Community mental health services (CMHS), also known as Community Mental Health Teams (CMHT) in the United Kingdom, support or treat people with mental disorders (mental illness or mental health difficulties) in a domiciliary setting, instead of a psychiatric hospital (asylum). The array of community mental health services vary depending on the country in which the services are provided.
Community services include supported housing with full or partial supervision (including halfway houses), psychiatric wards of general hospitals (including partial hospitalization), local primary care medical services, day centers or clubhouses, community mental health centers, and self-help groups for mental health.
The services may be provided by government organizations and mental health professionals, including specialized teams providing services across a geographical area, such as assertive community treatment and early psychosis teams. They may also be provided by private or charitable organizations. They may be based on peer support and the consumer/survivor movement.
The World Health Organization states that community mental health services are more accessible and effective, lessen social exclusion, and are likely to have less possibilities for the neglect and violations of human rights that were often encountered in mental hospitals. However, WHO notes that in many countries, the closing of mental hospitals has not been accompanied by the development of community services, leaving a service vacuum with far too many not receiving any care.
New legal powers have developed in some countries, such as the United States, to supervise and ensure compliance with treatment of individuals living in the community, known as outpatient commitment or assisted outpatient treatment or community treatment orders.
History
The 19th to mid-20th century saw a large expansion of the number and size of asylums in Western countries. Originally based on principles of moral treatment, they were often situated in rural areas or on the outskirts of cities. Following human rights and financial concerns, a deinstitutionalization movement led to the closing down of many asylums. Community services (known in the UK as Care in the Community) were meant to take their place, but were often were poorly funded, uncoordinated and unable to meet complex needs. Homelessness and prison were the result for many. Expectations that community care would lead to fuller social integration were not achieved, with many remaining without employment, having limited social contacts and often living in sheltered environments that still lead to institutionalization. Services in the community sometimes provided a new ghetto, where service users meet each other but have little contact with the rest of the community. It has been said that instead of “community psychiatry”, reforms established a “psychiatric community”.