Twenty-five years have passed since the major socio-political changes in Central and Eastern Europe and our aim was to map and analyze the development of mental health care practice for people with severe mental illnesses in this region since then. A scoping review was complemented by an expert survey in 24 countries. Mental health care practice in the region differs greatly across as well as within individual countries. National policies often exist but reforms remain mostly in the realm of aspiration. Services are predominantly based in psychiatric hospitals. Decision making on resource allocation is non-transparent, and full economic evaluations of complex interventions and rigorous epidemiological studies are lacking. Stigma seems to be high compared to other European countries, but consideration of human rights and user involvement are increasing. The region has seen respectable development, which occurred due to grassroots initiatives supported by international organizations, rather than due to systematic implementation of government policies.(150 words, unstructured)Funding: This study had no specific funding.

Background Stigma among healthcare providers is a barrier to the effective delivery of mental health services in primary care. Few studies have been conducted in primary care settings comparing the attitudes of healthcare providers and experiences of people with mental illness who are service users in those facilities. Such research is necessary across diverse global settings to characterize stigma and inform effective stigma reduction. Methods Qualitative research was conducted on mental illness stigma in primary care settings in one low-income country (Nepal), two lower-middle income countries (India, Tunisia), one upper-middle-income country (Lebanon), and three high-income countries (Czech Republic, Hungary, Italy). Qualitative interviews were conducted with 248 participants: 64 primary care providers, 11 primary care facility managers, 111 people with mental illness, and 60 family members of people with mental illness. Data were analyzed using framework analysis. Results Primary care providers endorsed some willingness to help persons with mental illness but reported not having appropriate training and supervision to deliver mental healthcare. They expressed that people with mental illness are aggressive and unpredictable. Some reported that mental illness is incurable, and mental healthcare is burdensome and leads to burnout. They preferred mental healthcare to be delivered by specialists. Service users did not report high levels of discrimination from primary care providers; however, they had limited expectations of support from primary care providers. Service users reported internalized stigma and discrimination from family and community members. Providers and service users reported unreliable psychiatric medication supply and lack of facilities for confidential consultations. Limitations of the study include conducting qualitative interviews in clinical settings and reliance on clinician-researchers in some sites to conduct interviews, which potentially biases respondents to present attitudes and experiences about primary care services in a positive manner. Conclusions Primary care providers’ willingness to interact with people with mental illness and receive more training presents an opportunity to address stigmatizing beliefs and stereotypes. This study also raises important methodological questions about the most appropriate strategies to accurately understand attitudes and experiences of people with mental illness. Recommendations are provided for future qualitative research about stigma, such as qualitative interviewing by non-clinical personnel, involving non-clinical staff for recruitment of participants, conducting interviews in non-clinical settings, and partnering with people with mental illness to facilitate qualitative data collection and analysis.

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Background The absence of economic evidence hinders current reforms of hospital based mental health systems in Central and Eastern Europe. We aimed to assess the costeffectiveness of care for people with chronic psychoses in psychiatric hospitals compared to discharging patients to the community in the Czech Republic. Methods We conducted a prospective study of people with chronic psychotic disorders and evaluated the impact associated with discharge into community services as compared to not discharging people from psychiatric hospitals at baseline in the Czech Republic. We measured utilization of services, health related quality of life, met and unmet needs, and global functioning using an adapted Client Services Receipt Inventory (CSRI), EQ-5D-5L, Camberwell Assessment of Need (CAN) and General Assessment of Functioning (GAF). Adjusting for baseline differences between the two groups, we assessed differences in societal costs in Euros (€) and QALYs over a year-long follow-up which we then used to estimate the incremental cost-effectiveness ratio (ICER). We conducted multiple sensitivity analyses to assess the robustness of our results. Outcomes In our base case scenario, we included 115 patients who were either inpatient or community services users at the baseline. The two groups were very similar in terms of their observed characteristics. The annual QALY was 0.77 and 0.80 in the group discharged to the community at the baseline compared to not being discharged (difference 0.03 95% confidence interval-0.04 to 0.1), but costs were €8,503 compared to €16,425 (difference €7,922, 95% confidence interval 4,371 to 11,472) such that the ICER reached over 250,000 € per QALY. This is considerably above levels that are conventionally considered to be costeffective and the estimated probability that discharge to the community was cost-effective was very high. None of the sensitivity analyses changed these results qualitatively. Interpretation This study provides economic evidence for deinstitutionalization by showing that discharge to community care is cost-effective when compared to care in psychiatric hospitals in the Czech Republic. Thus, it adds to the human rights-and clinical-based arguments for mental health care reforms in Central and Eastern Europe.

Background The overall objective of the study is to improve the mental health of the age group below 18 years through the investigation of the intra-and inter-sectoral cooperation between local suppliers and to make the intensity and quality of collaborations measurable. In this paper, based on Hungarian and international literature, we aim at describing the current and future optimal cooperation between the members of the mental health care system and examine the possibilities for documenting and measuring cooperation. Methods Semi-structured interviews were recorded with the leaders or representatives of 12 public educational institutions, six social and six health institutions involvement of the relevant experts (N = 24). Results The function of the institutions belonging to these systems, as well as the daily work of the professionals working there, have a signi cant impact on the mental health of children in either positive or negative directions. After exploring the current situation, the cooperation of local suppliers and inter-institutional relations can highly increase the mental health improvement of the youth. Conclusion According to the results, the developing progress can be more effective through organising the different forms of care, sectors and professionals together to achieve a common goal.