide a secure environment while allowing residents to develop independence and participate in community life.

Employment and education opportunities can also help people rebuild confidence, establish social relationships and achieve financial independence. However, these opportunities are difficult to access when individuals face discrimination, inadequate support or gaps in rehabilitation services.

Family members may require guidance and assistance as well. Caring for someone with a long-term mental health condition can create emotional, financial and practical pressures, especially when professional services are limited.

The WHO’s approach therefore recognises recovery as a broader process that extends beyond clinical treatment. Medication, therapy and psychiatric assessment remain important where appropriate, but social inclusion and the ability to make personal choices are also central to well-being.

Patients must participate in decisions

Another major element of the guidance is the involvement of people with direct experience of psychiatric institutional care in designing and evaluating mental health services.

The WHO said individuals who have experienced institutional treatment are often excluded from decisions about policies and systems that directly affect their lives. Their experiences can help identify barriers to recovery, problems in service delivery and the types of support needed to return to community living.

The agency stressed that these individuals should be active partners in reform rather than passive recipients of decisions made by healthcare authorities.

Consulting people with lived experience can help governments develop services that reflect actual needs, including accessible information, respectful treatment, privacy protections and meaningful participation in decisions about care.

It can also help address the stigma associated with mental illness. People who have experienced prolonged institutional care may face difficulties finding accommodation, returning to work or rebuilding relationships after discharge.

A rights-based model requires healthcare professionals and policymakers to recognise patients as individuals with preferences, abilities and aspirations, rather than defining them solely by their diagnoses.

Hospitals encouraged to review existing practices

The new WHO guide provides practical recommendations for psychiatric hospital leaders. These include reducing unnecessary admissions and prolonged stays, reviewing institutional practices that may restrict individual freedoms, and establishing arrangements that support patients’ transition back into their communities.

Hospitals will need to work closely with community mental health teams and social services to assess each person’s requirements before discharge. Continuity of care is essential to avoid interruptions in treatment and ensure that patients can seek assistance if their condition worsens.

Training healthcare workers is another important consideration. Staff must be equipped to deliver person-centred care, recognise individual rights and coordinate treatment with community providers.

Governments will also need systems to monitor outcomes, including whether patients can maintain stable housing, access treatment, participate in education or employment, and receive timely assistance during crises.

The WHO said its guidance was developed with contributions from international experts and people with lived experience, allowing its recommendations to be adapted to different national circumstances.

World Mental Health Day brings renewed attention

The WHO’s announcement coincides with World Mental Health Day 2026, whose theme is “Lived experiences heard: real voices, real change.”

The theme highlights the importance of listening to people who have experienced mental health conditions and ensuring that their perspectives influence services, policies and decisions.

The global discussion comes amid continuing challenges in providing accessible mental healthcare, reducing discrimination and ensuring that people can obtain treatment without facing unnecessary barriers.

Expanding community-based services requires sustained political commitment, adequate funding and cooperation between healthcare systems and other public services. Governments must also ensure that reform does not leave people without essential treatment during the transition away from institutional care.

The WHO’s message is that mental healthcare should support both clinical recovery and participation in society. By investing in accessible local services, protecting individual rights and involving patients in decision-making, countries can work towards systems that provide effective treatment while preserving personal dignity and independence.