Full title: 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
Authors: Dr Petr Winkler, PhDr†, Dzmitry Krupchanka, PhD†, Tessa Roberts, MSc, Lucie Kondratova, MSc, Vendula Machů, BSc, Prof Cyril Höschl, DrSc, Prof Norman Sartorius, PhD, Prof Robert Van Voren, PhD, Oleg Aizberg, PhD, Prof Istvan Bitter, PhD, Arlinda Cerga-Pashoja, PhD, Azra Deljkovic, MD, Naim Fanaj, PhD, Prof Arunas Germanavicius, PhD, Hristo Hinkov,PhD, Aram Hovsepyan,MD, Prof Fuad N Ismayilov, DrSc, Prof Sladana Strkalj Ivezic, DrSc, Marek Jarema, PhD, Vesna Jordanova, MD, Selma Kukić, MSc, Nino Makhashvili, PhD, Brigita Novak Šarotar, PhD, Oksana Plevachuk, PhD, Daria Smirnova, PhD, Bogdan Ioan Voinescu, PhD, Jelena Vrublevska, MD, Prof Graham Thornicroft, PhD. †Contributed equally
A central aim of the Global Mental Health movement is to highlight gaps in mental health service provision worldwide, and to galvanise action to address mental health issues where these have been neglected.
Most research in Global Mental Health focuses on the global South, where typically resources for mental health care are scarce and mental health is low on the public agenda. This paper argues that to date the Global Mental Health community has overlooked an important region of the global North, however, where attention is urgently needed.
Central and Eastern Europe has the highest proportion of disease burden due to mental and substance use disorders in the world, the highest rates of suicide worldwide, and extremely high levels of alcohol consumption. Despite this, there are stark contrasts between the state of mental health services in these countries as compared to their EU neighbours, which spend on average 15 times more on mental health care provision.
This paper tries to provide 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?
The findings show that progress since the end of the Communist era has been disappointing, with countries still over-reliant on centralised mental institutions, human rights violations continuing to occur and a lack of evidence to inform service planning. Although there have been some encouraging policy developments, in practice many of the promised reforms have yet to be implemented on the ground. The study also identified some excellent examples of community mental health programmes, but these are not accessible to most of the population and are often not sustainable since they have not been incorporated into routine health systems.
In short, there is a lot of work to be done to improve mental health care in Central and Eastern Europe. For those of us interested in promoting better mental health care for all, the authors pose the question; is this a blind spot on the Global Mental Health map?
Image: Psychiatric hospital Eastern Europe. Credit: Flickr/Matt Bigwood