Breaking the mold

What a small Belgian town can teach us about approaching mental health differently

If you are anything like me, you probably like to travel. No, not another trip for work, but travel, travel! You know, the type of travel where you worry less about if your laptop is charged, and more about which book you have closest to you. The type of travel where you get out of your home, out of the country, see new sites, and experience different cultures and cuisines.

There’s a small Belgian town you may have not have heard of, Geel. It’s a small town of about 38,000 people Northeast of Brussels. I came across Geel when reading an article from 1976 entitled, A Model to Replace Psychiatric Hospitals. While this particular article focused on Denver, Colorado, and is a worthy read unto itself, it was the introduction section of this article that got me. You see, the authors carefully laid out the context of a “well known community care system in Geel, Belgium,” which I had never heard of. Sure, like many folks I get asked about other models of care in different parts of the world, so was surprised this one wasn’t on my radar. This, of course, led me down a research rabbit hole where I found some pretty interesting treasures.

Apparently Geel is renowned for its distinctive approach to caring for individuals with mental illness, which is rooted in its historical association with St. Dymphna. Legend has it that in the 7th century, she was martyred there by her father. Saint Dymphna was an Irish princess who sought refuge in the village of Geel in the seventh century. Following her tragic death, Dymphna was revered as a martyr and later designated as the patron saint of the mentally ill. This was all new to me!

Since then, those with mental illness have sought out this Saint and her tomb. These individuals, and their families, alongside their desire to find some help with mental illness, led to an evolution in this small town where a unique system of family care emerged.

Unlike traditional approaches to mental health, Geel's system emphasized much more the need to socially integrate the individual experiencing mental illness into the community. “Patients” lived with foster families, becoming part of a supportive household and broader social network rather than isolated or separated from social supports in a hospital.

What set Geel apart was its focus on the person — a true patient-centered approach that prioritized acceptance and gradual progress over predetermined pathways to health and well-being. Unlike modern mental health systems that seem to have one way in (good luck!) and one way out (without knowing what you got!), Geel encouraged patients to find their own pace towards better health all while receiving the non-judgmental support of their community.

Geel went along like this for centuries until in the mid-19th century, the system transitioned into a medically supervised government institution. The more I read about Geel, the more I saw how its success was in its ability to have the whole community come together to meet the needs of individuals, providing meaningful work and social opportunities, and foster a sense of community belonging. These are the magic ingredients!

I am such a punk rocker at heart that this very counter culture approach resonates with me. The Geel model challenged conventional views of mental health care, emphasizing the importance of compassion and kindness in supporting individuals dealing with whatever mental health issues they might be dealing with. In contrast to rigid care pathways and bureaucratic structures, Geel offered a simpler intervention: human connection. What’s not to love about this?

In summary, I think there’s a lot to learn from models like Geel. While not perfect, and I am sure there are a thousand things that could be done different to improve it, there’s something here we should pay attention to.

1. Community Integration and Acceptance: Geel's model emphasizes the integration of individuals with mental disorders into the community, with families accepting them as boarders. This approach challenges the stigma surrounding mental illness and fosters a supportive environment where individuals feel valued and included. There’s no isolation of social or structural stigma here!

2. Comprehensive Support and Flexibility: The Geel approach provides not only housing but also support tailored to individual needs, such as encouraging social connections and creative solutions to manage challenging behaviors. This more holistic approach acknowledges the diverse needs of individuals with mental illness and promotes their well-being beyond medical treatment alone.

3. Long-term Stability and Continuity of Care: Research indicates that boarders in Geel often experience stable living arrangements over many years, with some remaining in these supportive family homes for decades becoming a part of the family and community. This continuity of care contributes to the overall well-being and quality of life for these individuals , offering a sense of belonging and stability that is crucial for long-term recovery and support. This is true healing!

When I was in New York recently, I had a chance to stop by and visit my friends at Fountain House. Their unique clubhouse model may be the closest thing I have seen to something like Geel. While it’s not a city, it is a community; a community of people experiencing mental illness working together to help each other, their community, and the broader world. I highly encourage any of you when you are in New York City to stop by - it’s an inspiration and a challenge all in one visit.

As mental health care continues to evolve at snails pace, the lessons from Geel remind us of the profound impact of community support and individualized care. In a world where transactions often overshadow human connection, Geel stands out as a reminder that true healing begins with empathy and understanding all of which we have within us and our communities - let’s use it!