Mental health service networks to strengthen community-based care integration and patient’s recovery: Results from the Belgian psychiatric reform

Background/Objectives: The Belgian health-care system is characterised by a large autonomy of health providers and extensive freedom of choice for patients. It lacks of mechanisms supporting care continuity, such as local health authorities, organised referrals, and pooled funding. Belgium also has a high number of psychiatric beds in hospitals. However, since 2011, a reform of the mental-health care delivery system is ongoing. Psychiatric hospitals were proposed to set up networks with community-based services to strengthen care in the community, supply integrated care pathways, and support patient’s recovery. Networks were free to include any type of partner and developed their own governance mechanisms. Hence, within a nation-wide evaluation process that goes with the reform, we assessed how these networks were structured and whether they were likely to reach the reform’s aims. Methods: Each service member of a network received an online questionnaire that included items on clinical contacts between services (referrals, information exchange), contacts on network organisation activities, and preferred partners. Network structure was measured using Social Network Analysis metrics: density of ties, centralisation, and homophily. Results: Off 990 services identified within 19 networks, 519 (53%) participated to the survey. A cluster analysis showed that networks varied greatly in terms of size and service types, density of ties, centrality of key services, and core homophily. Discussion/Conclusion: There is a wide variety of local network partnerships, hampering homogenous effects of the reform across the country. Indeed, the literature shows that network density facilitates care individualisation whereas centralisation facilitates coordination. The influence of hospitals remains high and may hinder community care development. The position of social services in network organisation has to be strengthened to support patient’s recovery. Hence, it remains unclear whether one network structure is adapted to reach the multiple reform aims simultaneously