Community Psychiatry in Hungary – Our Roots

Hungary has longstanding traditions in community psychiatry. Most inpatient psychiatric wards historically operated within general hospitals, and a strong humanistic approach shaped the field. Already from the 1920s, the first community-based outpatient clinics appeared, and after 1950 these services progressively developed, offering early forms of what we now recognize as community psychiatry.

Our Comprehensive Community Psychiatry Program

The modern pilot program of community psychiatry in Hungary was carried out by the Awakenings Foundation in Budapest, in close collaboration with the Centre of Community Psychiatry at Semmelweis University. From 1994, under the leadership of Dr. Judit Harangozó, we introduced and adapted Assertive Community Treatment, based on the work of Leonard Stein, and the Optimal Treatment Program developed by Ian Falloon.

We also established the principles of community addictology under the leadership of Dr. Andrea Bodrogi. Supported employment services were adapted and implemented by Tünde Bulyáki. Our team published handbooks, booklets and methodological materials for these fields.

Soon after 1994, we launched our own community psychiatry and addictology service in Budapest. Our model is built on recovery-orientation, family involvement, assertive outreach, psychoeducation, crisis prevention through monitoring early warning signs, optimal individualized pharmacotherapy, skills training, stress management, assertivity, and supported employment.

Rehabilitation plans are based on the personal life goals of service users and their families. We identify the difficulties that interfere with these goals and address them through a multidisciplinary team that includes peer supporters as full and valued coworkers. Nonviolent approaches and de-escalation strategies have always been fundamental to our practice.

Impact and International Collaborations

Our service has produced remarkable outcomes. After one year of community care, employment or learning rates increased from 15–20% to 55–65% across all diagnostic groups.

We have been active members of the World Psychiatric Association’s Antistigma programme and received volunteer training from Norman Sartorius. Our colleagues took part in international stigma research led by Graham Thornicroft at King’s College London. We cooperate closely with Agnes Rupp from the NIMH (USA) in the field of mental health policy and economics. More than 300 of our publications relate to these professional activities. Staff members of the Foundation regularly contribute to undergraduate and postgraduate training for medical doctors, nurses, social workers and psychologists.

Innovation and Coproduction

Continuous innovation is one of our core principles. We implemented the Hearing Voices approach in 2012 and adopted the organizational culture of Coproduction, understanding mental health as a shared creation of service users and professionals. We train peer supporters and involve them in every aspect of our work, from clinical support to education and research.

We provide several online services, including therapy, self-help groups, digital platforms, applications and online peer support. Our professional leader is the co-chair of the “Mental Health Economics” section of the World Psychiatric Association.

One of our peer supporters, Peter Kéri, is a board member of the European Psychiatric Association and President of GAMIAN-Europe, the leading umbrella organization for user-centered mental health associations in Europe.

National Development and Methodology Transfer

In the early 2000s, community psychiatry became part of the renewed Hungarian Social Act. More than 100 new community services were established nationwide for psychiatric and addictology care. Their methodological foundation was the community psychiatry pilot program developed by our foundation.

Our colleagues and peer supporters designed, wrote and delivered the official national training programs for the staff of these services, supported by governmental frameworks and professional organizations.