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Mental health care delivery system reform in Belgium: The challenge of achieving deinstitutionalisation whilst addressing fragmentation of care at the same time

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  • Nicaise, Pablo
  • Dubois, Vincent
  • Lorant, Vincent

Abstract

Most mental health care delivery systems in welfare states currently face two major issues: deinstitutionalisation and fragmentation of care. Belgium is in the process of reforming its mental health care delivery system with the aim of simultaneously strengthening community care and improving integration of care. The new policy model attempts to strike a balance between hospitals and community services, and is based on networks of services. We carried out a content analysis of the policy blueprint for the reform and performed an ex-ante evaluation of its plan of operation, based on the current knowledge of mental health service networks. When we examined the policy's multiple aims, intermediate goals, suggested tools, and their articulation, we found that it was unclear how the new policy could achieve its goals. Indeed, deinstitutionalisation and integration of care require different network structures, and different modes of governance. Furthermore, most of the mechanisms contained within the new policy were not sufficiently detailed. Consequently, three major threats to the effectiveness of the reform were identified. These were: issues concerning the relationship between network structure and purpose, the continued influence of hospitals despite the goal of deinstitutionalisation, and the heterogeneity in the actual implementation of the new policy.

Suggested Citation

  • Nicaise, Pablo & Dubois, Vincent & Lorant, Vincent, 2014. "Mental health care delivery system reform in Belgium: The challenge of achieving deinstitutionalisation whilst addressing fragmentation of care at the same time," Health Policy, Elsevier, vol. 115(2), pages 120-127.
    • Handle: RePEc:eee:hepoli:v:115:y:2014:i:2:p:120-127
    DOI: 10.1016/j.healthpol.2014.02.007
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    References listed on IDEAS

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    1. Myrna Mandell & Robyn Keast, 2008. "Evaluating the effectiveness of interorganizational relations through networks," Public Management Review, Taylor & Francis Journals, vol. 10(6), pages 715-731.
    2. Mur-Veeman, Ingrid & van Raak, Arno & Paulus, Aggie, 1999. "Integrated care: the impact of governmental behaviour on collaborative networks," Health Policy, Elsevier, vol. 49(3), pages 149-159, November.
    3. Kun Huang & Keith G. Provan, 2007. "Structural embeddedness and organizational social outcomes in a centrally governed mental health services network," Public Management Review, Taylor & Francis Journals, vol. 9(2), pages 169-189, June.
    4. Lega, Federico, 2007. "Organisational design for health integrated delivery systems: Theory and practice," Health Policy, Elsevier, vol. 81(2-3), pages 258-279, May.
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    Cited by:

    1. Kovess-Masfety, V. & Rabaté, L. & Caby, D. & Nicaise, P., 2023. "French mental health care system: Analysis of care utilisation patterns and the case for a stepped care approach," Health Policy, Elsevier, vol. 138(C).
    2. Petrea, Ionela & Shields-Zeeman, Laura & Keet, Rene & Nica, Raluca & Kraan, Karel & Chihai, Jana & Condrat, Victoria & Curocichin, Ghenadie, 2020. "Mental health system reform in Moldova: Description of the program and reflections on its implementation between 2014 and 2019," Health Policy, Elsevier, vol. 124(1), pages 83-88.
    3. Nicaise, Pablo & Giacco, Domenico & Soltmann, Bettina & Pfennig, Andrea & Miglietta, Elisabetta & Lasalvia, Antonio & Welbel, Marta & Wciórka, Jacek & Bird, Victoria Jane & Priebe, Stefan & Lorant, Vi, 2020. "Healthcare system performance in continuity of care for patients with severe mental illness: A comparison of five European countries," Health Policy, Elsevier, vol. 124(1), pages 25-36.

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