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.