In recent decades, many countries have made meaningful progress in developing community-based mental health services. Moreover, rights-based approaches have gained traction as people with lived experience increasingly have a voice in shaping mental health policy and services. These developments have shown that people living with mental health conditions can flourish in their communities when given the right support.
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.
We think of institutional mental health care as an outdated model. But it is far more than that. It is a human rights issue hiding in plain sight.
Many countries still rely heavily on standalone psychiatric institutions. Across the world, we estimate that nearly half of all public mental health funding is spent on maintaining these large facilities, while access to community-based mental health care, including in general hospitals, for millions of people remains underfunded and overlooked. 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. Facilities that uphold human rights, dignity, and personal autonomy promote recovery.
However, when care is characterized by coercion, rigid control, or social isolation, it risks becoming a form of confinement rather than care. 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.
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