Dzmitry Krupchanka

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

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, rather than by systematic implementation of government policies.

Experience of stigma in private life of relatives of people diagnosed with schizophrenia in the Republic of Belarus

PurposeFamily stigma constitutes a major problem in schizophrenia worldwide. Data on first-hand experience of stigma in families is necessary for planning and implementing interventions to reduce its burden. The aim of the study was to investigate the experience of stigma among relatives of persons with schizophrenia in Belarus.MethodsQualitative research methods, such as the thematic analysis of in-depth semi-structured interviews with 20 relatives of people diagnosed with schizophrenia, were used. Experience of discrimination, strategies used to cope with it, and requests for interventions were investigated.ResultsThe most salient themes in experience of stigma in the private domain of life elicited in the narratives included anticipated stigma and dissolution of families. The experience of stigma was associated with burdensome feelings of guilt, tiredness and loneliness, together with fear and anxiety due to uncertainty in the future and sorrow because of frustrated hopes in past. Analysis of the strategies used to overcome the difficulties revealed concealment and “life behind closed doors”, avoidance of the rest of the family, taking full responsibility and sacrificing one’s personal life.ConclusionTo reduce the burden of stigma in the private life of the family members of people living with schizophrenia in Belarus, important steps should be taken to promote the empowerment of families including: reforming mental health services; provision of better access to information; family support services, community care; development of family organisations; assistance in communication, re-socialisation and independent living for people diagnosed with schizophrenia.

Long-term hospitalizations for schizophrenia in the Czech Republic 1998-2012.

Deinstitutionalization has not been pursued in the post-communist Europe until recently. The population of psychiatric patients institutionalized in the regional mental hospitals is, however, largely understudied. The aim of this study is to assess discharges of long-term inpatients with schizophrenia from Czech psychiatric hospitals and to analyse re-hospitalizations within this group. The nationwide register of all-cause inpatient hospitalizations was merged with the nationwide register of all-cause deaths on an individual level basis. Descriptive statistics, survival analysis and logistic regression were performed. 3601 patients with schizophrenia previously hospitalized for more than a year were discharged from Czech mental hospitals between 1998 and 2012. This included 260 patients hospitalized for >20years. Nearly one fifth (n=707) of the long-term patients died during the hospitalization; and discharges of 19.36% (n=697) were only administrative in their nature. Out of 2197 truly discharged patients, 14.88% (n=327) were re-hospitalized within 2weeks after the discharge. The highest odds of rehospitalization were associated with being discharged against medical advice (OR 5.27, CI: 3.77-7.35, p<0.001). These data are important for the ongoing mental health care reforms in the Czech Republic and other countries in the Central and Eastern Europe.

Mortality in people with mental disorders in the Czech Republic: a nationwide, register-based cohort study

BACKGROUND The region of central and eastern Europe is estimated to have high rates of premature mortality due to mental disorders. However, epidemiological evidence is scarce and insufficient to inform policy actions and health system development. We aimed to assess mortality associated with mental disorders in the Czech Republic. METHODS We did a nationwide, register-based, retrospective cohort study using routinely collected health data from two nationwide registries in the Czech Republic: the register of inpatient discharges (from Jan 1, 1994, to Dec 31, 2013) and the causes of death registry (from Jan 1, 1994, to Dec 31, 2014). We first identified all individuals discharged from mental health institutions with WHO International Classification of Diseases tenth edition (ICD-10) diagnoses of mental and behavioural disorders (from 1994 to 2013). We then did a deterministic individual-level linkage of these data with all-cause mortality data for the whole period (1994-2014). Standardised mortality ratios (SMRs) and 95% CIs were calculated for the year 2014, comparing deaths in people with mental and behavioural disorders discharged from psychiatric hospitals with deaths in the general population. FINDINGS The final study population comprised 283 618 individuals. 3819 of these individuals died in 2014, corresponding to a mortality risk more than two times higher than that of the general population (SMR estimate 2·2; 95% CI 2·2-2·3). Differences in SMR estimates across diagnostic groups were substantial, with the highest SMR for substance use disorders (3·5; 95% CI 3·4-3·7) followed by schizophrenia, schizotypal, and delusional disorders (2·3; 2·1-2·5), personality disorders (2·3; 2·0-2·6), neurotic, stress-related, and somatoform disorders (1·8; 1·6-1·9), and mood (affective) disorders (1·6; 1·5-1·7). INTERPRETATION Mortality among people with mental disorders in the Czech Republic is markedly higher than in the general population. Our findings should stimulate and inform policy in the central and eastern Europe region, as well as ongoing national mental health-care reforms in the Czech Republic. FUNDING Czech Ministry of Education, Youth and Sports.

Satisfaction with psychiatric in-patient care as rated by patients at discharge from hospitals in 11 countries

PurposeThere is disregard in the scientific literature for the evaluation of psychiatric in-patient care as rated directly by patients. In this context, we aimed to explore satisfaction of people treated in mental health in-patient facilities. The project was a part of the Young Psychiatrist Program by the Association for the Improvement of Mental Health Programmes.MethodsThis is an international multicentre cross-sectional study conducted in 25 hospitals across 11 countries. The research team at each study site approached a consecutive target sample of 30 discharged patients to measure their satisfaction using the five-item study-specific questionnaire. Individual and institution level correlates of ‘low satisfaction’ were examined by comparisons of binary and multivariate associations in multilevel regression models.ResultsA final study sample consisted of 673 participants. Total satisfaction scores were highly skewed towards the upper end of the scale, with a median total score of 44 (interquartile range 38–48) out of 50. After taking clustering into account, the only independent correlates of low satisfaction were schizophrenia diagnosis and low psychiatrist to patient ratio.ConclusionFurther studies on patients’ satisfaction should additionally pay attention to treatment expectations formed by the previous experience of treatment, service-related knowledge, stigma and patients’ disempowerment, and power imbalance.

Equal access for all? Access to medical information for European psychiatric trainees

Access to medical information is important as lifelong scientific learning is in close relation with a better career satisfaction in psychiatry. This survey aimed to investigate how medical information sources are being used among members of the European Federation of Psychiatric Trainees. Eighty-three psychiatric trainees completed our questionnaire. A significant variation was found, and information availability levels were associated with training duration and average income. The most available sources were books and websites, but the most preferred ones were scientific journals. Our findings suggest that further steps should be taken to provide an equal access to medical information across Europe.

State of mental healthcare systems in Eastern Europe: do we really understand what is going on?

The article examines the current state of mental healthcare systems in countries of Eastern Europe and derives implications for future research and service development. Analysis of available statistics from the World Health Organization’s Mental Health Atlas suggests the need for better-quality data collection. Nonetheless, there appear to be insufficient resources allocated to mental health, lack of involvement of service users in policy-making and, to a large extent, systems continue to rely on mental hospitals. Based on the data presented, a set of directions for future reforms was drafted.

Early career psychiatrists corner: Third young psychiatrists’ network meeting: Stigma in YPs’ perspective

The movement of the young psychiatrists’ (YPs) network (YPN) was born in 2009 and has developed substantially since then. The idea of network collaboration was suggested by the Swedish Eastern Europe Committee (Assoc. Professor Jerker Hanson) and found approval of YPs from Lithuania, Sweden, Belarus, and Russia in Kaliningrad in May 2009. Next 2 meetings took place in Vilnius, Lithuania in 2010 devoted to neuropsychiatry and diagnostic scales and Riga, Latvia in 2011 with the main topics of personality disorders and coercive care. The number of countries-delegates has increased from 4 in 2009 to 18 (90 YPs) in 2011. YPN is open to all interested YPs all over the world and supports any activity of participants in the field of professional development. YPN preferentially focuses on international exchange of recent evidence-based knowledge about mental health and treatment focusing on patient’s rights, national diversities and cultural traditions and working toward destigmatizing psychiatrists and mental disorders in society using the creative ideas of young minds and innovative technologies. The interaction between in YPN is based on mutual respect, openness and already friendship. The activity of organization includes both on-line collaboration and annual conferences with publishing of abstract booklets of young researchers. Programmes of YPN Meetings include not only lectures by prominent professors but maintain workshops and social program as a way to increase activity and involvement of young participants. After each conference all YPs are welcomed to take part in organizing committee of the future meeting. The forthcoming Meeting is supported by European Federation of Psychiatric Trainees and will take place in Minsk, Belarus, 27–29th September 2012. The project is oriented on the development of new perspectives in understanding of phenomenon of stigma of mental disorders in patients, professionals and society, as it seems to be a real substantial obstacle in contemporary psychiatry. The program of the conference is accessible at www.ypsnet. org and includes lectures by Professors N. Sartorius (Switzerland), Sir D. Goldberg (UK), W. Gaebel (Germany), W. Rutz (Sweden), R. D’Souza, A. Janca (Australia), E. Mohandas, Anu Kant Mital (India), R. Evsegneev, O. Skugarevsky, S. Igumnov (Belarus). Members of early career psychiatrists’ organizations such as EFPT, WPA ECPC, AFECP, Russian ECPC and others will discuss their collaboration during the meeting of YPN without involvement or creation of any new organization. YPN is just the unity of early career psychiatrists from all countries of Europe and Russia. YPN is not an organization of any hierarchy but collaboration of enthusiastic YPs from Europe and Russia who encourage each other in an open dialogue and a brainstorming fostering atmosphere. The importance of meeting is emphasized by first participation of young colleagues from AFECP and their involvement in activities of organizing committees of future annual Meetings. It is an important step for AFECP to promote itself on the international level among ECPs organizations, demonstrate the opinion, share experience and make a contribution into networking on behalf of Asia. Members of AFECP are welcomed to provide the ideas of networking worldwide through the countries of Asia and strengthen collaboration between European and Asian YPs for further assistance in solving current professional problems and mutual benefits of early career psychiatrists in their own countries. YPN is sincerely grateful to Elsevier who kindly supported the process of developing and publishing of promoting materials about the Meeting.

Factors associated with health service utilisation for common mental disorders: a systematic review

BackgroundThere is a large treatment gap for common mental disorders (CMD), with wide variation by world region. This review identifies factors associated with formal health service utilisation for CMD in the general adult population, and compares evidence from high-income countries (HIC) with that from low-and-middle-income countries (LMIC).MethodsWe searched MEDLINE, PsycINFO, EMBASE and Scopus in May 2016. Eligibility criteria were: published in English, in peer-reviewed journals; using population-based samples; employing standardised CMD measures; measuring use of formal health services for mental health reasons by people with CMD; testing the association between this outcome and any other factor(s). Risk of bias was assessed using the adapted Mixed Methods Appraisal Tool. We synthesised the results using “best fit framework synthesis”, with reference to the Andersen socio-behavioural model.ResultsFifty two studies met inclusion criteria. 46 (88%) were from HIC.Predisposing factors: There was evidence linking increased likelihood of service use with female gender; Caucasian ethnicity; higher education levels; and being unmarried; although this was not consistent across all studies.Need factors: There was consistent evidence of an association between service utilisation and self-evaluated health status; duration of symptoms; disability; comorbidity; and panic symptoms. Associations with symptom severity were frequently but less consistently reported.Enabling factors: The evidence did not support an association with income or rural residence. Inconsistent evidence was found for associations between unemployment or having health insurance and use of services.There was a lack of research from LMIC and on contextual level factors.ConclusionIn HIC, failure to seek treatment for CMD is associated with less disabling symptoms and lack of perceived need for healthcare, consistent with suggestions that “treatment gap” statistics over-estimate unmet need for care as perceived by the target population. Economic factors and urban/rural residence appear to have little effect on treatment-seeking rates. Strategies to address potential healthcare inequities for men, ethnic minorities, the young and the elderly in HIC require further evaluation. The generalisability of these findings beyond HIC is limited. Future research should examine factors associated with health service utilisation for CMD in LMIC, and the effect of health systems and neighbourhood factors.Trial registrationPROSPERO registration number: 42016046551.

Discrimination and Stigma

Since Goffman’s seminal work on stigma (Goffman 1963), research in this field has steadily grown (Abelev et al. 2006). Until recently, most stigma research in relation to mental illness consisted of surveys among the general public of attitudes towards people with mental illness (Sartorius and Schulze 2005; Rabkin 1974; Link et al. 1999; Thornicroft 2006a). Much less is known about the subjective experiences of stigma and discrimination faced by people with mental illness (Thornicroft 2006a) or about the effective interventions to reduce stigma (Thornicroft 2006a).