For millions of people living with mental health conditions, the road to recovery can be complicated not only by illness but also by prolonged institutionalisation, social isolation and limited opportunities to rebuild their lives within their communities.
The World Health Organization (WHO) is seeking to change that reality, urging countries to move away from long-term institutionalised mental health care towards community-based services that protect individual rights, dignity and freedom of choice.
Ahead of World Mental Health Day, the global health agency unveiled a new guide to help governments reform psychiatric services, reduce prolonged hospital admissions and support people transitioning from institutions to independent community living.
The initiative reflects a growing recognition that effective mental health care must go beyond clinical treatment to address the social, economic and personal circumstances that shape recovery.
According to WHO, many people with mental health conditions remain in large psychiatric hospitals and social care institutions, with nearly half reportedly held involuntarily for months, years or even decades.
Such prolonged confinement raises concerns about personal autonomy, family relationships and access to opportunities for education, employment and meaningful participation in society.
WHO defines deinstitutionalisation in this context as helping people who have spent six months or longer in psychiatric hospitals return to community life with appropriate care and support.
But moving people out of institutions is only one part of the process. Without suitable housing, accessible healthcare, social protection and opportunities to earn a living, people leaving psychiatric facilities may struggle to rebuild their lives.
WHO Director-General, Dr Tedros Ghebreyesus, said people should not have to sacrifice their freedom, dignity or community relationships to receive continuous mental health support.
He called on governments to reduce dependence on long-term institutional care and redirect investments towards rights-based services that enable people to receive appropriate support while living within their communities.
The WHO guide emphasises that the transition cannot be accomplished by psychiatric hospitals alone. It requires coordinated action across healthcare, housing, education, employment and social welfare systems, alongside practical assistance for families and caregivers.
The scale of the challenge is reflected in findings from WHO’s Mental Health Atlas. Only nine per cent of reporting countries had fully transitioned to community-based mental health care, while 53 per cent remained at an early stage of reform.
The report also found that more than one in four people admitted to psychiatric hospitals stayed for longer than six months, underscoring the difficulties countries face in replacing prolonged institutionalisation with sustainable community support.
For countries still developing their mental health systems, the findings highlight the importance of investing not only in psychiatric facilities but also in community mental health teams, accessible counselling, rehabilitation, supported accommodation and services that help people return to everyday life.
Equally important is the involvement of people who have experienced institutional care. WHO says they should participate directly in designing policies and services rather than remain passive recipients of decisions made by professionals and authorities.
The guide aligns with this year’s World Mental Health Day theme, “Lived experiences heard: real voices, real change,” which calls for people with direct experience of mental health conditions to have a stronger voice in shaping reforms.
Grace Gatera, an independent lived experience consultant and advocate, stressed that people who have experienced institutional care possess essential knowledge for developing services that promote personal choice, recovery and participation in community life.
Developed with contributions from experts across different countries, including people with lived experience, the guide is intended to help governments adapt reforms to their national and local circumstances.
Ultimately, the shift towards community-based care is about redefining what successful mental health treatment means. Recovery should not be measured solely by clinical improvement, but also by whether people can maintain relationships, make decisions about their lives, access opportunities and participate meaningfully in society.
WHO’s message is clear: mental health care should provide treatment without unnecessarily separating people from their communities or depriving them of their rights.
Achieving that vision will require sustained investment, trained professionals, strong social support systems and a willingness to listen to those whose lives are directly affected.
For people living with mental health conditions, the promise of reform is not simply leaving a hospital. It is having the opportunity to live with dignity, exercise choice and find a place in the community they call home.
