Mental Health Resource Spotlight in Central and Eastern Europe

Dan is the Programme manager for Mental Health in the WHO Regional Office for Europe, based in Copenhagen, Denmark. He works closely with WHO's Headquarters Office and Country Offices, as well as with national and international partners, to provide technical support in the area of mental health to the countries making up WHO's European Region. He has been an active collaborator on MHIN since its inception. 

In many countries in Central and Eastern Europe, large psychiatric or social care institutions are still the main care setting for those deemed to require long-term support, despite years of stated policies in support of a process of deinstitutionalisation.  Right now, there are hundreds of thousands of persons with intellectual and psychosocial disabilities effectively caught between the stated policy goal of moving away from institutional care and a lack of effective means to bring about that change. The result is that many such institutions are run down, poorly maintained and too often the setting for practices that are inhumane or antithetical to safe, effective, high-quality care.

This issue has been recently and extensively evidenced by a number of recent international reports. In the summer of 2017, Lancet Psychiatry published a scoping review by Petr Winkler and colleagues of 25 years' development of mental health care for people with severe mental illnesses in central and Eastern Europe.  In December 2017 Mental Health Europe published its latest report on Mapping Exclusion in Europe, which provides new understandings and insights on the state of mental health care services across 38 European countries, including personal testimonies of lived experience in institutional care.

The most recent report comes from the WHO Regional Office for Europe, as part of its ongoing project on adults with psychosocial and intellectual disabilities living in institutions in the European Region (WHO, 2018).  Assessments of care standards and human rights protection – using the WHO QualityRights toolkit – were conducted in long-term institutions across more than 20 countries with a view to identifying deficiencies in current care standards from the perspective of the United Nations Convention on the Rights of Persons with Disabilities (CRPD).  Findings reveal and confirm that long-term institutional care for people with psychosocial and intellectual disabilities in many European countries is far below the standard.

The process and structure of deinstitutionalization and mental health reform more broadly is of course influenced and indeed embedded within each country’s culture and history.  A workshop convened and co-organised by the WHO Collaborating Centre on Culture and Health at the University of Exeter (United Kingdom), the National Institute of Mental Health (Czech Republic) and the WHO Regional Office for Europe looked into these cultural aspects of mental health reform in Central and Eastern Europe. The aim of this workshop was to improve understanding of the key cultural aspects that impact and drive mental health care reform in the central and eastern European region. A meeting report outlines the key points and recommendations made by participants in relation to this objective.

MHIN have put together a handy Mental Health Resource Round-Up on Central and Eastern Europe below:

1. Lancet Psychiatry Review & Podcast: A blind spot on the global mental health map: A scoping review in Central and Eastern Europe
   
   This is the largest review on mental health systems in the former eastern bloc ever conducted and provides an overview of mental health services in Central and Eastern Europe since the dissolution of the Soviet Union just over 25 years ago. By reviewing literature from the region and surveying mental health experts from each country, it tries to answer the questions:

• How have mental health services changed over the past 25 years and what is their current state?
• How has legislation around the rights of patients with severe mental illness evolved in the last 25 years, and to what extent do human rights violations and stigma still affect these individuals?
• What evidence exists to guide mental health service planning and inform the allocation of resources for mental health care
  
  ​You can also check out the associated podcast and webinar.
  
  2. Regional report: ‘Mental health, human rights and standards of care: Assessment of the quality of institutional care for adults with psychosocial and intellectual disabilities in the WHO European Region’
  Produced by: WHO Regional Office for Europe
  
  The findings from this regional report highlight the subpar standard of long-term institutional care for people with psychosocial and intellectual disabilities in many European countries. A significant proportion of the assessed institutions were found to be in violation of the fundamental rights of people with psychosocial and intellectual disabilities, including their legal capacity, autonomy, dignity, liberty and security of person, physical and mental integrity and freedom from torture and ill treatment and from exploitation, violence and abuse. There is enormous scope for improvement throughout the European Region and indicates that CRPD signatories are at risk or culpable of substantial breaches of the treaty.
  
  3. Meeting Report: Culture and reform of mental health care in central and eastern Europe 
  Produced by: The WHO Regional Office for Europe, the WHO Collaborating Centre on Culture and Health at the University of Exeter (United Kingdom) and the National Institute of Mental Health (Czechia).
  
  This workshop report looks at cultural aspects of mental health reform in Central and Eastern Europe. The aim of this workshop was to improve understanding of the key cultural aspects that impact and drive mental health care reform in the central and eastern European region. This report outlines the key points and recommendations made by participants in relation to this objective.
  
  4. New QualityRights Training & guidance: Tools
  Produced by: World Health Organization
  
  As part of the QualityRights Initiative, WHO has developed a comprehensive package of training and guidance modules. The modules can be used to build capacity among mental health practitioners, people with psychosocial, intellectual and cognitive disabilities, people using mental health services, families, care partners and other supporters, NGOs, DPOs and others on how to implement a human rights and recovery approach in the area of mental health in line with the UN Convention on the Rights of Persons with Disabilities and other international human rights standards.
  
  5. Mental Health Europe Report: Mapping & Understanding Exclusion in Europe
  Produced by: University of Kent and Mental Health Europe (MHE) with support from the Open Society Mental Health Initiative and the European Union’s Rights Equality and Citizenship Programme.
  
  This unique report is a new and expanded edition of Mental Health Europe’s 2012 Mapping Exclusion report and aims to capture updated and more comprehensive information on 35 European countries’ mental health laws, the use of involuntary or forced placements and treatments, the practice of seclusion and restraint, as well as emerging issues in the mental health field in Europe. In mapping mental health systems across Europe, the report also sheds light on the situation of human rights for people who use mental health services and people with psychosocial disabilities and provides exclusive data and testimonies about European mental health systems from people who have been forcibly treated.
  
  6. Mental Health Europe Webinar: Mental Health and the SDGs
  Produced by: Mental Health Europe
  
  Countries across the world, including the European Union (EU) and Member States have committed to implement the UN Sustainable Development Goals (SDGs) by 2030, including Goal Number 3 which seeks to ensure ‘healthy lives and promote well-being for all at all ages’.
  
  In this webinar, speakers and participants discuss:
   
• how the EU can support achieving ‘Health for All’ – the potential of the SDGs for mental health promotion and prevention
• the human rights perspective of the SDGs regarding mental health and disability
  
  The workshop also produced a factsheet on SDGs: health targets- Mental Health (SDG target 3.4) within Europe.