Acute psychiatric care: the need for contextual understanding and tailored solutions

Abstract

World Psychiatry 21:2 June 2022 care system has been used to estimate the optimal workforce in full time equivalents in acute wards and acute day care in the Basque Country (Spain), and the relative technical efficiency of service provision in catchment areas, including both acute and non­acute services. Impact analysis is another key compo­ nent of the evaluation in mental health care. This should not be limited to end­point re­ sults on individuals. Major attention should be paid to the process of implementation and the analysis of the readiness, usability, adoption and penetration of a new service in real world environments. The empha­ sis on fidelity should be balanced with the need for adaptation to local con texts. Additional mention should be made of the role of international networks in pro­ moting new models of care and imple­ mentation. Relevant examples are the Crisis Now/Recovery International glob­ ally growing network of facilities, which provides welcoming, peer­partnership and firmly community­based service fa­ cilities, not backed as yet by published rigorous research; the I­CIRCLE consor­ tium, that promotes community models in urban environments; and the EUCOM model of community care in Eu rope. The broader bio­psycho­socio­cultural innovations have evolved with an empha­ sis on complexity science, co­design with lived experience and family expertise, hu­ man rights facilitation and community­ based recovery approaches. Attempts to fragment and undo cost­effective commu­ nity­based reforms are often accompanied by demands for ever­more hospital beds. These hospital­centric views should no long ­ er prevail over responsive, wholistic ecosys­ tems, integrating community and hospital components. Transforming acute mental health care towards community models exceeds men­ tal health systems, heralding broader reform of general acute health care and support systems towards community care. To keep on­track with previous advances, the eval­ uation of the mental health sector acute care should adopt a health care ecosystem perspective, including systematic assess­ ment of the service delivery systems, their impact on processes, outcomes, workforce, and especially service users and families, val ­ orizing lived experiences.