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Tijdschrift voor Psychiatrie 53 (2011) 12, 917 - 926


Reorganisation of the mental health services in Belgium in 2011. Will this lead to better care for patients with a serious mental illness?

J. Van Hecke, L. Joos, J. Daems, V. Matthysen, S. De Bruyne

background In Article 107 of the hospital legislation the Belgian government provides for a possible reorganisation of current mental health care. According to the Article, hospital managers and the medical staff of residential care units in each region are permitted tot re-allocate resources in such a way that their current government allowance is used for the development of an alternative type of health care that is more community-based.
aim To explore the possible consequences that such a step is likely to have on the current users of long-term residential care.
method We looked critically at the draft text which was circulated in order tot explain the proposed reorganisation. We evaluated the scientific evidence concerning the feasibility of the ideas put forward in the text, focusing particularly on the care of patients with a serious mental illness.
results The method, which involves the re-allocation of funds in order to stimulate the reorganisation of care, is considered to be self-defeating. On the one hand, it constitutes a threat, leading to possible closure of the least profitable services, including hospital wards for long-stay patients. On the other hand, the proposed health care organisation poses a threat to the very group of patients who reside in such hospitals and it may in fact lower the level of care they receive.
conclusion It will be necessary to check on the effects that this reorganisaton will have on patients with a serious mental illness. We therefore propose some ways of monitoring the effects that the planned reorganisation is likely to have on this vulnerable group of patients.

keywords long-term psychiatric care, organisation of mental services, severe mental illness