Challenges and opportunities in the transition from institutional to community-based mental health care

Belgium’s mental healthcare system is shifting to community-based care under the "Article 107" reform, which transformed institutional care settings into functional categories. Despite progress in recovery-oriented care, organizational challenges remain and the reform’s impact on service users and their experiences have been underexplored. Key concerns include care professionals’ competencies, service accessibility, and informal coercion. This study identifies essential professional competencies for community-based care, as seen by service users and managerial stakeholders, and assesses their alignment with current structures. Service users’ experiences with new care models reveal competency gaps and accessibility issues. The study also examines informal coercion through case studies, engaging caregivers and service users to reflect on coercive practices. This special PhD fellowship will be used to engage healthcare professionals and peer workers in focus groups to discuss potential improvements in care access. A second study will explore interdisciplinary roles and the perceived interchangeability of the functions of mental health nurses and special needs educators under the 107 reform. These findings will offer critical insights into competency development, accessibility, and informal coercion, supporting the implementation of community-based mental healthcare system in Belgium.

Keywords:Deinstitutionalisation, Mental health, mental healthcare accessibility

Disciplines:Mental health nursing, Orthopedagogical interventions, Mental healthcare services