Optimizing Community Mental Health Teams (CMHTs) Implementation: Key Factors to Consider in Central and Eastern Europe

Abstract

Background: Severe mental illness (SMI), including psychotic and major depressive disorders, poses a significant global public health challenge, especially in Central and Eastern Europe, where care remains largely institutionalized. This study, part of the RECOVER-E project (Shields-Zeeman et al., 2020), aims to understand the contextual factors influencing the implementation of Community Mental Health Teams (CMHTs) in five Central and Eastern European countries: Bulgaria, Croatia, North Macedonia, Montenegro, and Romania. Methods: Using the Consolidated Framework for Implementation Research (CFIR), a pragmatic formative evaluation was conducted through focus groups, interviews, and observations at each site to identify barriers and facilitators to implementation. Results: Key barriers included intersectoral fragmentation, inadequate financing, high staff turnover, unclear role definitions, hierarchical structures, and stigma towards peer workers and individuals with SMI. Facilitators included prior experience with community mental health initiatives, broad stakeholder support, and positive attitudes toward home visits. Conclusion: The study highlights the importance of addressing overlapping barriers and enhancing facilitators across multiple CFIR domains to develop effective implementation strategies for CMHTs. It emphasizes the need for integrating health and social care services, defining clear roles, and launching anti-stigma campaigns. These findings underscore the importance of pre-implementation context analysis to tailor interventions effectively and enhance their sustainability.