Abstract
BackgroundDespite large-scale investments in mental health care in the community since the 1990 s, a trend towards reinstitutionalization has been visible since 2002. Since many mental health care providers regard this as an undesirable trend, the question arises: In the coming 5 years, what types of residence should be organized for people with mental health problems? The purpose of this article is to provide mental health care providers, public housing corporations, and local government with guidelines for planning organizational strategy concerning types of residence for people with mental health problems.MethodsA scenario analysis was performed in four steps: 1) an exploration of the external environment; 2) the identification of key uncertainties; 3) the development of scenarios; 4) the translation of scenarios into guidelines for planning organizational strategy. To explore the external environment a document study was performed, and 15 semi-structured interviews were conducted. During a workshop, a panel of experts identified two key uncertainties in the external environment, and formulated four scenarios.ResultsThe study resulted in four scenarios: 1) Integrated and independent living in the community with professional care; 2) Responsible healthcare supported by society; 3) Differentiated provision within the walls of the institution; 4) Residence in large-scale institutions but unmet need for care. From the range of aspects within the different scenarios, the panel was able to work out concrete guidelines for planning organizational strategy.ConclusionsIn the context of residence for people with mental health problems, the focus should be on investment in community care and their re-integration into society. A joint effort is needed to achieve this goal. This study shows that scenario analysis leads to useful guidelines for planning organizational strategy in mental health care.
Highlights
Despite large-scale investments in mental health care in the community since the 1990s, a trend towards reinstitutionalization has been visible since 2002
Mental health care providers have been planning policy interventions to restrict this trend. The question they face in relation to a new policy period, in which choices must be made concerning their residential facilities, is: In the coming 5 years, what types of residence should be organized for people with mental health problems? This question arose at Stichting Geestelijke Gezondheidszorg Eindhoven en de Kempen (GGzE), a mental health care provider in Eindhoven
Exploring the external environment The external environment was explored using the framework as described in the Methods section
Summary
Despite large-scale investments in mental health care in the community since the 1990s, a trend towards reinstitutionalization has been visible since 2002. Since many mental health care providers regard this as an undesirable trend, the question arises: In the coming 5 years, what types of residence should be organized for people with mental health problems? In the field of specialized mental health care in the Netherlands there are two main types of care for people with (complex) mental health problems. There is inpatient care, where patients stay in a psychiatric hospital unit (institutional care), or in a small-scale residential unit in the community with supervision and support from a mental health care provider. A recent report by the Dutch Association for Mental Health and Addiction Care shows a 3.6% growth in the number of patients receiving inpatient care between 2005 and 2007 [1].
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