Organisation of mental health care for adults in Belgium
Authors: Mistiaen Patriek , Cornelis Justien , Detollenaere Jens , Devriese Stephan , Farfan-Portet Maria-Isabel , Ricour Céline 
Published: January 2025

SCIENTIFIC REPORT 29 -- CHAPTER 00  OUTLINE OF THE STUDY 29 -- 1 BACKGROUND 29 -- 2 RESEARCH OBJECTIVE 30 -- 3 OUTLINE OF THE STUDY 31 -- 4 LIMITATION/SCOPE OF THE STUDY 31 -- 5 REFERENCES 32 -- CHAPTER 01 DESCRIPTION OF THE BELGIAN MENTAL HEALTH CARE WITHIN THE GENERAL HEALTH CARE ORGANISATION 33 -- AUTHORS: DETOLLENAERE J1, CORNELIS J1, DEVRIESE S1, MISTIAEN P1, RICOUR C1. 33 -- 1 GENERAL ORGANISATION OF THE BELGIAN HEALTH CARE SYSTEM: AN OVERVIEW 33 -- 1.1 PRINCIPLES OF HEALTH CARE ORGANISATION IN BELGIUM 33 -- 1.2 FINANCING OF THE BELGIAN HEALTH CARE SYSTEM 33 -- 2 ORGANISATION OF THE MENTAL HEALTH CARE SYSTEM IN BELGIUM 35 -- 2.1 HISTORICAL OVERVIEW 35 -- 2.1.1 Mental health care organisation in its early days 35 -- 2.1.2 Reforms in Belgian mental health care 36 -- 2.1.3 Sixth institutional state reform 39 -- 2.1.4 Spending on mental health care (problems) 42 -- 2.2 EVALUATION OF THE BELGIAN MENTAL HEALTH CARE SYSTEM 45 -- 2.2.1 Evaluation of the mental health care system in general 45 -- SCIENTIFIC REPORT 29 -- CHAPTER 00  OUTLINE OF THE STUDY 29 -- 1 BACKGROUND 29 -- 2 RESEARCH OBJECTIVE 30 -- 3 OUTLINE OF THE STUDY 31 -- 4 LIMITATION/SCOPE OF THE STUDY 31 -- 5 REFERENCES 32 -- CHAPTER 01 DESCRIPTION OF THE BELGIAN MENTAL HEALTH CARE WITHIN THE GENERAL HEALTH CARE ORGANISATION 33 -- AUTHORS: DETOLLENAERE J1, CORNELIS J1, DEVRIESE S1, MISTIAEN P1, RICOUR C1. 33 -- 1 GENERAL ORGANISATION OF THE BELGIAN HEALTH CARE SYSTEM: AN OVERVIEW 33 -- 1.1 PRINCIPLES OF HEALTH CARE ORGANISATION IN BELGIUM 33 -- 1.2 FINANCING OF THE BELGIAN HEALTH CARE SYSTEM 33 -- 2 ORGANISATION OF THE MENTAL HEALTH CARE SYSTEM IN BELGIUM 35 -- 2.1 HISTORICAL OVERVIEW 35 -- 2.1.1 Mental health care organisation in its early days 35 -- 2.1.2 Reforms in Belgian mental health care 36 -- 2.1.3 Sixth institutional state reform 39 -- 2.1.4 Spending on mental health care (problems) 42 -- 2.2 EVALUATION OF THE BELGIAN MENTAL HEALTH CARE SYSTEM 45 -- 2.2.1 Evaluation of the mental health care system in general 45 -- AUTHORS: DETOLLENAERE J1, BRUFFAERTS R2, GISLE L3, MISTIAEN P1 66 -- 1 INTRODUCTION 66 -- 2 METHODS 66 -- 2.1 THE EUROPEAN STUDY OF THE EPIDEMIOLOGY OF MENTAL DISORDERS (ESEMED) 66 -- 2.2 THE BELGIAN HEALTH INTERVIEW SURVEY (HIS) 66 -- 3 RESULTS 67 -- 4 CONCLUSION 71 -- 5 KEY MESSAGES 72 -- 6 REFERENCES 72 -- CHAPTER 04 INTERNATIONAL FRAMEWORKS FOR MENTAL HEALTH SERVICE ORGANIZATION 73 -- AUTHORS: RICOUR C1, DETOLLENAERE J1, CORNELIS J1, DEVRIESE S1, MISTIAEN P1. 73 -- 1 INTRODUCTION 73 -- 2 OVERVIEW OF THE FRAMEWORK DEVELOPMENT DURING THE 21TH CENTURY 74 -- 3 DESCRIPTION OF THE DEVELOPED INTERNATIONAL POLICIES 75 -- 3.1 THE WHO MENTAL HEALTH ACTION PLAN 2013-2020 75 -- 3.2 WHO/EUROPE ACTION PLAN 2013-2020 77 -- 3.3 FRAMEWORK FOR ACTION ON MENTAL HEALTH AND WELLBEING 2016 80 -- 3.4 SUSTAINABLE DEVELOPMENT GOALS OF THE UNITED NATIONS AND THE CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITIES 81 -- 3.5 OECD EVALUATION OF THE IMPACT OF MENTAL HEALTH ILLNESS IN OECD COUNTRIES 82 -- 4 STATUS OF BELGIUM IN THE DIFFERENT SURVEYS ORGANISED BY INTERNATIONAL ORGANISATIONS 83 -- 5 THE BELGIAN ART 107 REFORM PRINCIPLES IN THE LIGHT OF SOME OF THE INTERNATIONAL FRAMEWORKS 84 -- 6 KEY MESSAGES 86 -- 7 REFERENCES 86 -- CHAPTER 05 MAPPING MENTAL HEALTH CARE SERVICES IN BELGIUM 89 -- AUTHORS: LAGUESSE R1, LAMBERT M1, VAN NUFFEL R2, DE COEN M2, VAN SPEYBROECK J2, BONTEMPS C1 89 -- 1 LEXICON 89 -- 2 INTRODUCTION 92 -- 2.1 CONTEXT 92 -- 2.2 HISTORY 92 -- 2.3 BOUNDARIES OF MENTAL HEALTH CARE 93 -- 3 METHOD 95 -- 3.1 TYPE OF DATA AND STRUCTURE OF THEIR DESCRIPTION 95 -- 3.1.1 Distribution of services/institutions by levels 95 -- 3.1.2 Regions 95 -- 3.1.3 Data 95 -- 3.1.4 Overview of the situation 96 -- 3.1.5 Associations and networks involved in mental health 96 -- 3.1.6 Transfer of competences 96 -- 3.2 SCOPE (AND LIMITS OF THE SCOPE) 96 -- 3.2.1 Scope 96 -- 3.2.2 Limitations 96 -- 3.3 DATA DISCUSSION 97 -- 3.4 SOURCES OF DATA 97 -- 4 DESCRIPTION OF SERVICES CATEGORIES 98 -- 4.1 INFORMAL COMMUNITY CARE 98 -- 4.1.1 User associations and family associations 99 -- 4.1.2 Society 99 -- 4.1.3 Non-accredited accommodation structures 101 -- 4.2 MENTAL HEALTH SERVICES THROUGH PRIMARY HEALTH CARE AND RELATED SECTORS101 -- 4.2.1 General practitioner 102 -- 4.2.2 Centre for general welfare 103 -- 4.2.3 Family planning centre 105 -- 4.2.4 Health Relays 105 -- 4.2.5 Aid to maltreated elderly persons 106 -- 4.2.6 Helplines 106 -- 4.2.7 Child abuse 107 -- 4.2.8 Mental health in the related sectors 108 -- 4.3 COMMUNITY MENTAL HEALTH SERVICES AND PSYCHIATRIC SERVICES IN GENERAL HOSPITAL 114 -- 4.3.1 Community mental health centres 115 -- 4.3.2 Mobile teams 117 -- 4.3.3 Day centre 121 -- 4.3.4 Services on addiction 121 -- 4.3.5 Exile services (Wallonia and Brussels) / Psychological care for refugees (Flanders) 122 -- 4.3.6 Ambulatory private or hospital-related practice of mental healthcare professionals 122 -- 4.3.7 Suicide services 124 -- 4.3.8 Specialised rehabilitation centres with convention 125 -- 4.3.9 Psychiatric wards in general hospitals/specialised hospitals 126 -- 4.3.10 Psycho-social services in prisons 126 -- 4.3.11 Initiatives of sheltered living 127 -- 4.3.12 Psychiatric care homes 127 -- 4.4 LONG STAY FACILITIES & SPECIALIST SERVICES 128 -- 4.4.1 Hospitalization units inside psychiatric hospitals 128 -- 4.4.2 Internment 130 -- 4.5 E-MENTAL HEALTH 132 -- 5 OVERVIEW OF THE SECTOR 133 -- 6 THE NETWORKS AND ASSOCIATION OF HEALTH/MENTAL HEALTH CARE ACTORS 143 -- 6.1 THE PSY107 NETWORKS 143 -- 6.2 THE CONSULTATION PLATFORMS IN MENTAL HEALTH 144 -- 6.3 CHILDREN AND ADOLESCENT NETWORKS 145 -- 6.4 THE COORDINATORS OF THE CARE PATH FOR INTERNEES 146 -- 6.5 INTEGRATED CARE SERVICES AT HOME 146 -- 6.6 COORDINATION AND ADDICTION NETWORKS 146 -- 6.6.1 Networks of assistance and specialised care on addictions 146 -- 6.6.2 Flemish expertise centre on alcohol and other drugs 147 -- 6.6.3 Eurotox 147 -- 6.7 REGIONAL COORDINATION IN MH 147 -- 6.7.1 The centre of reference for mental health 147 -- 6.7.2 Mental Health Focal Point 148 -- 6.7.3 French-speaking Brussels league for mental health 148 -- 7 TRANSFER OF COMPETENCES (6TH STATE REFORM) 149 -- 8 DISCUSSION 150 -- 8.1 PRECAUTIONS ABOUT THE COLLECTED DATA 150 -- 8.2 MULTIPLICITY AND DIVERSITY OF THE OFFER 151 -- 8.3 DIVERSITY OF LOCAL AND REGIONAL REALITIES 151 -- 8.4 GAPS IN DATA 152 -- 8.5 COMPLEXITY OF THE OFFER 153 -- 8.6 OVERLAP 154 -- 8.7 ACCESSIBILITY 154 -- 8.8 RESIDENTIAL AND OUTPATIENT MHC 154 -- 8.9 TERRITORIAL COVERAGE 155 -- 8.10 PARTNERSHIPS 155 -- 8.11 COLLABORATION BETWEEN NETWORKS ACCORDING TO AGE GROUPS 155 -- 9 CONCLUSIONS 156 -- 10 SUGGESTIONS FOR RECOMMENDATIONS 158 -- 11 REFERENCES 159 -- CHAPTER 06 STRENGTHS, WEAKNESSES, GAPS, AND OVERLAPS IN THE CURRENT MENTAL HEALTH CARE SUPPLY: A FOCUS GROUP STUDY 166 -- AUTHORS: THUNUS S1, NEYENS I2, WALKER C1, HERMANS K2, SMITH P 1, NICAISE P1, VAN AUDENHOVE C2, LORANT V1 166 -- 1 AN EXPLORATION ON HOW MENTAL HEALTH CARE FOR ADULTS IN BELGIUM IS ORGANISED 166 -- 1.1 OBJECTIVES 166 -- 1.2 MATERIAL AND METHODS 166 -- 1.2.1 Development of focus group material 166 -- 1.2.2 Sampling process 168 -- 1.2.3 Recruitment method 170 -- 1.2.4 Description of sample 170 -- 1.2.5 Data collection 171 -- 1.3 DATA ANALYSIS 172 -- 2 RESULTS 173 -- 2.1 PROVISION OF MENTAL HEALTH CARE 173 -- 2.1.1 Characteristics of the current provision of mental health care 173 -- 2.1.2 Characteristics of providers of mental health care 174 -- 2.1.3 Provision needs 178 -- 2.2 ACCESS TO MENTAL HEALTH CARE 179 -- 2.2.1 Types of services and professionals 179 -- 2.2.2 Access for different groups of service users 181 -- 2.2.3 Access in rural versus urban areas 182 -- 2.3 COLLABORATION AND COORDINATION OF MENTAL HEALTH CARE 182 -- 2.3.1 Values and norms related to mental health care 183 -- 2.3.2 Factors influencing a collaborative culture shift 184 -- 2.3.3 Formal tools 186 -- 2.4 FINANCING OF MENTAL HEALTH CARE 189 -- 2.4.1 Allocation of financing across systems, sectors, services and networks 189 -- 2.4.2 Payment methods for professionals 191 -- 2.4.3 Resources allocation and decision-making power 193 -- 2.5 POLITICAL AND SOCIETAL CONTEXT OF MENTAL HEALTH CARE 195 -- 2.5.1 Political context 195 -- 2.5.2 Societal context 197 -- 3 CONCLUSION 198 -- 3.1 MAIN FINDINGS 198 -- 3.1.1 Provision 198 -- 3.1.2 Access to mental healthcare 199 -- 3.1.3 Mental healthcare coordination and collaboration 199 -- 3.1.4 Financing mechanisms 200 -- 3.1.5 Political context 200 -- 3.2 RECURRING CONTROVERSIES 200 -- 3.2.1 Priorities of the system 200 -- 3.2.2 Designing and building bridges in the mental healthcare system 201 -- 3.2.3 Paradigm shift and power divisions: policy-makers, professionals and the public 202 -- 3.3 REFLECTION ON THE RESEARCH PROCESS, MAIN LIMITATIONS AND NEXT STEPS 203 -- 3.3.1 Social embeddedness 203 -- 3.3.2 Limitations of this research 203 -- 3.3.3 The next steps 205 -- 4 REFERENCES 205 -- CHAPTER 07 VALUES AND SETS OF POSSIBLE ORGANISATIONAL SOLUTIONS: A CHOICE- BASED STAKEHOLDER ANALYSIS SURVEY 207 -- AUTHORS: SMITH P1, NICAISE P1, NEYENS I2, HERMANS K2, THUNUS S1, WALKER C1, VAN AUDENHOVE C2, LORANT V1 207 -- 1 INTRODUCTION: A TRANSITION TO MENTAL HEALTH CARE FOCUSED ON COMMUNITY CARE AND SOCIAL INTEGRATION 207 -- 2 OBJECTIVES 207 -- 3 DESIGN 208 -- 3.1 DEFINITIONS 209 -- 3.2 MATERIAL AND METHODS 209 -- 3.2.1 First part of the survey 209 -- 3.2.2 Second part of the survey 210 -- 3.2.3 Third part of the survey 212 -- 3.2.4 Part four to seven of the survey 214 -- 3.2.5 Validation of the content 214 -- 3.2.6 Sampling 215 -- 3.2.7 Data collection procedure 218 -- 3.2.8 Selection bias related to non-respondents 218 -- 3.3 DATA ANALYSIS 218 -- 4 RESULTS 220 -- 4.1 SAMPLING AND STAKEHOLDERS CHARACTERISTICS 220 -- 4.2 PRIORITY OBJECTIVES OF THE REFORM IN MENTAL HEALTH CARE IN BELGIUM 221 -- 4.3 DIFFERENCES BETWEEN REGIONS AND STAKEHOLDERS IN PRIORITY OBJECTIVES OF THE REFORM IN MENTAL HEALTH CARE 222 -- 4.4 COMPARISONS BETWEEN GOALS, SOCIAL INTEGRATION OR CARE IN THE COMMUNITY 224 -- 4.4.1 Differences in priority organisational interventions according to the objective to be achieved 224 -- 4.4.2 Differences in levels of the organisation of mental health care implicitly preferred according to the objective to be achieved 225 -- 4.5 CONJOINT ANALYSIS: EXPLICIT VALUES THAT UNDERLIE THE EXPECTATIONS ON THE ORGANISATION OF MENTAL HEALTH CARE IN BELGIUM 226 -- 4.5.1 Utility and importance of dimensions and levels of the organisation of mental health care 226 -- 4.5.2 Differences between regions and stakeholders in priority levels of the organisation of mental health care228 -- 4.5.3 A different organisation of mental health care according to the target group? 232 -- 4.6 ORGANISATIONAL INTERVENTIONS: PRIORITIES AND PREFERENCES 233 -- 4.6.1 Stakeholders' prioritized organisational interventions, for the overall sample, by region and by stakeholders profile 233 -- 4.6.2 Stakeholders' preferred organisational interventions 237 -- 4.6.3 Clustering of organisational interventions 239 -- 4.7 IMPLICIT VALUES OF THE ORGANISATION OF MENTAL HEALTH CARE BEHIND SELECTED ORGANISATIONAL INTERVENTIONS 242 -- 4.8 INTERVIEWS WITH STAKEHOLDERS 244 -- 4.8.1 Priority objectives of the reform in mental health care 244 -- 4.8.2 Conjoint analysis on the dimensions and levels of the organisation of mental health care 245 -- 4.8.3 Organisational interventions 247 -- 4.8.4 Final comment 249 -- 4.9 STAKEHOLDER COMMENTS IN THE ONLINE SURVEY 250 -- 5 CONCLUSION 251 -- 5.1 INTERPRETATION OF FINDINGS AND COMPARISON WITH PREVIOUS LITERATURE 251 -- 5.1.1 Objectives of the mental health care system 251 -- 5.1.2 A different mental health care organisation according to the target group? 253 -- 5.1.3 Coordination between providers and formalization of patients care pathways 255 -- 5.1.4 Funding of mental health care 256 -- 5.1.5 Organisational interventions focused on access to care 256 -- 5.1.6 Differences between stakeholders 257 -- 5.1.7 Differences between regions 258 -- 5.2 STRENGTHS AND LIMITATIONS 259 -- 5.3 FINAL RECOMMENDATIONS BASED ON THE QUALITATIVE AND QUANTITATIVE FINDINGS 259 -- 6 REFERENCES 266 -- CHAPTER 08 ACCEPTABILITY OF POSSIBLE RECOMMENDATIONS FOR FUTURE MENTAL HEALTH CARE ORGANISATION IN BELGIUM: A STAKEHOLDER SURVEY 272 -- AUTHORS: CORNELIS J1, DETOLLENAERE J1, DEVRIESE S1, MISTIAEN P1, RICOUR C1. 272 -- 1 INTRODUCTION 272 -- 2 METHOD 272 -- 2.1 CONSTRUCTION OF THE SURVEY 272 -- 2.2 STATISTICAL ANALYSIS OF THE ANSWERS 273 -- 3 RESULTS 274 -- 3.1 DESCRIPTION OF THE SAMPLE 274 -- 3.2 RESULTS OF THE MAIN THEMES 274 -- 3.2.1 Policy 274 -- 3.2.2 Intervention 276 -- 3.2.3 Registry 277 -- 3.2.4 Access 278 -- 3.2.5 Registration 280 -- 3.2.6 Research 281 -- 3.2.7 Participation 281 -- 3.2.8 Financing 282 -- 3.2.9 Priority 283 -- 3.2.10 Stigmatizing or health literacy 284 -- 3.2.11 Inclusion 284 -- 3.2.12 Cooperation 285 -- 3.2.13 Quality 286 -- 3.2.14 Respondent opinion on what to change 288 -- 3.3 RESULTS OF THE SUB-ANALYSES 289 -- 3.3.1 Sub-analysis by region of the organisation 289 -- 3.3.2 Sub-analysis by care organisation 289 -- 4 DISCUSSION 289 -- 5 KEY MESSAGES 291 -- 6 REFERENCES 292 -- APPENDICES 293