In the face of a serious and ongoing crisis in psychiatry, the reform of outpatient care is a priority. Outpatient care should be much more developed than it is currently. Community-based care has many benefits for individuals with mental health issues, such as preventing family and social disintegration, reducing the use of coercion, limiting stigma, and making treatment more acceptable and therefore more widely accepted. Despite recommendations from numerous reports on mental health, significant progress in this area has yet to be achieved. While many hospital beds have been eliminated, outpatient care has not been adequately expanded to replace them, leading to overburdened remaining services, unacceptable emergency room wait times, and a high number of treatment discontinuations.
The main obstacle to establishing a new care model seems to be the connection of outpatient psychiatric teams to hospitals. This connection promotes a hospital-centered culture in the design of care, which is detached from the lives of patients and other medical and social actors. Additionally, funding continues to prioritize hospitalization activities over outpatient care. This disparity is evident when it comes to community interventions that are unfamiliar to other specialties, such as home visits, social and vocational rehabilitation, therapeutic outings, group therapy, and interprofessional consultations. As a result, staff positions and schedules are dedicated to hospitalized patient care, neglecting community-based psychiatric care. Furthermore, there is no safeguard for psychiatric budgets within the current system, as funding is often reallocated to support other hospital needs in polyvalent establishments.
A different approach to mental health is needed to move psychiatry out of hospitals. A radical shift in the organization model is proposed, where the core of the psychiatric care system should be placed outside of hospitals, closer to patients. This transformation could occur in two stages. The first step would involve gathering all stakeholders involved in a region’s care pathways – such as psychiatric and child psychiatric services and facilities (both sector-specific and non-sector-specific, public and private), primary care professionals, user and caregiver associations, medical and social institutions and organizations, and municipal social action centers – under a coordination body.
The second stage of transformation would focus on developing a dynamic network of outpatient care services that are inclusive, accessible, and responsive to the diverse needs of the population. This network would prioritize community-based care over hospitalization, promoting early interventions, continuity of care, and personalized support. To achieve this vision, a significant shift in funding allocation is needed to rebalance resources towards outpatient care and away from hospital-centric models. By prioritizing outpatient and community-based care, the mental health system can better meet the evolving needs of individuals with mental health issues, reduce stigma, and improve overall outcomes.
