What is it about?
Mental health care is often delivered through separate organisations that do not always work effectively together. Hospitals, community mental health teams, primary care, housing services, and social support programmes may operate with different priorities, budgets, and responsibilities. This article explores how health and human services administrators can address this fragmentation and build better-connected community mental health systems. Drawing on the Italian experience of psychiatric reform and international guidance from the World Health Organization and OECD, it discusses the RISMe-T model (Integrated and Stepped Territorial Mental Health Network). The model organises services across four levels of care intensity, supported by shared governance, integrated information systems, and collaboration with service users and families. The article identifies three priorities for administrators: investing in prevention and accessible community support, coordinating services across organisational boundaries, and involving people with lived experience in planning and evaluating care. Rather than proposing a one-size-fits-all solution, it offers a practical framework for thinking about how mental health systems can contribute to healthier, more inclusive communities.
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Why is it important?
Improving community mental health care requires more than expanding individual services. It also requires changing how organisations coordinate decisions, allocate resources, share responsibilities, and measure success. This commentary translates principles of integrated, rights-oriented mental health care into practical questions for health and human services administration. It encourages policymakers and service leaders to invest in prevention and early support, strengthen coordination between healthcare and social services, and evaluate outcomes that matter to people, including recovery, social inclusion, and quality of life. Its central contribution is to frame mental health departments as coordinators of wider community networks, rather than simply providers of specialist treatment. RISMe-T offers a conceptual basis for organisational redesign and future evaluation. Its effectiveness in different settings remains to be empirically established.
Perspectives
Working within Italy’s public mental health system has reinforced my conviction that the quality of community care depends not only on clinical expertise, but also on how services are organised and connected. The Italian psychiatric reform demonstrated the importance of moving beyond institutional care. Yet closing psychiatric hospitals was only part of the challenge. Building accessible, coordinated, and sustainable community services remains an ongoing responsibility. I developed RISMe-T to help bridge the gap between the principles of community mental health and the administrative decisions needed to put them into practice. This commentary is particularly addressed to administrators and policymakers, whose decisions about governance, staffing, budgets, and accountability shape what services can actually deliver. My hope is that the model will stimulate critical discussion, practical experimentation, and comparative research, rather than being treated as a definitive organisational blueprint.
MD Paolo Camera
ASST Nord Milano
Read the Original
This page is a summary of: Organising Territorial Mental Health Networks for Healthy Communities: A Commentary on the RISMe-T Model, Journal of Health and Human Services Administration, April 2026, SAGE Publications,
DOI: 10.1177/10793739261446956.
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