A blind spot on the global mental health map: a scoping review of 25 years' development of mental health care for people with severe mental illnesses in central and eastern Europe

Petr Winkler; Dzmitry Krupchanka; Tessa Roberts; Lucie Kondratova; Vendula Machů; Cyril Höschl; Norman Sartorius; Robert Van Voren; Oleg Aizberg; Istvan Bitter; Arlinda Cerga-Pashoja; Azra Deljkovic; Naim Fanaj; Arunas Germanavicius; Hristo Hinkov; Aram Hovsepyan; Fuad N Ismayilov; Sladana Strkalj Ivezic; Marek Jarema; Vesna Jordanova; Selma Kukić; Nino Makhashvili; Brigita Novak Šarotar; Oksana Plevachuk; Daria Smirnova; Bogdan Ioan Voinescu; Jelena Vrublevska; Graham Thornicroft

doi:10.1016/S2215-0366(17)30135-9

A blind spot on the global mental health map: a scoping review of 25 years' development of mental health care for people with severe mental illnesses in central and eastern Europe

Lancet Psychiatry. 2017 Aug;4(8):634-642. doi: 10.1016/S2215-0366(17)30135-9. Epub 2017 May 8.

Authors

Petr Winkler¹, Dzmitry Krupchanka², Tessa Roberts³, Lucie Kondratova⁴, Vendula Machů⁴, Cyril Höschl⁴, Norman Sartorius⁵, Robert Van Voren⁶, Oleg Aizberg⁷, Istvan Bitter⁸, Arlinda Cerga-Pashoja³, Azra Deljkovic⁹, Naim Fanaj¹⁰, Arunas Germanavicius¹¹, Hristo Hinkov¹², Aram Hovsepyan¹³, Fuad N Ismayilov¹⁴, Sladana Strkalj Ivezic¹⁵, Marek Jarema¹⁶, Vesna Jordanova¹⁷, Selma Kukić¹⁸, Nino Makhashvili¹⁹, Brigita Novak Šarotar²⁰, Oksana Plevachuk²¹, Daria Smirnova²², Bogdan Ioan Voinescu²³, Jelena Vrublevska²⁴, Graham Thornicroft²⁵

Affiliations

¹ Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Electronic address: petr.winkler@nudz.cz.
² Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Institute of Global Health, University of Geneva, Geneva, Switzerland.
³ Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
⁴ Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic.
⁵ Association for the Improvement of Mental Health Programmes, Geneva, Switzerland.
⁶ Ilia State University, Tbilisi, Georgia; Vytautas Magnus University, Kaunas, Lithuania; Human Rights in Mental Health-FGIP, Hilversum, Netherlands.
⁷ Department of Psychiatry and Narcology, Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus.
⁸ Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
⁹ Mental Health Center, Health Care Center Pljevlja, Pljevlja, Montenegro.
¹⁰ Mental Health Center, Prizren, Kosovo.
¹¹ Clinic of Psychiatry, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
¹² National Center for Public Health and Analyses, Sofia, Bulgaria.
¹³ Department of Psychiatry, Yerevan State Medical University, Yerevan, Armenia.
¹⁴ Department of Psychiatry, Azerbaijan Medical University, Baku, Azerbaijan; National Mental Health Centre, Baku, Azerbaijan.
¹⁵ Croatian Medical Association, Zagreb, Croatia; Croatian Society for Clinical Psychiatry, Zagreb, Croatia.
¹⁶ 3rd Department of Psychiatry, Institute of Psychiatry and Neurology, Warszawa, Poland.
¹⁷ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹⁸ Mental Health Project in Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina.
¹⁹ Mental Health Resource Centre, Ilia State University, Tbilisi, Georgia; Foundation Global Initiative on Psychiatry-Tbilisi, Tbilisi, Georgia.
²⁰ University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia; Department of Psychiatry, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
²¹ Department of Psychiatry, Psychology and Sexology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
²² Department of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia.
²³ Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania; Department of Forensic and Neurodevelopmental Science, King's College London, London, UK.
²⁴ Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia.
²⁵ Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

PMID: 28495549
DOI: 10.1016/S2215-0366(17)30135-9

Abstract

Just over 25 years have passed since the major sociopolitical changes in central and eastern Europe; our aim was to map and analyse the development of mental health-care practice for people with severe mental illnesses in this region since then. A scoping review was complemented by an expert survey in 24 countries. Mental health-care practice in the region differs greatly across as well as within individual countries. National policies often exist but reforms remain mostly in the realm of aspiration. Services are predominantly based in psychiatric hospitals. Decision making on resource allocation is not transparent, and full economic evaluations of complex interventions and rigorous epidemiological studies are lacking. Stigma seems to be higher than in other European countries, but consideration of human rights and user involvement are increasing. The region has seen respectable development, which happened because of grassroots initiatives supported by international organisations, rather than by systematic implementation of government policies.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Europe
Global Health
Hospitals, Psychiatric / economics
Humans
Mental Disorders / psychology*
Mental Disorders / therapy*
Mental Health / trends*
Mental Health Services / organization & administration*
Social Stigma
Surveys and Questionnaires