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Psychiatry in Europe
There are some trends that are shared by almost all countries in Eastern especially with reference to vulnerable people. The magnitude and
Europe. One of these is the present-day effort for transition from a burden of mental disorders is high. Social stress and traumatic
system of provision of mental healthcare mainly based on large experiences have led to a deterioration of the mental health of the
psychiatric hospitals to a system based on community services. This is population. Post-traumatic stress disorder (PTSD) is frequent, as are
not an easy task, mainly for reasons associated with demanding and depression, suicide, anxiety, substance abuse, aggression, delinquency
urgent national priorities and related economic difficulties. Additionally, and violence, especially among young people. The incidence of
this transition requires not only administrative changes but also psychosomatic illnesses is high, as is the sudden death phenomenon
changes in the attitude of providers, recipients and the community as a among young people.
13,14
whole. The issue of integration of services is very closely related to this.
It is clearly not possible to establish integrated provision of services in There is a rising tide of suicides and premature mortality in some
the setting of isolated big psychiatric hospitals; ideally, this should be countries, as seen in the alcohol-related deaths of men in Eastern
done in general hospitals but also in the community. However, there Europe. According to the WHO, 150,000 people commit suicide each
has been some integration of services in the ‘dispensaries’ that operate year worldwide, and suicide is the leading (hidden) cause of death
in many countries in Eastern Europe, where provision of psychiatric among young adults. The highest rate is in the countries of Eastern
services goes hand in hand with provision of other medical services. Europe.
6
In 1999 the WHO started a worldwide initiative for suicide
prevention and published a series of booklets to sensitise and guide
Although mental healthcare is organised in the three known levels various professionals (primary care workers, prison officers, school
(primary, secondary and tertiary), primary care is insufficient, since only workers, those in the media, survivors’ groups, etc.).
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39% of patients with mental disorders are seen by general
practitioners. There is lack of community centres and residential Cases of Good Practice
homes. Tertiary services are well developed and represent the Since the conflict, the countries of Eastern Europe and the Balkans
predominant method of care (so-called ‘open access’).
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The catchment have taken steps towards renewal of collaboration, harmonisation,
area principle is not always respected and many patients are attracted stability and reconciliation. There are two important tools for these
by the reputation of the psychiatrist or the institution. Although this is steps: the mental health project of the Stability Pact for South-East
not in accordance with the modern principles of healthcare, we believe Europe (SEE), and multicentric studies.
that it gives the system a human face, which has been somewhat lost
in developed countries.
10,11
Many large hospitals are in poor condition, Partnership for Mental Health –
and most frequently there is non-involvement of patients. Here we use Stability Pact for South-East Europe
the term ‘patients’, which we find much more appropriate than the In 2000, seven countries entered the Stability Pact for SEE, and
popular and politically correct terms ‘service users’ or ‘consumers’. Moldova joined a little later. The countries of the Pact are Albania,
Bosnia, Bulgaria, Croatia, the Former Yugoslavian Republic of
There is a chronic lack of resources, and low motivation of staff is Macedonia (FYROM), Moldova, Montenegro, Romania and Serbia. The
prevalent due to chronic stress, apathy and unsatisfactory salaries. international community decided to take a proactive attitude instead
Many doctors experience the burn-out syndrome, since they share the of intervening only during crises, and therefore undertook a
destiny of their patients.
12
In most of the countries, prevention, mental comprehensive long-term conflict strategy by instigating various
health promotion and psychotherapy are not financed by the projects. The mental health project entitled ‘Enhancing social cohesion
government and are carried out voluntarily, thanks to the enthusiasm through strengthening community mental health services’ started in
of professionals, or in private settings or by non-governmental 2002 and has been supported by donor countries and the WHO.
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organisations (NGOs). Fortunately, there are some positive
developments in preventative programmes in some of the countries. The project has four components:
Stigmatisation of people suffering from mental disorders is widespread, • harmonisation of mental health policies and legislation related to
but psychiatrists and other mental health professionals are also it – all of the countries prepared their national policies according
stigmatised. In low-income countries, where there is an increase of mental to WHO guidelines and in accordance with the Helsinki Declaration,
disorders as well as of aggression, violence and other sociopathological and most of the countries also prepared laws for protecting the
phenomena, psychiatrists are often expected to respond to all kinds of rights of mentally ill people;
questions. Individuals with mental disorders as well as psychiatry itself are • establishment of a common SEE model for centres for mental
frequently stigmatised in the media, which often has sensationalistic health in the community;
purposes. With such an approach, the media contribute to the stigma and • training courses for professionals who are going to work in
increase prejudice against psychiatry. In fighting this stigma, partnership community mental health centres; and
with media and professionals with education of the public in mental • establishment of an information network.
healthcare issues is of great importance. In addition to destigmatisation,
this would, hopefully, contribute to the prevention of mental disorders Experts from the countries involved in the mental health project for
and mental health promotion. SEE are planning to further develop collaboration through an evolution
of the project into a sustainable mental health programme. The
High Prevalence of Mental Disorders existing network is a good prerequisite, and there is a need to move
Many of the countries of Eastern Europe and the Balkans are facing out from the umbrella of international aid into an era of international
prolonged stress, which has significant psychological sequelae, co-operation, self-determination and growth.
10 EUROPEAN PSYCHIATRIC REVIEW
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