A blind spot on the global mental health map: a scoping review of 25 years' development of mental health care for people with severe mental illnesses in central and eastern Europe

Winkler, Petr; Krupchanka, Dzmitry; Roberts, Tessa; Kondrátová, Lucie; Machů, Vendula; Höschl, Cyril; Sartorius, Norman; Voren, Robert van; Aizberg, Oleg; Bitter, István; Cerga-Pashoja, Arlinda; Deljkovic, Azra; Fanaj, Naim; Germanavičius, Arūnas; Hinkov, Hristo; Hovsepyan, Aram; Ismayilov, Fuad; Ivezić, Slađana Štrkalj; Jarema, Marek; Jordanova, Vesna; Kukic, Selma; Makhashvili, Nino; Šarotar, Brigita Novak; Plevachuk, Oksana; Smirnova, Daria; Voinescu, Bogdan; Vrubļevska, Jeļena; Thornicroft, Graham

doi:10.1016/s2215-0366(17)30135-9

Cited by 122 publications

(162 citation statements)

References 26 publications

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“…Overall, our data regarding the obstacles to ED/EI implementation additionally confirmed that the greatest challenges in mental healthcare in CEE seem to be insufficient resource allocation and non‐transparent decision making (Winkler et al, ). This affects the implementation of novel, advanced methods in psychiatry, including ED/EI services for psychosis in most CEE countries.…”

Section: Discussionsupporting

confidence: 73%

Implementation of early detection and intervention services for psychosis in Central and Eastern Europe: Current status

Maric

Petrović²,

Rojnić-Kuzman

et al. 2019

Early Intervention Psych

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Aim: Unequal development of early detection (ED) and early intervention (EI) programs/services for psychosis has been shown across Europe. The present report aims to fill in the knowledge gap regarding the implementation and several other important aspects of ED/EI services in Central and Eastern Europe (CEE), a region with highly underdeveloped mental health service research.Methods: A 17-item questionnaire was created to address the information regarding ED/EI organization and factors limiting their implementation. This questionnaire was distributed to professionals recognized as experts in the field from 23 CEE countries. The data were collected between December 2017 and February 2018.Results: We found that ED/EI services were rather an exception than a rule in CEE. The majority of the countries involved in the present survey reported no national plans or programmes for ED/EI development. The existing services were mostly state-funded, hospital-based, healthcare sites for both adolescent and adult help-seekers. The lack of adequate infrastructure, finances and governmental support, as well as the insufficient number of staff, were identified as the most important factors limiting service implementation.Conclusions: Although ED/EI services for psychosis exist in some CEE countries, this could be largely attributed to enthusiastic individuals and organizations, rather than to a strategic development. To the best of our knowledge, this was the first mapping of ED/EI development in the region, which could be used as a starting point to plan the improvement of services, to accelerate their implementation and to facilitate timely detection of and intervention in psychosis across Europe.

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Section: Discussionsupporting

confidence: 73%

Implementation of early detection and intervention services for psychosis in Central and Eastern Europe: Current status

Maric

Petrović²,

Rojnić-Kuzman

et al. 2019

Early Intervention Psych

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“…17 Despite this, they tend to have high institutional inertia because they are historically rooted. [18][19][20][21][22] Finally, they operate on a high marginal cost per service user-resources that could be better used for community-based services. [23][24][25] Therefore, one of the key tenets of deinstitutionalization is for mental health care to be provided through service outlets accessible to the general population.…”

Section: Introductionmentioning

confidence: 99%

Mainstreaming Mental Health Care in 42 Countries

Shen

Eaton

Snowden

2017

Health Systems & Reform

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Global consensus and national policies have emphasized deinstitutionalization, or a shift in providing mental health care from institutional to community settings. Yet, psychiatric hospitals and asylums receive the majority of mental health funding in many countries, at odds with research evidence that suggests that services should be delivered in the community. Our aim is to investigate the norms, actors, and strategies that influence the uptake of deinstitutionalization internationally. Our study is informed by prior literature on management and implementation science. The success and failure of mental health care operations depend on identifying and overcoming challenges related to implementing innovations within national contexts. We surveyed 78 experts spanning 42 countries on their knowledge and experiences in expanding community-based mental health care and/or downsizing institutionbased care. We also asked them about the contexts in which said methods were implemented in a country. We found that mental health care, whether it is provided in institutions or in the community, does not seem to be standardized across countries. Our analysis also showed that moving deinstitutionalization forward requires meaningful engagement of three types of actors: government officials, health care professionals, and local experts. Progress toward deinstitutionalization depends on the partnerships formed among these actors and with diverse stakeholders, which have the potential to garner resources and to scale-up pilot projects. In conclusion, different countries have adapted deinstitutionalization in ways to meet idiosyncratic situations and population needs. More attention should be given to the management and implementation strategies that are used to augment treatment and preventive services.

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“…Culturally-specific stigma studies are still lacking, and most studies on the subject used Western-developed stigma measures or lacked explicit stigma-specific conceptual frameworks (Yang et al, 2014). Evidence from Central and Eastern Europe on stigma is particularly limited, especially on stigma experienced by family members and carers (Evans-Lacko et al, 2014;Winkler et al, 2017).…”

mentioning

confidence: 99%

Experience of stigma and discrimination in families of persons with schizophrenia in the Czech Republic

Krupchanka

Chrtkova

Vítková

et al. 2018

Social Science & Medicine

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We identified several features of mental health related stigma and the ensuing discrimination in Czech Republic experienced by persons with severe mental illness and their relatives. We developed a set of recommendations for policy-makers aimed at reducing ignorance and prejudice amongst the public and professionals, improving health and social services-including employment, housing and community integration-and the provision of family support.

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A blind spot on the global mental health map: a scoping review of 25 years' development of mental health care for people with severe mental illnesses in central and eastern Europe

Cited by 122 publications

References 26 publications

Implementation of early detection and intervention services for psychosis in Central and Eastern Europe: Current status

Implementation of early detection and intervention services for psychosis in Central and Eastern Europe: Current status

Mainstreaming Mental Health Care in 42 Countries

Experience of stigma and discrimination in families of persons with schizophrenia in the Czech Republic

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