Psychological Medicine

Original Articles

The balanced care model for global mental health

G. Thornicrofta1 c1 and M. Tansellaa2

a1 Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, UK

a2 Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Italy

Background For too long there have been heated debates between those who believe that mental health care should be largely or solely provided from hospitals and those who adhere to the view that community care should fully replace hospitals. The aim of this study was to propose a conceptual model relevant for mental health service development in low-, medium- and high-resource settings worldwide.

Method We conducted a review of the relevant peer-reviewed evidence and a series of surveys including more than 170 individual experts with direct experience of mental health system change worldwide. We integrated data from these multiple sources to develop the balanced care model (BCM), framed in three sequential steps relevant to different resource settings.

Results Low-resource settings need to focus on improving the recognition and treatment of people with mental illnesses in primary care. Medium-resource settings in addition can develop ‘general adult mental health services’, namely (i) out-patient clinics, (ii) community mental health teams (CMHTs), (iii) acute in-patient services, (iv) community residential care and (v) work/occupation. High-resource settings, in addition to primary care and general adult mental health services, can also provide specialized services in these same five categories.

Conclusions The BCM refers both to a balance between hospital and community care and to a balance between all of the service components (e.g. clinical teams) that are present in any system, whether this is in low-, medium- or high-resource settings. The BCM therefore indicates that a comprehensive mental health system includes both community- and hospital-based components of care.

(Received January 11 2012)

(Revised May 29 2012)

(Accepted May 29 2012)

(Online publication July 11 2012)

Key words

  • Community mental health;
  • global mental health;
  • health service research;
  • needs assessment


c1 Address for correspondence: G. Thornicroft, Professor of Community Psychiatry, Health Service and Population Research Department, King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. (Email: