Policies for psychiatric rehabilitation: inclusion through planning permit legislation changes

Abstract

Abstract Issue Mental illness increases. Europe has the highest suicide rates. Yet, psychiatric provision is stull pushed towards the fringes even in new small-scale structures. This, contradicts Social Psychiatry, ignores WHO directions and undermines European health and equity. Description of the problem Changing mental health facilities planning legislation could support integration. Using Greece as a case study, we examine how mental health planning and licensing legislation affected national integration outcomes. This was policy, time-intensive project to address gaps remaining at the end of Psychargos-the national de-institutionalisation programme. It revisited the licensing of facilities to prevent the Greek psychiatric population from facing homelessness with Psychargo’s closure. The research identified solutions for the licensing of psychiatric service provision. Most of the remaining issues related to planning permits. Methodology included literature review, site-visits, consultations with Psychargos leadership and a detailed questionnaire designed by the researchers distributed via email to all facilities of Greece. 112 out of 116 of all community based facilities chose to participate. Results We identified the country’s planning legislation as important contributor to exclusion. The uses of land prevented facilities from being located in neighborhoods and promoted the development of mental health accommodation in industrial-type buildings or segregated areas. Uses needed relaxing for mental health. This generated functional complications. It necessitated the introduction of new national design guidelines. Lessons This project shed light on a model of de-institutionalisation that has already been applied in a European country with limited resources. It could have great value to countries starting de-institutionalisation. It could be relevant to the most advanced countries such as the UK, as several of their ’community-based wards’ are still in hospital campi. Key messages Buildings affect psychiatric de-institutionalisation (types, location, layout and equipment). De-institutionalisation buildings might undermine re-integration. National provision(s) need revisiting. Special use creates difficulties for mental health facilities to be located close to where people leave. Enabling flexibility in the choice of buildings promotes inclusion.