Highlights from the Thematic workshop for sustainability and health policy and legislation: community mental health care

Recap of the Thematic workshop for sustainability and health policy and legislation: community mental health care

The first thematic workshop for sustainability, intended for countries implementing the Belgian Mental Health Reform, the MSPC members, and the Stakeholder Forum, was held in Utrecht, Netherlands, last week. The meeting, organized with colleagues from WHO Europe, consisted of a two-day hybrid workshop, with almost a total of 100 people attending onsite and online.

Day 1 highlights

We kicked off the workshop by discussing together with our guest speakers Bernard Jacob and José Miguel Caldas de Almeida (both part of the work package 5 advisory group) how we can conceptualise sustainability for community mental health. What should it entail? What can we learn about it from past experiences? Bernard Jacob touched upon establishing intersectoral collaboration with e.g. justice and education, innovative funding models that fund networks rather than services and, international collaboration being essential for sustaining community mental health care systems. José Miguel Caldas de Almeida further enriched this by going into the facilitators and barriers of sustaining a community mental health reform. Recommendations include among others: building consensus among stakeholders, supporting user and family participation, research capacity for evidence-based reform, leadership skills at various levels, and capacity-building extends to ministries of health for effective policy implementation. Using these insights together with all participants we tried to detangle what in the JA ImpleMENTAL project sustainability of implementing the Belgian Mental Health Reform can entail:

Financial and Structural Sustainability:
• Cost-effectiveness monitoring, including indirect costs and costs of isolation and neglect.
• Implementation phase sustainability with constant funding.
• Continuous improvement through regular evaluation, research, and collaboration with policymakers.
Collaborative and Integrated Services:
• Complimentary models of service instead of working in isolation, fostering innovation.
• Professionals working as a team, learning from each other
• Good management and leadership, fostering an equitable healthcare system.
User-Centered and Accessible Care:
• User-friendly services, incorporating climate psychology.
• Ensuring accessibility, stability, and funding, with a functional consensus between mental health services servers and users.
Long-Term Commitment and Holistic Approach:
• Establishing a long-term care service that is multidisciplinary and preventive.
• Ensuring continuity of service in all areas of a country, driven by values, collaboration with clients, and their personal network.
Patient-Centered and Timely Accessible Service:
• Focusing on good mental health for all, with evolution based on existing systems.
• Providing timely, accessible services and maintaining the necessary human resources.
• Ensuring mental health care is an integral part of the structure, securing ongoing funding.

The next two guest speakers, Raluca Nica and René Keet, gave us insights into policy engagement strategies and how a fidelity scale for community mental health (using F-ACT as a lead example) can be very beneficial, if not essential, for sustainability purposes. In smaller groups we discussed both topics to see how it applies in different countries and what we can learn from each other. For example, in Spain, bottom-up approaches are seen to be very beneficial in policy engagement strategies, while in Greece top-down approaches have been very beneficial in policy engagement. With regards to fidelity, a reflexive approach should be taken that allows us to apply original principles, while also being able to react to our context and learnings along the way.

To close off day 1, colleagues from Semmelweis University provided a fictional case study on how and why to organise a policy dialogue. They emphasised the importance of policy dialogues as a tool for sustainability of community mental health endeavours. We went through who you should and could invite, topics that could be discussed, and what the aim of the policy dialogue should be in your country. The guidance for policy dialogues will be available soon. We are looking forward to hearing results from your policy dialogues during the JA ImpleMENTAL!

Day 2 highlights

The thematic workshop continued with a deep dive into the WHO guidance on mental health policy and strategic action plans that is currently under development. The guidance presented integrates the human-rights based approach and social and structural determinants are well addressed in the guidance as well. A snippet of the discussed areas and directives were mental health sector contributions to structural & social determinants & society wide issues impacting mental health and well-being; person- centred, recovery oriented and rights-based assessment, interventions, and support; Service organisation and development; leadership, governance, and other enablers. A lot of input was gathered from the participants in the workshop to support WHO in further developing the guide.

The second guidance presented and discussed was the WHO guidance and practice on Mental Health, Human Rights and Legislation. This guidance starts with challenges, and current legislation and ends with the how. It also has a checklist to help countries assess if their legislation is aligned with this approach.

The workshop concluded on an inspiring note with a presentation and site visit to Enik Recovery College with Ton Verspoor and Martijn Kole, leaving us with practical insights into and the importance of developing a 100% peer-led recovery college. They explained how they got the municipality to finance Enik Recovery College; the new style of support offered; training and much more. “We try to protect space to grow without exclusion and separation, everyone is welcome”.

Sources and information:

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