Chapter 2. Changes in Health Care Systems and Their Impact on Mental Health Care

  1. Norman Sartorius2,
  2. Wolfgang Gaebel3,
  3. Juan José López-Ibor4 and
  4. Mario Maj5
  1. Heinz Häfner

Published Online: 29 APR 2002

DOI: 10.1002/0470846488.ch2

Psychiatry in Society

Psychiatry in Society

How to Cite

Häfner, H. (2002) Changes in Health Care Systems and Their Impact on Mental Health Care, in Psychiatry in Society (eds N. Sartorius, W. Gaebel, J. J. López-Ibor and M. Maj), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/0470846488.ch2

Editor Information

  1. 2

    University of Geneva, Switzerland

  2. 3

    University of Düsseldorf, Germany

  3. 4

    Complutense University of Madrid, Spain

  4. 5

    University of Naples, Italy

Author Information

  1. Schizophrenia Research Unit, Central Institute of Mental Health, J 5, D-68159 Mannheim, Germany

Publication History

  1. Published Online: 29 APR 2002
  2. Published Print: 30 APR 2002

ISBN Information

Print ISBN: 9780471496823

Online ISBN: 9780470846483



  • mental illness;
  • human and civil rights;
  • health care systems;
  • mental health care systems;
  • mental hospital;
  • isolation of mental health care;
  • integration of mental health care in general health care;
  • health-care reform;
  • social care;
  • mental health in low-income countries


In the 19th century the mental health care systems were less influenced by the national architectures of general health care and the patients' needs than by the needs of society and by specific mental health ideologies of that day. With effective treatments lacking, mental hospitals, the centrepieces of the system, increasingly degenerated into total institutions. The result was social exclusion, stigmatization and inhuman treatment of the mentally ill. The rediscovery of human and civil rights after World War II and the advent of new treatments led to a drastic change from hospital-centred to community mental health care and its integration in general health care systems. As a result, quality of care and patients' quality of life have improved. Nevertheless, the seriously mentally ill continue to need support in various domains of life. Consequently, good mental health care needs well-organized cooperation with social care on the political, financial and practical level. Now, many countries are striving to reform their expensive health care systems, some with serious implications for mental health care. In low income countries extreme financial constraints and shortages of trained personnel cause serious problems to mental health care.