Designing Networks for Integrated Care Within the Belgian Mental Health Care Ecosystem

Abstract

Mental health care in Belgium is historically characterized by a medical and residential care approach. The mental health system has been highly criticized, expensive and commonly seen as being in a structural crisis. To revitalize it, the prior governments decided to promote an outreach approach, through legislative interventions. Regional Networks in the mental health ecosystem were to be created and the money gained by reducing the number of mental health hospital beds were to be injected in an ambulant patient centered approach. In shaping the networks, the focus of the network actors was primarily on building a governance structure, without designing the primary process of caregiving. This led to immobility and certain dysfunctions in providing good mental health care. To overcome these problems some networks started by redesigning their core processes, using Lowlands Socio-Technical Systems (STS) theory and tools. The underlying question is about the way in which adequate mental health care for patients with different needs and pathology can be best organized. This chapter demonstrates that the Lowlands STS ideas (also referred to as Total Workplace Innovation) represent a systems approach which, while historically used for designing stand-alone organizations or teams, can be applied to building networks as an eco-system design strategy. There are however certain conditions to be fulfilled to be able to design primary processes. We argue that ecosystems cannot be subject to design, only (goal-oriented) networks can. Policy makers, scientists, professional designers and other “actors” can however build “collaborative capacity”, creating conditions for future collaboration between existing actors or for the erection of new structures. They can do so by making interventions to explore and facilitate the potential of building new collaborative structures, which at their turn can be subject to further design.