Services for the Chronically Mentally Ill in Moldova: A Struggle to Survive (original) (raw)
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Mental healthcare reform in the Republic of Moldova
International Psychiatry
Mental healthcare in the countries of the former Soviet Union faces considerable challenges as result of the socio-economic transition. In this article we look at the changes in the Republic of Moldova. We identify weaknesses and strengths in the traditional hospital-based system and describe examples of the successful implementation of modern mental health services. We follow the reform process in mental health law and service provision in view of the recommendations from the Council of Europe (2004) for the protection of human rights of persons with mental disorder. Some of the information in this article was gathered during official visits to mental healthcare institutions in the Republic of Moldova in 2006.
International Journal of Social Psychiatry
Aim: The current research was conducted in the context of an ongoing reform of mental health services in the Republic of Moldova since 2014, where efforts have been devoted to creating community-based mental health services. This article presents a snapshot of the needs of mental health service users in the Republic of Moldova and helps to understand how and with which services their needs can be addressed. Methods: This cross-sectional study compared the levels of needs (CANSAS scale), quality of life (EQ-5D 3L), mental health status (MINI for psychotic disorders) and functioning (WHO-DAS) among mental health service users in the psychiatric hospital in Chisinau, Moldova. All service users resided in districts where community mental health services were being developed. Correlations between quality of life, functioning and unmet need were explored. Results: Of 83 participants, one third had a psychotic or a mood disorder. On average, participants reported needs in 9.41 domains ( SD...
Assessing the community needs of mental health residential care service users in Republic of Moldova
2015
Background: Mental health problems are a major clinical and social issue in the Republic of Moldova, accounting for a significant share of disability and ranking in top five of the ten lines in the hierarchy of conditions. The incidence rate has been growing in the Republic of Moldova to reach approximately 15 thousand a year (14,655 in 2011), i.e. 411.4 per 100 thousand population, and a prevalence rate of 97,525 thousand people in 2011, i.e. 2,737.9 per 100 thousand population. Psychiatric care system provides for scanty mental health services at community level, aiming mainly at centralized hospital-based therapy through a network of three psychiatric hospitals tallying up 1,860 beds and 4 psycho-neurological boarding houses with 1,890 beds, thus fuelling up patient stigmatization. Objectives: The purpose of this study was to assess the individual needs of beneficiaries and their level of autonomy within residential care for the planning of mental health system reforms and deinstitutionalization in the Republic of Moldova. This study was commissioned by the Ministry of Labour, Social Protection and Family and by the Ministry of Health, with the World Health Organization support, to provide for effective enforcement of article 19 of the UN CRPD. The study pursued the following goals: To evaluate the level of autonomy of the psychiatric hospital and psycho-neurological boarding house residents by using a representative sample of 10 per cent of the total number of patients / residents and cross-comparison; To evaluate four psycho-neurological boarding houses for adults and three psychiatric hospitals; To develop recommendations for planning the deinstitutionalization of people with mental health problems and community placement based on the study findings. Methodology and results: The study made use of two global tools: questionnaire for individual assessment of mental health facility residents, and institutional assessment questionnaire. All interviewees were divided into four categories by one's degree of dependence and readiness to live independently in the community. Only 1.2% of respondents from PNHB were fully dependent on a third party or specialized services, making up category 4, requiring continuous care and support. In PH this category of people is absent. Conclusions: The condition of respondents was worse in PNBH than in PH. However, yet, those ready to be deinstitutionalized accounted for most of respondents there. All hospitals had the resident's consent to admission and treatment, whereas there was no consent in PNBH whatsoever. It is quite obvious that both the hospitals and residential care system do not achieve their intended purpose, meaning that the majority of residents may be deinstitutionalized without any support therapy.
Changes in the Provision of Institutionalized Mental Health Care in Post-Communist Countries
PLoS ONE, 2012
Background: General psychiatric and forensic psychiatric beds, supported housing and the prison population have been suggested as indicators of institutionalized mental health care. According to the Penrose hypothesis, decreasing psychiatric bed numbers may lead to increasing prison populations. The study aimed to assess indicators of institutionalized mental health care in post-communist countries during the two decades following the political change, and to explore whether the data are consistent with the Penrose hypothesis in that historical context. Methodology/Principal Findings: General psychiatric and forensic psychiatric bed numbers, supported housing capacities and the prison population rates were collected in Azerbaijan,
The lancet. Psychiatry, 2017
Just over 25 years have passed since the major sociopolitical changes in central and eastern Europe; our aim was to map and analyse 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 not transparent, and full economic evaluations of complex interventions and rigorous epidemiological studies are lacking. Stigma seems to be higher than in other European countries, but consideration of human rights and user involvement are increasing. The region has seen respectable development, which happened because of grassroots initiatives supported by international organisations, r...
The Provision of Psychiatric Care in Romania–Need for Change or Change of NEEDS1?
Transylvanian Review of …
The reform of the mental health system in Europe takes place under the umbrella of deinstitutionalization, development of alternative community services, integration of health services and integration with social services (Becker and Vázquez-Barquero, 2001). Current article discusses the reform of the mental health system in Romania by using the results of two studies. The goal was to draw an overview of the reform processes in Romania in the last few years by analysing in parallel the actual status of mental health inpatient and community services. One study was conducted in 2007-2008 where a diagnosis of psychiatric hospitals and psychiatric inpatient units in general hospitals took place. The second study conducted in 2006 addressed the development of community mental health services. The results show that developing a strategic approach for change at system level is most urgently needed. This should be characterised by a clear vision at decision making level, by coupling of responsibilities for reform with the resources needed to conduct change, and by cooperation among the involved institutional stakeholders.
The Lancet Regional Health - Europe, 2021
Over the past decade, there has been increased attention to global mental health, which emphasizes improving access to quality mental health care in order to reduce the worldwide treatment gap. However, Eastern European and Central Asian countries and their specific mental health needs have largely been underemphasized, evidenced by a dearth in literature and funding. Here, we provide an overview of the mental health needs in Ukraine and its challenges with quality care provision as a key example in highlighting these gaps, then broaden our discussion to include parallels with other countries in the Eastern European and Central Asian region. We describe the unique strengths relative to mental health care provision that are present in Eastern Europe and Central Asia and suggest the importance of postgraduate training, regional collaboration, and capacity building specific to research management as strategies to address the current challenges. We stress that greater investment from funders, government, and the global mental health community are needed to improve the current mental health situation in Ukraine, specifically, and Eastern Europe and Central Asia, broadly. We argue that greater attention to Eastern Europe and Central Asia is needed to fully advance the agenda of the global mental health field.
Community Mental Health Journal
Eight community mental health care centres (initiated by the South-Eastern Europe Stability Pact) in Albania, Bosnia-Herzegovina, Croatia, Macedonia, Moldova, Montenegro and Romania were evaluated. Characteristics of patients, patient reported outcomes and patient views of care were assessed in 305 psychiatric patients. Patient characteristics varied across centres, with most patients having long term psychotic disorders. Treatment satisfaction and therapeutic relationships were rated favourably. Subjective quality of life mean scores were rather low, with higher satisfaction with health and dissatisfaction with the financial and employment situation. Being unemployed was the only factor associated with poor quality of life and lower treatment satisfaction. Most developing centres target patients with persistent psychotic disorders. Care appears highly valued by the patients. The findings encourage establishing more centres in the region and call for employment schemes for people with mental illnesses.
EVALUATION OF MENTAL HEALTH OPPORTUNITIES PROGRAMS IN MOLDOVA
The general recommendations advocate for the coherent use of relevant cash benefit and fiscal policies in order to promote reintegration of children with disabilities and development of the social services. The development of the social services could be effectively done through the partnership and cooperation of central and local authorities and not disjoint by either of them as the former have not adequate expertise and the later financial capacity, yet the former have financial means and quality assurance competence, while the later understanding of specifics and resources to supply.