What do Belgium and Japan have in common, besides a friendship spanning more than 160 years? 🇧🇪🤝🇯🇵
More than meets the eye. Both countries struggle with a significant gap between inpatient and outpatient mental health care. Engaging in this debate without increasing the tension between these two forms of care is not easy. That is precisely why BFAP chooses a constructive approach.
In Belgium, approximately half of the people with a genuine need for specialized mental health care do not receive appropriate treatment or must wait for months or even years. At the same time, Belgium has the highest psychiatric bed density in the European Union; Japan has the highest within the OECD. This is not the result of “good” or “bad” choices, but of historically developed funding models. The strong inpatient tradition in Belgium even dates back to the mid-19th century.
Today, outpatient psychiatry is still reimbursed significantly lower than inpatient care. The consequences are clear: according to national figures, approximately one in five psychiatrists is over the age of 65, while young colleagues are increasingly less likely to choose an outpatient career and are more often attracted by the higher remuneration within hospitals. Not because outpatient care is less valuable, but because the current system makes it increasingly difficult to remain viable.
BFAP identifies three important building blocks for the future:
→ Balanced funding for outpatient care, protected living, mobile teams, and inpatient psychiatry, fully in line with the objectives of Article 107.
→ Timely access to specialized outpatient care, so that patients receive care that aligns with their needs from the very beginning.
→ Management of the care pathway by outpatient providers – psychiatrists, psychotherapists, and specialized nurses – so that admission only occurs when clinically necessary, and is not influenced by available beds or financial incentives.
Inpatient psychiatry naturally remains indispensable for acute crises and complex or therapy-resistant conditions. The goal is therefore not to dismantle hospital care, but to restore the balance between both forms of care. That debate can only be conducted fairly when both sectors are supported in an equivalent manner.
Mental health conditions currently cost Belgium an estimated 28 billion euros per year – approximately 5% of GDP. According to the WHO and The Lancet, every euro invested in mental health care yields an average of four euros in social and economic profit. The time to invest is now.
The UN Convention on the Rights of Persons with Disabilities (UN CRPD) also emphasizes that people have the right to treatment as well as inclusion in their own community. A society that recognizes unbearable psychological suffering must also guarantee that quality care is accessible in a timely manner.
BFAP is particularly honored that this vision could be presented during the congress of the Japanese Society of Psychiatry and Neurology (JSPN) in Yokohama. International cooperation and knowledge exchange are essential to building a more accessible, person-centered, and future-proof mental health care system together.