In Belgium, access to mental healthcare is difficult to evaluate properly, as it is not a federalized field. For instance, psychiatric services, outpatient mental healthcare, and psychologists all follow different systems and regulations. Therefore, there is no standardized data on mental healthcare coverage in Belgium. Nonetheless, certain indicators can provide valuable insight into access to mental healthcare in the country.
Due to their key role in the mental healthcare system and the lack of available data on other actors, the number of active psychiatrists is an international indicator of access to mental healthcare. In 2017, the number of psychiatrists in Belgium increased to just under 2 thousand. A relatively low number when compared to the 14 thousand psychologists practicing in the country.
Mental, social, or psychological concerns represented 1.6 percent of admissions in Belgian hospital emergency services. The use of emergency units for psychological reasons can reflect a lack of consistency in a country’s access to mental healthcare. Such services would not be used as a solution if people had access to outpatient mental care and could start being treated before reaching a critical state. One possible reason for such lacking access to outpatient care could be the long waiting times for consultations. According to mental healthcare centers in Flanders, the average waiting time for a consultation increased from 40 days in 2013 to over 50 days in 2018. Longer waiting times also lead to less patients arriving for consultations.
In the last ten years, Belgium reformed its mental healthcare sector towards deinstitutionalization. This restructuring of mental healthcare aims at keeping people who suffer from mental illness functioning in their everyday life and social environment, rather than in institutions. In other words, the focus of mental healthcare is no longer on psychiatric hospitals only. Therefore, a decreasing number of psychiatric hospital stays was recorded. However, over the years, the length of stays in Belgium’s psychiatric facilities increased. Belgium, like many other European countries, regulated the criteria for forced admissions to protect the mentally ill. Paradoxically, the rate of involuntary admissions in psychiatric hospitals increased steadily. Although forced admissions can reveal crisis episodes, they can also uncover to what extent the healthcare system can provide alternative health options in more complex cases.
The rate of readmission under 30 days to a psychiatric facility is widely used as an indicator of the number of relapse or complications after a stay in a psychiatric hospital. It can also indicate an early discharge, a lack of coordination between outpatient and inpatient healthcare, or a lack of treatment continuity. In 2016, the most recent data available, the rate of readmission under 30 days in a psychiatric hospital reached 14 percent in Belgium. However, as Belgium does not use a unique patient identification number, it is impossible to follow a patient’s use of health care services and to properly evaluate the readmission rates.
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