Assessing the structure of mental health service networks in Belgium: implications for recovery-oriented systems of care

Service collaboration ensures care continuity and recovery-oriented care for individuals with mental disorders (MD). A recovery-oriented system of care (ROSC) encompasses diverse person-centred services that collaborate to address individual needs and foster social integration. We examined the characteristics of care provision for individuals with MD in Belgium with regard to ROSC principles. Specifically, we analysed the structure of collaboration within existing mental health service networks, focusing on the division between mental health services and specialised services for substance use disorders (SUD). We conducted an online survey involving 309 services across five networks, of which 190 participated. We collected data on referrals and service characteristics. We used Social Network Analysis (SNA) to assess collaboration patterns within service networks, considering network density (i.e. number of ties), transitivity (i.e. tendency toward clustered collaboration), degree distribution (i.e. concentration of ties around certain services), service attributes (e.g. category, care function, and exclusion criteria), and homophily (i.e. tendency to connect with similar services). Exponential Random Graph Model (ERGM) was used to test whether observed collaboration patterns differed from random collaboration. Hospital units and specialised SUD services were central services. Specialised SUD services and generic mental health services were more likely to collaborate with similar services. Likewise, services with the same care function were more likely to collaborate, except hospital units. Networks showed significant transitivity. Mental health service networks appear to be structured around organisational boundaries, with limited collaboration between complementary services and a highly hospital-centred configuration. These patterns suggest a misalignment with ROSC principles and may constrain the capacity of care systems to support recovery processes.