Although community-based services are widely regarded as the best approach for providing mental health treatment and care, most low- and middle-income countries continue to spend the vast majority of their scarce mental health resources managing people with mental disorders in mental hospitals.

To better understand this vexing issue, 78 mental health experts representing 42 countries were surveyed on the relative usefulness of different methods to expand community-based mental health services, and/or to downsize institution-based care. Results indicate that there are several successful paths to deinstitutionalization. Most respondents emphasized—directly or indirectly—the importance of political skill and timing.

Based on the survey, five principles for deinstitutionalization were identified: community-based services must be in place; the health workforce must be committed to change; political support at the highest and broadest levels is crucial; timing is key; and additional financial resources are needed.

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