Reorienting health systems in South-East Asia to deliver care for mental and neurological disorders

Abstract

Traditionally, care for mental and neurological disorders has been concentrated in tertiary care hospitals located in large cities. These custodial types of facility were designed to ‘protect’ the community from patients with a mental illness, as such persons were considered dangerous and a threat to the community. Given the state of medical knowledge in the 19th and 20th centuries, this mode of care was considered appropriate. However, in recent decades more humane and effective concepts of care have evolved. These concepts recognise the stigma attached to hospital-based care and also its limited outreach to the community, leaving out the vast majority of people living in rural and remote areas. Violation of human rights, sometimes seen in mental hospitals, has also been of concern.