Yet, around the world, very large numbers of people with mental health conditions live behind closed doors in psychiatric hospitals and social care institutions. Some have been there for months; others for decades. According to the World Health Organization’s Mental Health Atlas, about half were brought in against their will, stripped of basic daily choices like what to wear or when to eat, and cut off from the outside world.
Sri Lanka embraced mental healthcare reform by replacing isolated institutions with community-based services. Guided by the country’s mental health policies over the past 20 years, Sri Lanka has made significant progress in transforming the mental health system from an asylum-based model to a decentralized network of district and community services. Today, mental health care in Sri Lanka is delivered through inpatient and outpatient units in general hospitals, outreach clinics, intermediate rehabilitation units, and child mental health clinics throughout the country.
Deinstitutionalization is not simply about reducing hospital beds. It is about creating the conditions for people to live independently and participate fully in society, with access to appropriate housing, education, employment, social protection, and person-centered mental and physical health care. This is the foundation of recovery, inclusion and human rights-based mental health care.
Countries worldwide are proving that advancing deinstitutionalization is achievable across all income levels, from changing care practices and expanding alternatives to psychiatric hospitals to establishing comprehensive networks of community-based services. Deinstitutionalization is a cultural shift that requires the meaningful involvement of people with lived experience, health service providers, and the whole of society.
We must ensure that people receive the support they need in environments that promote dignity, autonomy, relationships and inclusion. We call on governments, health and social care systems to make this a priority, with people with lived experience as partners throughout the transition.
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