New directions in mental health services in the 1990s and implications for geriatric psychiatry

Worldwide changes in the provision and focus of mental health services in recent decades have been via initial efforts to deinstitutionalize large psychiatric institutions and later attempts to build up a comprehensive regional infrastructure of community based mental health support services including the mainstreaming into general health of psychiatric services (Health Department of Victoria, 1992b). The direction of the changes being implemented has been to shift the focus of service from separate centralized institutions to integrated regionalized community facilities that will assist in maintaining those with psychiatric disabilities in the community via more effective outreach, advocacy and support, rehabilitation and case management (Rosen, 1992). This shift from largely institutionally based to community provided services is requiring new skills and capacities of mental health personnel and a cultural change in the focus of service intervention to facilitate community coping capacity and competence in clients/consumers.

The direction of contemporary changes has been towards:

1. shorter stays in institutional settings

2. more episodic care for the acutely mentally ill

3. the creation of more innovative and humane long-term care settings

4. increased relative allocation of resources to community-based facilities

5. a greater focus on assertive community outreach and rehabilitation

6. greater liaison with general practice, local government and other community agencies to facilitate better primary prevention and ongoing community support.

7. provision of a comprehensive range of community care programs including assessment, case management, rehabilitation, vocational guidance and housing support.