FOCUS March 2026 Volume 123

Community-based Mental Health Care

The death of two patients in Tochigi prefecture, Japan in 1983 due to assaults by members of the nursing staff in a psychiatric hospital led a group of citizens in Osaka, including people with mental disabilities and their families, medical and welfare professionals and lawyers, to establish a center on and for the rights of people with mental disabilities.

The goal was to "engage in activities that would protect the human rights of people with mental disabilities in psychiatric care and in their social life, promote social understanding of people with mental disabilities, and contribute to having a society where people live in peace, regardless of having disability or not."[i]

This is the Osaka Center for Mental Health and Human Rights that was founded in 1985. It adopted the view that even though the Act on the Elimination of Discrimination against Persons with Disabilities was enacted in 2013[ii] and the Convention on the Rights of Persons with Disabilities was ratified by Japan in 2014, the situation in which the rights of people hospitalized in psychiatric hospitals are greatly restricted has not changed.

The Center advocates the shift of the[iii]

treatment of persons with mental disabilities to medical and welfare services that support community life. "There should be more outpatient care, day care, psychological support, home visits, nursing visits, welfare for the persons with disabilities, and collaboration with nursing care institutions instead of confinement to the hospital.

This brings up the issue of the role of the community in providing mental health care.

Community-based Mental Health Care

The World Health Organization (WHO) South-East Asia Region has defined the concept of community-based mental health care in its 2023 report[iv] as quoted below:

Community-based mental health care includes any mental health care that is provided outside of a psychiatric hospital. It is more accessible and acceptable than institutional care, helps prevent human rights violations, and delivers better recovery outcomes for people with mental health conditions when compared with institutional care.

Community-based mental health care recognizes the need for a person-centred, recovery-based approach that ensures that all people have access to a range of services and support, from promotion and prevention to treatment and rehabilitation. At the level of the individual, such services take a person-centred, rights-focused approach to promoting mental well-being, addressing the diverse and complex needs of individuals and families requiring mental health care. This involves a network of services that provide support to address the multiple needs of people with mental health conditions and of caregivers, which cannot be addressed by a single intervention or facility.

Community networks should therefore be coordinated across different levels and sites within and beyond the health sector, according to people's needs throughout the life-course. To do so, community-based services also rely on strong collaborations with local organizations, schools and other community entities to address not only individual mental health needs but also the broader systemic factors contributing to mental health conditions.

By providing mental health support in communities, prevailing societal norms begin to shift, creating an environment in which seeking help is normalized. This encourages more individuals to engage with mental health services.

This collaborative approach strengthens community bonds, creating a supportive network that is essential for both prevention and intervention.

Further, community-based mental health services are particularly important during times of crisis, such as in the aftermath of a natural disaster or a global pandemic. They provide timely and localized assistance, catering to the unique needs that emerge during such challenging periods. The WHO South-East Asia Region is particularly vulnerable to natural disasters and effects of climate change, which have a negative impact on the mental health of communities. Evidence is now accumulating to show that the climate crisis impacts mental health in multiple ways.

Countries can design and implement different types of community-based mental health models of care, based on their specific needs and priorities. Traditionally, most efforts in the field of mental health focus on integration of mental health into primary health care. However, it is essential to expand mental health services beyond primary health care.

Importance of Community-based Mental Health Care

WHO emphasizes the importance of community-based mental health services, as its 2025 report states:[v]

For many countries, a key step towards community-based care is deinstitutionalization - shifting resources from psychiatric hospitals towards community-based services. This is not simply about closing institutions; it is about replacing outdated, often harmful, models with person-centred, recovery-oriented care.

Long-stay psychiatric hospitals often fail to meet basic standards of care. Many adopt a narrow biomedical approach, have poor living conditions, and are linked to human rights violations. Yet millions are in these facilities each year, with many staying for extended periods -sometimes for life.

Deinstitutionalization does not mean discharging everyone at once. It is a gradual, complex process that includes improving hospital care, shortening stays, preventing new admissions and addressing livelihoods, housing and care of former residents. It requires the development of robust community-based alternatives to support discharged individuals and prevent rehospitalization.

This transition demands financial and strategic investment, careful planning, a committed health work force, and the meaningful involvement of long-stay residents, their families and communities.

Needed Policy

Recommended policies on mental health care are also linked to community-based approach to mental health care. Below are examples of such policy recommendations:[vi]

• Scaling up service provision and access to mental health care via a network of primary and community-based support and timely referral to specialists. This entails prioritizing mental health within public policy and enhancing investment;
• Strengthening public understanding and engagement of people with mental disorders. This will decrease the stigma, improve mental health literacy, and promote help-seeking behaviors;
• Reducing health workforce shortages. Training of community and allied health workers will build workforce capacity from primary to specialist care; and
• Adopting and supporting digital technology for mental health and enhancing data collection. Measures can include mobile applications, platforms for collection of patients' data for monitoring, and teleconsultation to access mental health services.

Types of Community-based Mental Health Care

Expanding community-based mental health services would encompass three main areas as identified in the World Mental Health Report 2022:[vii]

• community mental health services - includes community mental health centres and teams, psychosocial rehabilitation, peer support services and supported living services;
• mental health in general health care - includes mental health services provided in primary care, general hospitals and specific programmes such as maternal health; and
• mental health beyond the health sector - encompasses services in non-health settings, such as in schools, and social sector programmes such as provision of benefits and child protection.

Community-based mental health services can take varied forms:

• Community mental health centres and teams provide a range of mental health services to individuals in the community. These centres offer counselling, therapy, and psychiatric support on an outpatient basis. They focus on promoting mental well-being, preventing mental health crises. They have the potential to provide accessible care and support close to where people live, work closely with non-specialized primary care, and work with the wider network of support in local communities;
• Mental health units in general hospitals are designed to address acute mental health crises and provide immediate intervention. Inpatient wards offer short-term admissions for individuals requiring hospital care, while crisis support services provide assistance and counselling to those experiencing acute emotional distress or a mental health emergency. Local acute inpatient care should be available in dedicated wards of general hospitals (preferably not within the same building as other wards or operating theatres). Their role is to provide care for the acutely ill who cannot be managed at home;
• Psychosocial rehabilitation or intermediate care centres provide support and treatment for individuals transitioning from acute mental health care to community living. These centres focus on skill-building, rehabilitation, and fostering independence. They offer a structured environment where individuals can receive therapeutic services and learn essential life skills. Intermediate care services are developed at district level close to the community to support ongoing rehabilitation for those who need it. These services can also offer support to people who are unable to return to their family home because they experience enduring problems that necessitate rehabilitation;
• Supported living facilities and services provide both short-stay and long-stay facilities and other services. Living facilities offer a supportive residential environment for individuals with mental health conditions who are transitioning from institutional settings to independent living. These homes provide a structured and supervised living arrangement, offering a supportive community and assistance with daily activities to help individuals regain stability and autonomy. Supported living services encompass a variety of community-based supports tailored to individuals with mental health needs. These services may include assistance with daily living activities, vocational training, social integration and ongoing psychosocial support. The goal is to empower individuals to live independently and participate fully in community life. Supported living services are also instrumental in the process of deinstitutionalization of psychiatric hospitals and mental asylums;
• Day care services offer a structured and supportive environment for individuals to engage in therapeutic activities during the day. Community-based day care is an important additional component of a local community-based mental health service. These services are designed to enhance social skills, provide vocational training and offer counselling or group therapy sessions. Day care can be the first service component to be established as part of a wider service system;
• Peer support services and non-professional support involves individuals with lived experience of mental health conditions, volunteers and non-professional health workers providing guidance, understanding and encouragement to those with mental health conditions. Such initiatives aim to create a non-judgemental and empathetic space where individuals can share their experiences, receive practical advice and build a sense of community. This type of support is valuable in promoting recovery and resilience. The use of non-professional staff, volunteers and peer support workers can help to establish innovative and effective low-cost support;
• Other services can include those offered through primary and secondary health care, specific health programmes such as maternal health, and services offered through the social sector.

The Osaka Center for Mental Health and Human Rights advocates the establishment of local mental health and human rights centers in different parts of Japan to support this "deinstitutionalization" concept and strengthen community-based systems on mental health care. National policy (appropriate supporting law) would help ensure the existence of community-based mental health care in different parts of the Japan, similar to what is needed in any other country.

Jefferson R. Plantilla is a researcher at HURIGHTS OSAKA.

For further information, please contact: Jefferson R. Plantilla, HURIGHTS OSAKA, e-mail: jeff@hurights.or.jp

Endnotes

[i] Osaka Mental Health Human Rights Center, "Advocating for the Rights of Persons with Mental Disabilities," Human Rights Education in Asia-Pacific, volume 15, 2025, pages 25-42. The article is available in the website of HURIGHTS OSAKA: www.hurights.or.jp/archives/asia-pacific/.

[ii] See unofficial translation into English of this law in Japanese Law Translation, www.japaneselawtranslation.go.jp/en/laws/view/3052/en.

[iii] Osaka Mental Health Human Rights Center, ibid.

[iv] The following discussion is taken from Community-based mental health services in the WHO South-East Asia Region. New Delhi: World Health Organization, Regional Office for South-East Asia; 2023. Licence: CC BY-NC-SA 3.0 IGO.

[v] See Mark van Ommeren, From isolation to inclusion: community-based mental health care, WHO, 24 July 2025, www.who.int/news-room/commentaries/detail/from-isolation-to-inclusion---community-based-mental-health-care.

[vi] See Vasoontara Yiengprugsawan, Michelle Apostol, Dinesh Arora, Five Steps to Address Mental Health in Asia and the Pacific and Beyond, 22 May 2024, https://blogs.adb.org/blog/five-steps-address-mental-health-asia-and-pacific-and-beyond.

[vii] Community-based mental health services in the WHO South-East Asia Region, op. cit.

---

• « When a Hashtag Became a Lifeline: The Story of MentalHealthPH
• FOCUS