M. Kardelen Bilir Uslu

This article presents the historical transformation of the mental health system and policies in the case of Turkey and discusses the challenges to their effective implementation. The mental health system in Turkey has undergone a series of reforms in three periods, namely, the institutionalization of psychiatry and hospital-based mental health services in the mid-19th century, the introduction of first-generation community-based mental healthcare services in the 1960s, and the policy of deinstitutionalization after the 1980s. In this transformation process, certain initiatives have been implemented with the participation of interested actors across periods and small but important improvements. A draft has been prepared after a series of studies were conducted with regard to mental health policies and plans. However, no results have been obtained. The necessity of the mental health law has been clear. A notion that has been known is that the mental health law, which offers a holistic perspective, positively influences the functioning of the mental health system in terms of service users and providers. However, whether or not it actually pursues these intended improvements has been subject to doubt. Until now, no mental health law has been effectively implemented in Turkey, and measuring and evaluating in which aspects the law will be successful and where it will fail have been impossible. Turkey continues to be in need of a mental health law is practical and in line with international standards for the rights of patients and supervision against coercive measures.

The mental health policy of Turkey has been undergoing a transformation process since 2006. This change aims to prioritize the establishment of community-based mental health care services and to organize an accessible mental healthcare service network across the country. The principal aim is to analyze the politics of mental health policy change in Turkey and to understand the role of user groups in this process by a qualitative analysis of the views of mental health user groups on these transformations. In this context, semistructured interviews were conducted with representatives (n = 13) of patient organizations based in Istanbul, Ankara, and İzmir. This article reveals that this policy change took the form of the balanced care model, and introducing community-based mental health care centers provided to increase the utilization of mental health care services. However, the services in community-based
settings were questioned by the respondents because of their purely medical approach to users’ recovery processes and this policy change falls short of introducing a holistic perspective to the Turkish mental health care system that would facilitate recovery not only through medical support but also through social support that would empower individuals living with mental health issues.

This article offers a critical examination of the 2006 Turkish mental healthcare reform aimed at deinstitutionalisation and introduction of a community-based approach. Combined with Turkey’s ratification of the Convention on the Rights of Persons with Disabilities, the rhetoric of the reform signified a step towards a rights-based approach. Despite some evidence of progress towards deinstitutionalization, this article suggests that the reform has largely failed in its goal of implementing a rights-based approach, for three reasons: its inability to address unmet needs for mental healthcare, its failure to complement community-based mental healthcare provision with social policy programmes, and its deficiency in legislating civil rights protections. These failures have engendered an ineffective trend towards deinstitutionalisation rather than facilitating the transition to independent living. Finally, this article calls for a nuanced understanding of deinstitutionalisation, with consideration of the broader social policy and civil rights environment within which the mental healthcare system is embedded.