Kamusal Bir Hak Olarak Ruh Sağlığı Hizmetlerine Erişim: Türkiye’de Toplum Temelli Ruh Sağlığı Politikalarının Karşılaştırmalı Analizi

Abstract

Ruhsal iyilik hâli temel bir insan hakkı ve kamusal politika alanıdır. Buna karşın ruh sağlığı hizmetlerinin kapsayıcılığı, yalnızca klinik kapasiteyle değil; bütçeleme tercihleri, hizmet organizasyonu, damgalama, sosyal eşitsizlikler ve politika tasarımıyla yakından ilişkilidir. Bu çalışma, Türkiye’de toplum temelli ruh sağlığı politikalarını hak temelli bir perspektiften incelemekte ve seçili ülke örnekleriyle karşılaştırmalı olarak değerlendirmektedir. Araştırmada nitel doküman incelemesine dayalı karşılaştırmalı kamu politikası analizi ile eleştirel politika analizi birlikte kullanılmıştır. İngiltere, İtalya, Kanada, Japonya ve Çin örnekleri; hizmet sunum modeli, birinci basamak entegrasyonu, insan kaynağı ve kurumsal kapasite, veri-izleme mekanizmaları ve önleyici politika araçları bakımından incelenmiştir. Türkiye’de ruh sağlığı hizmetlerine ilişkin düzenli ve karşılaştırılabilir veri setlerinin sınırlı olması, çalışmanın yöntemsel tercihlerini belirleyen önemli bir unsur olmuştur. Bulgular, Türkiye’de toplum temelli modele geçiş yönünde önemli kurumsal adımlar atıldığını; ancak TRSM’ler, birinci basamak yapıları ve diğer toplum temelli hizmet bileşenleri arasında eşgüdüm, standardizasyon, performans izleme ve sosyal belirleyicilere duyarlı önleyici kapasite bakımından sınırlılıklar bulunduğunu göstermektedir. Sonuç olarak çalışma, Türkiye’de temel sorunun kurumsal yapıların yokluğundan çok, mevcut yapıların bütünleşik, erişilebilir ve ölçülebilir bir kamu hizmeti rejimine dönüştürülememesi olduğunu savunmakta ve bu doğrultuda veri temelli, çok aktörlü ve hak odaklı politika iyileştirmeleri önermektedir.

Keywords

• İnsan hakları
• Ruh sağlığı hizmetlerine erişim
• Toplum temelli ruh sağlığı politikası
• Karşılaştırmalı kamu yönetimi
• Kamu politikası analizi

Access to Mental Health Services as a Public Right: A Comparative Analysis of Community-Based Mental Health Policies in Türkiye

Abstract

Mental well-being is a fundamental human right and a key public policy domain. However, the inclusiveness of mental health services depends not only on clinical capacity but also on budgeting priorities, service organization, stigma, social inequalities, and policy design. This study examines community-based mental health policies in Türkiye from a rights-based perspective and provides a comparative analysis with selected country cases. The research employs a qualitative document-based comparative public policy analysis combined with critical policy analysis. England, Italy, Canada, Japan, and China are analysed in terms of service delivery models, primary care integration, workforce and institutional capacity, data monitoring mechanisms, and preventive policy instruments. Given the limited availability of systematic and comparable data on mental health service utilization and system performance in Türkiye, the study adopts a document-based analytical approach. Findings indicate that while Türkiye has taken significant institutional steps toward a community-based model, important limitations persist in coordination, standardization, performance monitoring, and preventive capacity sensitive to social determinants. The study argues that the main problem in Türkiye is not the absence of institutional structures, but the limited capacity to transform existing mechanisms into an integrated, accessible, measurable public service system. Accordingly, it proposes data-driven, multi-actor, and rights-based policy improvements.

Keywords

• Human rights
• Access to mental health services
• Community-based mental health policy
• Comparative public administration
• Public policy analysis

References

1. KAYNAKÇA Aoki, A. Sugiura, K. & Akiyama, T. (2025). Overview of the Japanese mental health services through legislation, policies, and recent initiatives: a narrative review. International Review of Psychiatry, 37(3-4), 397-408.
2. Artukoğlu-Kayacan, P. ve Kılıç, B. (2023). Türkiye’de toplum ruh sağlığı hizmetleri: Kalitatif bir çalışma. Halk Sağlığı Araştırma ve Uygulamaları Dergisi, 1(1), 56–64.
3. Babaoğlu, C. ve Yılmaz, F. H. (2021). Kamu politikası analizi: Yöntemler ve teknikler. Nobel Kitap.
4. Bacchi, C. (2009). Analysing policy: What’s the problem represented to be? Pearson.
5. Bacchi, C. (2016). Problematizations in health policy: Questioning how “problems” are constituted in policies. SAGE Open, 6(2), 1-16.
6. Badano, V. (2024). The Basaglia Law. Returning dignity to psychiatric patients: The historical, political, and social factors that led to the closure of psychiatric hospitals in Italy in 1978. History of Psychiatry, 35(2), 226-233.
7. Barbui, C., Papola, D., & Saraceno, B. (2018). Forty years without mental hospitals in Italy. International Journal of Mental Health Systems, 12(1), 43.
8. Bartram, M., & Chodos, H. (2013). Changing Directions, Changing Lives: The mental health strategy for Canada calling for critical deliberation on implementation. Canadian Journal of Community Mental Health, 32(4), 1-8.

9. Bilir-Uslu, M. K. (2022). Mental healthcare policy reform in Turkey: A qualitative study on the perspectives of user groups. Toplum ve Sosyal Hizmet, 33(1), 113-132.
10. Bongiorno, V. (2013). Proposals for mental health in Italy at the end of the nineteenth century: between utopia and anticipating the “Basaglia Law.” Clinical Practice and Epidemiology in Mental Health, (9), 210-213.
11. Chen, R., Zhang, W., & Wu, X. (2023). Mental health policy and implementation from 2009 to 2020 in China. SSM - Mental Health (4), 1-5.
12. Chodos, H. (2017). The path to national mental health policy in Canada. Canadian Journal of Community Mental Health, 36(4), 145-158.
13. Clark, D. M. (2018). Realizing the mass public benefit of evidence-based psychological therapies: the IAPT program. Annual Review of Clinical Psychology, 14(1), 159–183.
14. Dönmez, A. ve Çam, O. (2021). Dünyada ve Türkiye’de toplum ruh sağlığı hizmetleri. Aylaz, R. ve Dönmez, A. (Ed.), Toplum ruh sağlığı hemşireliği (2-10). İstanbul Tıp Kitabevi.
15. Ertürk-Keskin, N. (2024). Kamu yönetiminde karşılaştırma yöntemi. Şat, N. (Ed.), Kamu yönetiminde nitel araştırma (73-85). Nobel Akademik Yayıncılık.
16. Fioritti, A. (2018). Is freedom (still) therapy? The 40th anniversary of the Italian mental health care reform. Epidemiology and Psychiatric Sciences, 27(1), 319-323.
17. Garratt, K. (2024). Mental health policy and services in England. House of Commons Library. https://commonslibrary.parliament.uk/research-briefings/cbp-7547/
18. Government of Canada. (2025). Suicide in Canada. https://www.canada.ca/en/public-health/services/suicide-prevention/suicide-canada.html
19. Gül, H. (2015). Kamu politikası analizi, yöntemleri ve teknikleri. Yasama Dergisi, (29), 5-31.
20. Harvey, D. (2005). A brief history of neoliberalism. Oxford University Press.
21. Heidenheimer, A. J., & Elvander, N. (1990). Comparative public policy: The politics of social choice in America, Europe, and Japan. St. Martin’s Press.
22. Kasai, K., Ando, S., Kanehara, A. Kumakura, Y., Kondo, S., Fukuda, M., Kawakami, N., & Higuchi, T. (2017). Strengthening community mental health services in Japan. Lancet Psychiatry, 4(4), 268-270.
23. Kawakami, N., & Tsutsumi, A. (2016). The Stress Check Program: A new national policy for monitoring and screening psychosocial stress in the workplace in Japan. Journal of Occupational Health, 58(1), 1–6.
24. Kuno, E., & Asukai, N. (2000). Efforts toward building a community-based mental health system in Japan. International Journal of Law and Psychiatry, 23(3–4), 361–373.
25. Lal, S. (2019). E-Mental health: Promising advancements in policy, research, and practice. Healthcare Management Forum, 32(2) 56-62.
26. Liang, D., Mays, V., & Hwang, W. (2018). Integrated mental health services in China: Challenges and planning for the future. Health Policy and Planning, (33), 107-122.
27. Lund, C., Breen, A., Flisher, A. J., Kakuma, R., Corrigall, J., Joska, J., ... and Patel, V. (2011). Poverty and common mental disorders in low and middle income countries: A systematic review. Social Science and Medicine, 71(3), 517–528.
28. Marmot, M. (2010). Fair society, healthy lives (The Marmot review). Institute of Health Equity. https://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review
29. Mental Health Commission of Canada (MHCC). (2012). Changing Directions, Changing Lives: The Mental Health Strategy for Canada. https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/MHStrategy_Strategy_ENG.pdf
30. Mental Health Commission of Canada (MHCC). (2017). Mental Health Strategy for Canada. Ottawa.
31. Ministry of Health, Labour, and Welfare of Japan. (2024). The 2024 – White Paper on Suicide Countermeasures. https://www.mhlw.go.jp/content/001464705.pdf
32. Navarro, V. (2007). Neoliberalism, globalization, unemployment, inequalities, and the welfare state. International Journal of Health Services, 37(1), 1–25.
33. Ng, C., Setoya, Y., Koyama, A., & Takeshima, T. (2010). The ongoing development of community mental health services in Japan: Utilizing strengths and opportunities. Australian Psychiatry, 18(1), 57-62.
34. Nishi, D., Ishikawa, H., & Kawakami, N. (2019). Prevalence of mental disorders and mental health service use in Japan. Psychiatry and Clinical Neurosciences, (73), 458–465.
35. Organisation for Economic Co-operation and Development – OECD. (2021). Fitter minds, fitter jobs: from awareness to change in integrated mental health, skills, and work policies. https://www.oecd.org/content/dam/oecd/en/publications/reports/2021/11/fitter-minds-fitter-jobs_81033d43/a0815d0f-en.pdf
36. Office for National Statistics of United Kingdom – Population Health Monitoring Group. (2025). Quarterly suicide death registrations in England: 2001 to 2023 registrations and quarter 1 to quarter 4 - 2024 provisional data. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/quarterlysuicidedeathregistrationsinengland/2001to2023registrationsandquarter1jantomartoquarter4octtodec2024provisionaldata
37. Parsons, W. (1995). Public policy: an introduction to theory and practice of policy analysis. Edward Elgar Publishing.
38. Pfeiffer, J., & Chapman, R. (2010). Anthropological perspectives on structural adjustment and public health. Annual Review of Anthropology, 39(1), 149–165.
39. Pollard, T., & Howard, N. (2021). Mental healthcare for asylum‑seekers and refugees residing in the United Kingdom: A scoping review of policies, barriers, and enablers. International Journal of Mental Health Systems, 15(1), 1-15.
40. Ronchetti, C., Toffolutti, V., McKee, M., & Stuckler, D., (2025). The quantification of the psychiatric revolution: a quasi-natural experiment of the suicide impact of the Basaglia Law. The European Journal of Public Health, 30(3), 492-496.
41. Saha Merkezi. (2023). 2000–2023 yılları arası intihar verileri çalışma raporu. https://sahamerkezi.org/2000-2023-yillari-arasi-intihar-verileri-calisma-raporu/
42. T.C. Sağlık Bakanlığı. (2020). Ulusal Ruh Sağlığı Eylem Planı (2021-2023). https://hsgm.saglik.gov.tr/depo/Yayinlarimiz/Eylem_Planlari/Ulusal_Ruh_Sagligi_Eylem_Plani_2021-2023.pdf
43. T.C. Sağlık Bakanlığı. (2024). Toplum Ruh Sağlığı Merkezleri (TRSM) Listesi. https://khgmsaglikhizmetleridb.saglik.gov.tr/TR,43118/toplum-ruh-sagligi-merkezleri-trsm-listesi.html
44. T.C. Sağlık ve Sosyal Yardım Bakanlığı – SSYB. (1973). Sağlık hizmetlerinde 50. yıl. SSYB Yayınları.
45. Taylor, S. (1997). Critical policy analysis: Exploring contexts, texts, and consequences. Discourse: Studies in the Cultural Politics of Education, 18(1), 23–35.
46. Thornicroft, G., & Tansella, M. (2004). Components of a modern mental health service: a pragmatic balance of community and hospital care. British Journal of Psychiatry, 185(4), 283-290.
47. Türk Psikiyatri Derneği (TPD). (2020). Toplum Ruh Sağlığı Merkezleri Görev Grubu Çalışma Raporu. https://psikiyatri.org.tr/uploadFiles/128202016824-TRSMGGRaporu1282020.pdf
48. Türkiye İstatistik Kurumu. (2025). İntihar sayısı ve kaba intihar hızı, 1975-2024. https://share.google/YDWSa6lGKY15uexxz
49. Twenge, J. M., & Campbell, W. K. (2018). Associations between screen time and lower psychological well-being among children and adolescents: evidence from a population-based study. Preventive Medicine Reports, 12, 271–283.
50. Wakefield, S., Kellett, S., Simmonds-Buckley, M., Stockton, D., Bradbury, A., & Delgadillo, J. (2021). Improving Access to Psychological Therapies (IAPT) in the United Kingdom: a systematic review and meta-analysis of 10-years of practice-based evidence. British Journal of Clinical Psychology, 60(1), 1-37.
51. Wang, J., Pasyk, S. P., Slavin-Stewart, C., & Olagunju, A. T. (2024). Barriers to mental health care in Canada identified by healthcare providers: a scoping review. Administration and Policy in Mental Health and Mental Health Services Research, (51), 826–838.
52. World Health Organization – WHO [Dünya Sağlık Örgütü – DSÖ]. (1948). Constitution of the World Health Organization. https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1
53. World Health Organization – WHO [Dünya Sağlık Örgütü – DSÖ]. (2001). Atlas: mental health resources in the world 2001. World Health Organization. https://www.who.int/publications/i/item/WHO-NMH-MSD-MDP-01.1
54. World Health Organization – WHO [Dünya Sağlık Örgütü – DSÖ]. (2025). Suicide rates. https://www.who.int/data/gho/data/themes/mental-health/suicide-rates
55. Xiang, Y., Yu, X., Sartorius, N., Ungvari, G., & Chiu, H. (2012). Mental health in China: Challenges and progress. The Lancet, 380(9855), 1715-1716.
56. Xu, Z., Gahr, M., Xiang, Y., Kingdon, D., Rüsch, N., & Wang, G. (2022). The state of mental health care in China. Asian Journal of Psychiatry, (69), 1-8.
57. Yan, J., Yu, X., & Zhang, X. (2023). The development and evolution of community mental health policies in China from 1998 to 2013. Chinese Centre for Disease Control and Prevention, 5(40), 900-908.