Table 4 Overview results comparative, normative and felt need

(1) Comparative need (gap between what services exist in one area and what services exist in another)

(1) Country comparison

Mental health care remains largely institutionalized evidenced by a far higher number of beds per mental hospital (690) and a higher number of mental hospital beds per 100,000 population (59.8) in 2014 than both the SEEHN (376.97 and 47.63) and EU15 average (184.6 and 36.6). In contrast with an average decline of the number of mental hospitals per 100.000 population both in the SEEHN (− 11.77%) and the EU15 countries (− 23.31%) Moldova has shown no decline in number of mental hospitals between 2011 and 2014

(2) Normative need (what the expert or professional, administrator or social scientist defines as need)

(2.1) Comparison Moldovan mental health services structure with norms WHO

The Moldovan mental health services structure shows an inversion of the WHO ‘Pyramid Framework’. In other words, long-stay facilities and specialist services provide the bulk of care, followed by traditional outpatient services, with limited services offered in the community by primary care-, social care- or mental health care professionals. Informal services seem underdeveloped with little to no involvement of community stakeholders

(2.2) Perspective of professionals involved in the reform including health care practitioners, health care managers and implementation team members

The majority of professionals (82.8%) were in favour of a mental health services reform. A number of issues and reform needs were expressed by the professionals with the most mentioned being the need to (1) deinstitutionalise and implement a CBMHS model with integrated services; (2) reintegrate service users in society, community and family; (3) improve access and quality of services; (4) improve governance and finance; and (5) address health workforce issues

(3) Felt need (what the population feel they need)

(3) Perspective of care recipients of services involved in the reform including service users and carers

Almost all care recipients (92.3%) were in favour of a mental health services reform. A number of issues and reform needs were expressed largely in line with the responses of the professionals, but in a different order based on their frequency mentioned with the need to (1) improve the access and quality of services; (2) reintegrate in society, community and family; (3) deinstitutionalise and implement CBMHS; (4) address problems with medicines and technology and (5) address health workforce issues