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In the report “How healthy is mental health care in Belgium?” Itinera charts the deficiencies of mental health care. Mental illnesses are the primary cause of invalidity in Belgium, 27% of long term absenteeism is related to mental issues and life expectancy of psychiatric patients is on average 15 year shorter. One in two patients does not receive care, only 25% receives appropriate care. Care provision occurs often too late. On a global scale, Belgium remains in the lead of admitting patients to residential care organizations. Belgium falls behind and needs to step up policy action urgently. Itinera recommends fundamental reforms of the financial structure of mental health care, to integrate care in society as an alternative for residential stay, to position quality of care centrally within the self interest of all actors, to encourage early detection and to address existing prevention and care needs.