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Mental Health in Former Soviet Countries:From Past Legacies to Modern Practices

Abstract

Introduction: For decades, the image of mental health in Soviet countries has been associated with past political abuses in psychiatry, stigmatising attitudes and discriminating practices against people with any form of disability. Twenty years after the fall of the Soviet Union, the tainted reputation of psychiatry still persists. Living conditions in mental hospitals remain poor, sometimes inhumane and treatment of people with mental health problems is still marked by paternalistic, disempowering, even abusive practices. The Soviet practice of hiding people deemed disabled translates nowadays into the practice of relocating people with the most severe mental illnesses from mental health hospitals to social care institutions, outside the jurisdiction of the health sector, and outside the scope of mental health reforms.

Size of the problem. Morbidity rates from mental health problems in former Soviet countries are similar to those in other European countries. But suicides rates are the highest in Europe, particularly among men, despite decreases since 2000.

Resources and organisation. Mental health expenditures account for only three percent of health budgets, in these countries, mostly spent on large psychiatric hospitals. Former Soviet countries have similar organisations of services, but the Russian Federation, Belarus and Kazakhstan report significantly higher resources (services and staff) than the other CIS countries. A contributing factor is the migration of staff from lower income economies, facilitated by similarities between the education and health systems, and fluency in the Russian language.

Reforms of specialist services. Besides the development of policy and legislation, progress in implementing reform priorities can be traced mainly to projects that benefited from expert and financial support from international partners. Namely: setting up pilot mental health centres, advocacy for human rights of patients and building capacity in primary care.

Mental health in primary care. Introducing mental health services in primary care is challenging due to limitations in roles of primary care staff, but also in their competencies and skills, and their reluctance to take on more responsibilities.

Conclusions. With reforms in the early stages of implementation, and slim prospects of suitable resources for necessary developments, modern mental health services remain largely out of reach for most people in former Soviet countries in the near future.

References

  1. 1.

    World Psychiatric Association. Member Societies. 2013. Available from URL: http://www.wpanet.org/detail.php?section_id=5&content_id=674&sort_by=T (accessed 16 September 2013).

    Google Scholar 

  2. 2.

    Gordon H, Meux C. Forensic psychiatry in Russia: past, present and future. Psychiatrist. 2000;24:121–3.

    Google Scholar 

  3. 3.

    Bonnie RJ. Political abuse of psychiatry in the Soviet Union and in China: complexities and controversies. J Am Acad Psychiatry Law. 2002;30:136–44.

    PubMed  Google Scholar 

  4. 4.

    Birley J. Political abuse of psychiatry in the Soviet Union and China: a rough guide for bystanders. J Am Acad Psychiatry Law. 2002;30:145–7.

    PubMed  Google Scholar 

  5. 5.

    United States Delegation to Assess Recent Changes in Soviet Psychiatry. Report of the U.S. Delegation to Assess Recent Changes in Soviet psychiatry. Schizophr Bull. 1989;15(4 Suppl):1–219.

    Google Scholar 

  6. 6.

    van Voren R. Political abuse of psychiatry—an historical overview. Schizophr Bull. 2010 Jan;36:33–5.

    Article  PubMed  Google Scholar 

  7. 7.

    World Psychiatric Association General Assembly. The Declaration of Hawaii. Honolulu (HI): World Psychiatric Association; 1977. Amended, Vienna, Italy; 1983.

    Google Scholar 

  8. 8.

    Ougrin D, Gluzman S, Dratcu L. Psychiatry in post-communist Ukraine: dismantling the past, paving the way for the future. Psychiatrist. 2006;30:456–9.

    Google Scholar 

  9. 9.

    Jenkins R, Lancashire S, McDaid D, Samyshkin Y, Green S, et al. Mental health reform in the Russian Federation: an integrated approach to achieve social inclusion and recovery. Bull World Health Organ. 2007;85:858–66.

    PubMed  PubMed Central  Google Scholar 

  10. 10.

    Phillips SD. Disability and Mobile Citizenship in Postsocialist Ukraine. Bloomington, (IN): Indiana University Press; 2011.

    Google Scholar 

  11. 11.

    Fefelov V. V SSSR invalidov net! (There are no Invalids in the USSR!) London: Overseas Publications Interchange Ltd.; 1986.

    Google Scholar 

  12. 12.

    Phillips SD. “There are no invalids in the USSR!”: a missing Soviet chapter in the new disability history. Disabil Stud Q. 2009;29(3).

    Google Scholar 

  13. 13.

    Mundt AP, Franciskovic T, Gurovich I, Heinz A, Ignatyev Y, et al. Changes in the provision of institutionalized mental health care in post-communist countries. PLoS One. 2012;7:e38490.

  14. 14.

    Jenkins R, Klein J, Parker C. Mental health in post-communist countries. BMJ. 2005;331:173–4.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Bromet EJ, Gluzman SF, Paniotto VI, Webb CP, Tintle NL, et al. Epidemiology of psychiatric and alcohol disorders in Ukraine: findings from the Ukraine World Mental Health survey. Soc Psychiatry Psychiatr Epidemiol. 2005;40:681–90.

    Article  PubMed  Google Scholar 

  16. 16.

    World Health Organization. The global burden of disease: 2004 update. Geneva: WHO; 2008.

    Google Scholar 

  17. 17.

    Petrea I, Muijen M. Policies and practices for mental health in Europe. Copenhagen: WHO Regional Office for Europe; 2008.

    Google Scholar 

  18. 18.

    WHO Regional Office for Europe. European mortality database. January 2010 edition. WHO Regional Office for Europe; 2012. Available from URL: http://data.euro.who.int/hfamdb/ (accessed 20 November 2012).

    Google Scholar 

  19. 19.

    World Health Organization. European Regional Information System on Resources for the Prevention and Treatment of Substance Use Disorders. Geneva: WHO; 2013. Available from URL: http://apps.who.int/gho/data/node.main-euro.RSUD?lang=en?showonly=RSUD (accessed 25 August 2013).

    Google Scholar 

  20. 20.

    World Health Organization, Department of Mental Health and Substance Abuse. Mental Health Atlas 2011. Geneva: WHO; 2011.

    Google Scholar 

  21. 21.

    World Health Organization, Department of Mental Health and Substance Abuse. Mental Health Atlas 2011. Armenia. Geneva: WHO; 2011. Available from URL: http://www.who.int/mental_health/evidence/atlas/profiles/arm_mh_profile.pdf (accessed 20 November 2012).

    Google Scholar 

  22. 22.

    World Health Organization, Department of Mental Health and Substance Abuse. Mental Health Atlas 2011. Azerbaijan. Geneva: WHO; 2011. Available from URL: http://www.who.int/mental_health/evidence/atlas/profiles/aze_mh_profile.pdf (accessed 20 November 2012).

    Google Scholar 

  23. 23.

    World Health Organization, Department of Mental Health and Substance Abuse. Mental Health Atlas 2011. Belarus. Geneva: WHO; 2011. Available from URL: http://www.who.intmental_health/evidence/atlas/profiles/blr_mh_profile.pdf (accessed 20 November 2012).

    Google Scholar 

  24. 24.

    World Health Organization, Department of Mental Health and Substance Abuse. Mental Health Atlas 2011. Georgia. Geneva: WHO; 2011. Available from URL: http://www.who.int/mental_health/evidence/atlas/profiles/geo_mh_profile.pdf (accessed 20 November 2012).

    Google Scholar 

  25. 25.

    World Health Organization, Department of Mental Health and Substance Abuse. Mental Health Atlas 2011. Kazakhstan. Geneva: WHO; 2011. Available from URL: http://www.who.int/mental_health/evidence/atlas/profiles/kaz_mh_profile.pdf (accessed 20 November 2012).

    Google Scholar 

  26. 26.

    World Health Organization, Department of Mental Health and Substance Abuse. Mental Health Atlas 2011. Republic of Moldova. Geneva: WHO; 2011. Available from URL: http://www.who.int/mental_health/evidence/atlas/profiles/mda_mh_profile.pdf (accessed 20 November 2012).

    Google Scholar 

  27. 27.

    World Health Organization, Department of Mental Health and Substance Abuse. Mental Health Atlas 2011. Russian Federation. Geneva: WHO; 2011. Available from URL: http://www.who.int/mental_health/evidence/atlas/profiles/rus_mh_profile.pdf (accessed 20 November 2012).

    Google Scholar 

  28. 28.

    World Health Organization, Department of Mental Health and Substance Abuse. Mental Health Atlas 2011. Tajikistan. Geneva: WHO; 2011. Available from URL: http://www.who.int/mental_health/evidence/atlas/profiles/taj_mh_profile.pdf (accessed 20 November 2012).

    Google Scholar 

  29. 29.

    World Health Organization, Department of Mental Health and Substance Abuse. Mental Health Atlas 2011. Uzbekistan. Geneva: WHO; 2011. Available from URL: http://www.who.int/mental_health/evidence/atlas/profiles/uzb_mh_profile.pdf (accessed 20 November 2012).

    Google Scholar 

  30. 30.

    McCulloch A, Muijen M. Mental health. In: Walshe K, Smith J, (editors). Healthcare Management. Maidenhead: McGraw-Hill; 2011.

    Google Scholar 

  31. 31.

    Krasnov V, Gurovich I. History and current condition of Russian psychiatry. Int Rev Psychiatry. 2012;24:328–33.

    Article  PubMed  Google Scholar 

  32. 32.

    Cheian-Andrei D. Feasibility study regarding the development of the mental health services in the Republic of Moldova. Chisinau: Swiss Agency for Development and Cooperation; 2011.

    Google Scholar 

  33. 33.

    WHO Regional Office for Europe. Merano Declaration on mental health in CIS countries. Merano: WHO Regional Office for Europe; 2008.

    Google Scholar 

  34. 34.

    Mental Health Foundation of Armenia. Community based service program. Available from URL: http://www.mentalhealth.am/ (accessed 20 November 2012).

    Google Scholar 

  35. 35.

    Swiss Agency for Development and Cooperation. Mental Health Project. Chisinau: Swiss Agency for Development and Cooperation; 2012. Available from URL: http://www.swiss-cooperation.admin.ch/moldova//ressources/resource_en_206404.pdf (accessed 20 November 2012).

    Google Scholar 

  36. 36.

    Association SOMATO. Raport de evaluare privind activitatea centrelor comunitare de sanatate mintala din Republica Moldova. Chisinau: Ministry of Health of Moldova; 2012. [In Romanian]

    Google Scholar 

  37. 37.

    Global Initiative on Psychiatry. Developing and piloting sheltered housing service for people with mental illness. 2011. Available from URL: http://www.gip-global.org/p/44/411/%93sheltered-housing%94-service-was-launched-in-balti-moldova (accessed 20 November 2012).

    Google Scholar 

  38. 38.

    Priebe S, Matanov A, Demi N, Blagovcanin Simic J, Jovanovic S, et al. Community mental health centres initiated by the South-Eastern Europe Stability Pact: evaluation in seven countries. Community Ment Health J. 2012;48:352–62.

    Article  PubMed  Google Scholar 

  39. 39.

    Balabanova D, McKee M, Pomerleau J, Rose R, Haerpfer C. Health service utilization in the former Soviet Union: evidence from eight countries. Health Serv Res. 2004;39:1927–50.

    Article  PubMed  PubMed Central  Google Scholar 

  40. 40.

    Borowitz M, O’Dougherty S, Wickham C, Hafner G, Simidjiyski J, et al. Conceptual Foundations for Central Asian Republics Health Reform Model. Almaty: USAID/CAR; 1999.

    Google Scholar 

  41. 41.

    WHO Regional Office for Europe. European Health for All Database. January 2013. Available from URL: http://www.euro.who.int/en/what-we-do/data-and-evidence/databases/european-health-for-all-database-hfa-db2 (accessed 11 April 2013).

    Google Scholar 

  42. 42.

    Galbur O. Raport cu privire la analiza comparativa a clasificatorului si nomenclatorului specialitatilor medicale din UE si Republica Moldova cu propuneri concrete de modificari si ajustari la standardele europene. Chisinau: Ministry of Health of Moldova; 2010. [In Romanian]

    Google Scholar 

  43. 43.

    Zakroyeva A, Goldberg D, Gask L, Leese M. Training Russian family physicians in mental health skills. Eur J Gen Pract. 2008;14:19–22.

    Article  PubMed  Google Scholar 

  44. 44.

    WHO Regional Office for Europe. Mental Health Action Plan for Europe. Facing the challenges, building solutions. Copenhagen: WHO Regional Office for Europe; 2005.

    Google Scholar 

  45. 45.

    United Nations General Assembly. Universal Declaration of Human Rights. Resolution 217 A (III). New York (NY): United Nations; 1948.

    Google Scholar 

  46. 46.

    United Nations General Assembly. Principles for the protection of persons with mental illness and the improvement of mental health care. Resolution 46/119. New York (NY): United Nations; 1991.

    Google Scholar 

  47. 47.

    United Nations General Assembly. Convention on the Rights of Persons with Disabilities. New York (NY): United Nations; 2006.

    Google Scholar 

  48. 48.

    WHO Regional Office for Europe. Biennial Collaborative Agreement (BCA) between the Ministry of Health of Azerbaijan and the Regional Office for Europe of the World Health Organization 2008/2009. Copenhagen: WHO Regional Office for Europe; 2007.

    Google Scholar 

  49. 49.

    WHO Regional Office for Europe. Biennial Collaborative Agreement (BCA) between the Ministry of Health of Kyrgyzstan and the Regional Office for Europe of the World Health Organization 2008/2009. Copenhagen: WHO Regional Office for Europe; 2007.

    Google Scholar 

  50. 50.

    WHO Regional Office for Europe. Biennial Collaborative Agreement (BCA) between the Ministry of Health of Tajikisan and the Regional Office for Europe of the World Health Organization 2010/2011. Copenhagen: WHO Regional Office for Europe; 2009.

    Google Scholar 

  51. 51.

    WHO Regional Office for Europe. Biennial Collaborative Agreement (BCA) between the Ministry of Health of Tajikistan and the Regional Office for Europe of the World Health Organization 2008/2009. Copenhagen: WHO Regional Office for Europe; 2007.

    Google Scholar 

  52. 52.

    WHO Regional Office for Europe. Biennial Collaborative Agreement (BCA) between the Ministry of Health of the Republic of Moldova and the Regional Office for Europe of the World Health Organization 2010/2011. Copenhagen: WHO Regional Office for Europe; 2009.

    Google Scholar 

  53. 53.

    WHO Regional Office for Europe. Biennial Collaborative Agreement (BCA) between the Ministry of Health of Uzbekistan and the Regional Office for Europe of the World Health Organization 2008/2009. Copenhagen: WHO Regional Office for Europe; 2007.

    Google Scholar 

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Correspondence to Ionela Petrea PhD, MSc.

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Petrea, I. Mental Health in Former Soviet Countries:From Past Legacies to Modern Practices. Public Health Rev 34, 5 (2012). https://doi.org/10.1007/BF03391673

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Key Words

  • Post Soviet psychiatry
  • Commonwealth of Independent States
  • mental health services in former Soviet Union
  • health care reform
  • primary health care