ORIGINAL PAPER Outsourcing Mental Health Care Services? The Practice and Potential of Community-Based Farms in Psychiatric Rehabilitation Sorana C. Iancu • Marjolein B. M. Zweekhorst • Dick J. Veltman • Anton J. L. M. van Balkom • Joske F. G. Bunders Received: 15 March 2013 / Accepted: 16 June 2014 / Published online: 26 June 2014 Ó Springer Science+Business Media New York 2014 Abstract Psychiatric rehabilitation supports individuals with mental disorders to acquire the skills needed for independent lives in communities. This article assesses the potential of outsourcing psychiatric rehabilitation by ana- lysing care farm services in the Netherlands. Service characteristics were analysed across 214 care farms retrieved from a national database. Qualitative insights were provided by five case descriptions, selected from 34 interviews. Institutional care farms were significantly lar- ger and older than private care farms (comprising 88.8 % of all care farms). Private, independent care farms provide real-life work conditions to users who are relatively less impaired. Private, contracted care farms tailor the work activities to their capacities and employ professional supervisors. Institutional care farms accommodate for the most vulnerable users. We conclude that collaborations with independent, contracted and institutional care farms would provide mental health care organizations with a diversity in services, enhanced community integration and a better match with users’ rehabilitation needs. Keywords Farms Á Rehabilitation Á Community integration Á Outsourcing professionalization Á Logistic regression Introduction Psychiatric rehabilitation aims to provide individuals with mental disorders with the skills needed for an independent life in the community (Anthony et al. 2002). The role of psychiatric rehabilitation professionals is to help individ- uals identify their preferred roles in the ‘‘real world’’ and to link them to opportunities in communities where such roles can be practiced (Farkas and Anthony 2010; Ro ¨ssler 2006). Therefore, psychiatric rehabilitation professionals are required to be active in communities, beyond the organi- zational boundaries of mental health care, in order to promote and support users’ (re)integration into society (Le Boutillier et al. 2011; Slade 2012; Ware et al. 2007). Many countries are currently exploring innovative ways of delivering high-quality mental health services that close the gap between services and communities. For example, one recent study analysed the involvement of local community members in the provision of psychiatric services, with promising results (Patel et al. 2010). However, extensive training programmes for community members might require financial, personal and time resources that limit their feasi- bility on a large scale. Another option debated in the litera- ture refers to outsourcing or contracting out of specific services, thus improving efficiency and reducing costs (Young 2008). In the Netherlands, the experience of out- sourcing of vocational rehabilitation to generic vocational agencies that provide services to unemployed people in general has had limited success, due to the inability of these agencies to match the specific needs of people with mental disorders (Michon et al. 1998). Therefore, until now, the debate regarding outsourcing in psychiatric rehabilitation remains restricted to the discussion of possible alternatives, but there is clearly a need for scientifically evaluated alter- natives that have already been implemented. S. C. Iancu (&) Á M. B. M. Zweekhorst Á J. F. G. Bunders Department of Innovation in the Health and Life Sciences, ATHENA Institute, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands e-mail: s.c.iancu@vu.nl D. J. Veltman Á A. J. L. M. van Balkom Department of Psychiatry, EMGO? Institute for Health and Care Research, VU University Medical Center, GGZ InGeest, Amsterdam, The Netherlands 123 Community Ment Health J (2015) 51:175–184 DOI 10.1007/s10597-014-9742-7