Russian psychiatry has a dramatic history, and until now has been at a transitional stage of development. It is facing problems not only common in world psychiatry, but also specific to eastern Europe, in particular Russia. Starting from the beginning of the 1990s, considerable changes have occurred in psychiatry, especially after 1992 when the law on psychiatric care and guarantees of citizens' rights in its provision was adopted. It became the ideological and legislative basis for reforms. However, there are definite obstacles to structural reforms in psychiatry. They are unfavourable technical conditions in many psychiatric clinics, hypercentralization of psychiatric services, shortage of clinical psychologists and social workers in psychiatry, some difficulties in cooperation between psychiatric and general medical institutions. Economic difficulties in the transition period of Russia's social development prevent the overcoming of these problems. They are being actively discussed and some of them are being gradually solved, e.g. the organization of team work in mental health services, the increasing number of specialists on social work, and the involvement of non-government organizations in psychosocial rehabilitation.
Comparing our earlier data on chronic schizophrenic patients with present data, we hypothesise that FES patients are at the stage that leads to a stable, pathological state of metabolism.
The Russian Federation is a country with an enormous territory, of over 17 million km2. Its population is 141.9 million (2010 figure). The population was declining, especially at the end of the 1990s, but in more recent years the tendency has been towards stabilisation. Life expectancy has remained relatively low, although it has increased somewhat over the past few years, to reach 67.5 years in 2008 (61.4 for men and 73.9 for women), up from 65.3 years in 2004 (58.9 for men and 72.3 for women).
This article presents the analysis of the large-scale reform in psychiatric care systems in developed countries that is underway since the second half of the 20 th century till now, its positive results and some negative consequences, important for the further development of Russian psychiatric care. The authors focus on two trends in the development of psychiatric care abroad, specifically, integration of psychiatry into general medicine and public-oriented psychiatry development. The use of publications from the mentioned countries on both specific (cited as examples) and global issues, enables to consider general trends and changes in major branches of psychiatric care. Using this data, the authors evaluate the deinstitutionalization (hospital admission decrease) stage and the most topical issues in current Russian psychiatric care, as well as directions for its further development.
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