Tosevski 30/6/08 02:28 Page 9
Psychiatry in Europe
Provision of Psychiatric Services and Mental Healthcare Reform in
Eastern Europe and the Balkans
a report by
Dusica Lecic Tosevski,
1
George N Christodoulou,
2
Vassilis Kontaxakis
3
and Nikolaos Christodoulou
3
1. Institute of Mental Health, School of Medicine, University of Belgrade; 2. Hellenic Centre for Mental Health and Research, Athens;
3. Department of Psychiatry, Athens University
Psychiatry has developed differently in various parts of Europe owing to EU while others do not, and then there is the Balkan area with its
several factors, including economic development, professional resource specific past and recent history.
availability, national priorities, history of conflict and the particular culture.
Therefore, regional variation is substantial and may be as important as Eastern Europe represents a mosaic of developed and developing regions,
cross-national differences.
1
However, mental healthcare reform is ongoing with modern and traditional parts with similarities and differences. Most
across the European region with broadly similar trends. The World Health of the countries are post-communist and have seen rapid social,
Organization (WHO) Helsinki Declaration is being implemented with a economic and political change since the late 1980s, at a pace that is
focus on community care, prevention of mental disorders, mental health unparalleled in history. According to the WHO, the human rights
promotion, antistigma campaigns and continuous education.
2
However, situation in this region is unsatisfactory:
5
political abuse of psychiatry is
there are difficulties in this implementation, especially in terms of thought to be frequent and professionals have to face justified and
prevention and mental health promotion. Despite the growing body of unjustified accusations, which is a challenge to their role.
evidence-based preventative programmes that have shown their efficacy,
they are still neglected and marginalised, especially in low-income Wars, civil strife and migration characterise many of the countries in
countries,
3,4
and are difficult to carry out due to more demanding priorities the region. Social transition and transformation of countries led to a
determined by socioeconomic problems or adverse conditions such as high unemployment rate, ranging from 29% in Serbia to 42% in
disasters, civil conflict, violence or previous economic sanctions. Bosnia. Gross national product (GNP) per capita ranges from US$756
to US$2,295. National debts are high and the percentage of gross
According to the WHO data, stress-related conditions cause more than half domestic product (GDP) for healthcare differs, from as low as 1.6% in
of the total psychiatric disability.
5
Because of this, life expectancy is Azerbaijan to 9.4% in Greece.
8
The percentage for mental healthcare
decreased by 10 years. The incidence of depression is increasing, especially is mostly known, but is very low in most of the countries. Due to
among adolescents, and suicide is a major cause of death in adolescents and prolonged adversity, health systems have deteriorated and are facing
young adults, ranging from two to 44 in 100,000. Therefore, the global specific challenges, the ‘brain drain’ is increasing and mental
burden of diseases is rising in Europe, especially in developing countries.
5
healthcare reform is a demanding and difficult task.
In spite of this, there is a serious treatment gap. According to the
Dusica Lecic Tosevski is a Professor of Psychiatry in the
WHO, 47% of depressed people never receive treatment, and this is
School of Medicine at the University of Belgrade. She is
the case for 36–45% of those suffering from schizophrenia. While also Director of the Institute of Mental Health and Chair
10% of children and adolescents need treatment, three-quarters of
of the Serbian National Committee for Mental Health.
Professor Tosevski is the Zonal Representative for Central
them remain untreated. There is overhospitalisation in some Eastern
Europe to the World Psychiatry Association (WPA), Chair
European countries, where 60% of all patients are in big hospitals.
of the WPA Task Force for Mass Violence and Mental
Integration with primary care is incomplete, as are mental health
Health, an International Fellow of the American
Psychiatric Association (APA), a Fellow of the European
programmes and legislation. Stigma, discrimination and social Psychiatric Association (EPA), an honorary member of the WPA and a member of the WPA
exclusion are prevalent in many countries, and 50% of homeless
Operational Committee on Sections. In addition, she is President Elect of the Psychiatric
Association of Eastern Europe and the Balkans and Editor in Chief of Psychiatry Today. Her
people are psychotic.
6
research interests include personality disorders, post-traumatic stress disorders,
depression, co-morbidity and prevention.
Mental Healthcare in Eastern Europe and the Balkans
E: dusica.lecictosevski@eunet.yu
It is not easy to discuss psychiatry in Eastern Europe and the Balkans
George N Christodoulou is a Professor of Psychiatry at the
since it cannot be determined with certainty which countries are
University of Athens, a Fellow of the Royal College of
included in that region. There are different maps and divisions of Psychiatrists (RCP) and Chair of the RCP’s European
Europe today, such as Western, Northern, Central, Southern and
Division. He is Honorary President of the Hellenic
Psychiatric Association, President of the International
Eastern Europe. For instance, many countries belonging to Eastern
College of Psychosomatic Medicine (ICPM), President of
Europe are included in Central Europe according to the World
the Psychiatric Association of Eastern Europe and the
Balkans and Director of the World Federation for Mental
Psychiatry Association (WPA). The UN recently proposed splitting the
Health (WFMH). Professor Christodoulou is also Chair,
groups into two categories – rapidly developing and developing Secretary and an Honorary Fellow of the World Psychiatric Association (WPA), for which
countries – and placing Eastern European countries into a separate
he has also served as Chair of the Institutional Program on Disasters and Mental Health
and Chair of the Standing Committee on Ethics.
group because they have characteristics that distinguish them from
other European countries.
7
In addition, some countries belong to the
© TOUCH BRIEFINGS 2008 9
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