Acute psychiatric hospitalization traditionally takes place in closed psychiatric hospitals and is intended to help people who are experiencing an acute mental health crisis and are in need of intensive support. A range of services have been developed in various countries as an alternative to acute psychiatric hospitalization, which advocate community-based mental health services and community integration. These services have been developed in view of the traumatic experiences of hospitalization and due to the high costs of hospitalization. The recovery-oriented approach in mental health– which sees the service consumer as a key and equal partner in their own recovery process along with professionals – as well as the deinstitutionalization trend across the world since the 1950s have also contributed to the development of alternative solutions to hospitalization. Unlike conventional psychiatric hospitalization, its alternatives are advantageous in that they offer a prompt, individually adapted response, which is provided in a community setting rather than in a segregated setting, excluded from the community. Community-based services for people experiencing an acute mental health crisis are also intended to prevent recurrent psychiatric hospitalizations; they cost less compared with psychiatric hospitalization; and they are perceived as less intimidating and are thus preferred by service consumers. Also, the stigma associated with community-based mental health services is not as pronounced as that attached to psychiatric hospitalization. It is therefore essential to maintain and promote community-based services.
The Ministry of Finance commissioned the Myers-JDC-Brookdale Institute to conduct an international review of community-based services offered as an alternative to acute psychiatric hospitalization of adults.
To present a comprehensive, up-to-date review of the types of models of community-based services for adults experiencing an acute mental health crisis that are in use around the world.
- An international review of academic articles and open access publications on the Internet, such as research reports and gray literature on community-based services offered in various countries to adults experiencing an acute mental health crisis. The review was focused on prevalent approaches, practices, and models, and examined their application to services offered.
- Semi-structured interviews (conducted from December 2021 to March 2022) with an academic expert, a professional, and a social activist in the field of mental health in Israel. The interviews were conducted face-to-face or via an online video chat.
The review indicated that the community-based models could be classified into two types:
- Services offered in stay-in facilities
- Services offered outside stay-in facilities
Services offered in stay-in facilities provide short-term mental health services for a fixed period of time. The services in the stay-in facilities are noncoercive, and they are provided in line with the recovery-oriented approach. The services are based on support provided by peers with lived experience. In some cases, the stay-in services are provided exclusively by peers with lived experience but in most cases, other mental health services in the local community are also involved. The stay-in facilities offer ongoing mental health support and services even after the stay-in period.
Services offered not in stay-in facilities enable a person experiencing an acute mental health crisis to receive care while staying at home. Care may be provided in care centers, in social settings in the community, or at home by dedicated crisis resolution teams. In some cases, such services offer an emergency first response only while in other cases, services may be provided along an extended period of time, depending on the varying needs of the service consumer and his wishes.
Another model is the Trieste model, named after the city in Italy, which offers a comprehensive organizational framework for mental health services at the local level.
Models of community-based services for people experiencing an acute mental health crisis, whether offered in stay-in facilities or not in stay-in facilities, are often inspired by innovative concepts and approaches to the issue of acute mental health crises and its care.
A key aspect shared by these models is the establishment of close and trusting relationships between service consumers and care providers. Community-based services for acute mental health crisis are part of a continuum of care of mental health in the community.
Community-based services for acute mental health crisis accommodate the special needs of various consumer groups: women, the LGBTQ community, and others.
Citing suggestion: Rimon-Greenspan, H., & Koren, Y. (2022). Community-Based Services for People Experiencing an Acute Mental Health Crisis: An International Review. RR-912-22. Myers-JDC-Brookdale Institute. (Hebrew)