Community-based care in Belgium is stagnating
In recent years, Belgian mental health care has taken clear steps toward providing more care within the patients’ own living environments. Since the introduction of mental health care networks in 2010, with Article 107 serving as a lever for community-based care, there has been an explicit focus on collaboration, early detection, and care outside the hospital setting.
The strengthening of primary care psychological services in recent years has also significantly improved accessibility for individuals with mild to moderate symptoms (RIZIV, 2025). At the same time, recent evaluations, including the Health System Performance Assessment by the KCE (2024), show that the overall performance of mental health care is lagging, with persistent bottlenecks in the continuity of care and the follow-up of outpatient trajectories.
However, as soon as the issues become more complex, ambiguity often arises. Patients do not always easily find their way to specialized outpatient care. In practice, they sometimes remain in a primary care context for too long, even when their care needs exceed the limits of that setting. This is not without risk, especially for conditions such as treatment-resistant depression, psychosis, or bipolar disorder, where timely specialized intervention is essential.
This is related to how the system is structured today. A clearly organized, broadly accessible outpatient secondary line is missing between primary care and residential care. Furthermore, European comparisons show that despite the reforms since 2010, Belgium still ranks among the countries with a relatively high capacity of psychiatric hospital beds, while outpatient structures are less robustly developed (European Commission; Eurostat). The result is a system that struggles to scale up when care intensity increases.
Significant consequences for patients and society
The impact of this is concrete. Waiting times in specialized mental health care are not just an organizational problem; they have demonstrable effects on outcomes. For instance, the probability of returning to work decreases by approximately 2% for every month spent on a waiting list for specialized care (Prudon, 2023).
Furthermore, mental health conditions are responsible for approximately 37% of all long-term work disability in Belgium, accounting for an annual cost of around 2 billion euros in benefits (RIZIV, 2023). At the European level, the total economic impact of mental health conditions is estimated at more than 4% of GDP, primarily due to loss of productivity (OECD/EU).
When care is not scaled up in time, the risk of crises and hospitalizations also increases. Belgium remains characterized by a relatively high number of psychiatric admissions, and figures show a further increase in involuntary admissions in recent years (Zorgnet-Icuro, 2022; VRT NWS, 2025). This points to a system that often only intervenes when problems are already far advanced.
At the same time, international literature consistently shows that well-organized, integrated outpatient care leads to fewer crises, fewer hospitalizations, and better functional outcomes. Models such as collaborative care, in which psychiatric expertise is structurally integrated into outpatient settings, show significant improvements in treatment results (WHO, 2022; American Psychiatric Association, 2025).
The crucial link of outpatient psychiatry
Within a well-functioning network, outpatient psychiatry can play a vital role. It makes it possible to follow up with patients with more complex needs outside the hospital, with a focus on diagnostics, treatment, and coordination. This creates continuity and allows for faster adjustments when the situation changes.
International models also demonstrate that the involvement of psychiatrists in outpatient and primary care settings significantly improves clinical outcomes, particularly for depression and anxiety disorders within collaborative care structures (American Psychiatric Association, 2025).
Today, this role is not yet sufficiently anchored within the mental health care networks. This makes it difficult for care trajectories to proceed smoothly and leads to differences between regions and networks. For referring physicians, it is also not always clear where they can send their patients.
Toward a more coherent, integrated model
From the BFAP, we advocate for a next step in the development of mental health care networks, fifteen years after their inception. Not by fundamentally redesigning the existing model, but by completing it where it currently falls short. This means, among other things, that specialized outpatient care must become more clearly organized and visible within each network.
One possible implementation is the provision of a central point of contact for the outpatient secondary line, where patients and referring physicians can go for orientation and referral. Such models make it possible to better map waiting times and capacity and to provide more targeted management—something that is currently hindered by the lack of integrated data on outpatient trajectories (KCE, 2024).
At least as important is the need for clarity regarding responsibilities. The current fragmentation across different levels and structures makes it difficult to oversee and adjust the whole. International policy frameworks emphasize the importance of clear governance and integrated, community-based care models (WHO; European Commission).
The mental health care networks have laid the foundation for more integrated mental health care. To make this model work further in practice, it is necessary to strengthen the missing links. The development of a clear outpatient secondary line is a logical next step in this process.
References
HealthyBelgium. (2024, February 1). Mental health care networks for adults. Toward a Healthy Belgium.
European Commission. (n.d.). Mental health care – psychiatric hospital beds. Eurostat.
European Commission. (n.d.). Mental Health Services in the Community.
RIZIV. (2023). Work disability in 2023: How many people are on disability due to depression or burnout? How much does that cost in benefits?
HealthyBelgium. (2024, February). Mental health care networks for adults – Toward a healthy Belgium.
RIZIV. (2025). Providing primary care psychological services via mental health networks.
Zorgnet-Icuro. (2023). The myths questioned: Results of the Public Mental Health Monitor 2023.
Prudon, R. (2023, August 16). Chance of employment decreases due to long mental health care waiting lists. ESB.
Zorgnet-Icuro. (2022). Increase in the number of involuntary admissions continues.
VRT NWS. (2025, May 20). An average of 14 involuntary admissions in Flemish psychiatric hospitals per day.
American Psychiatric Association. (2025). Collaborative Care Model.