Mental health services in Ukraine

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					    Mental health services in
 provided at specialized mental institutions
  (mental hospitals and dispensaries);
 inpatient mental institutions (hospitals,
  boarding houses) financed on priority basis;
 outpatient mental institutions primarily
  provide sustaining biological treatment of
  patients with mental disorders and monitor
  their mental condition.
    Mental health services in
 mental institutions remain isolated from the
  rest of the health care system;
 mental institutions deal with severe forms of
  mental disorders requiring the involvement of
  psychiatric professionals, as well as minor and
  moderate mental disorders;
 people are unwilling to come to mental
  institutions wary of the stigma of mentally
 Depressive disorders are the most common
 form of psychopathology among all mental
               disorders and:

 account for 17.3% of total losses of able years due
  to other mental disorders;
 are among the ten most common causes of
 affect over 10% of patients contacting doctors
  within the primary care system and 22%-47% of
  patients with somatic disorders, depending on the
  type of somatic pathology;
 patients with depressive disorders show a high
  suicide rate.
    Creating an environment for
  efficient mental care within the
     public health care system:
 Ensure easy access to primary mental care for
  majority of the population through the primary
  care system.
 Set up interaction between primary care and
  specialized mental care facilities.
 Train primary care personnel to provide competent
  primary mental care.
 Mental care unit staffing:

 Psychologist (individual and team consulting,
  psychopathological diagnostics)
 Social worker (community social and
  educational activities)
 Mental practice nurse (a link between mental
  institutions, primary care units and family
  medicine centers (FMC), home nursing)
    Objectives of a mental
          care unit:
 Prevention activities and early detection of
  mental disorders
 Provision of primary care to patients with
  mental disorders, independently and with the
  assistance of consultants
 Training of medical personnel (doctors, nurses)
  in detecting mental disorders, and working
  with patients experiencing mental
  (psychological) problems
 Training for patients and family members
  Primary care personnel must possess the
                          skills to:
 detect and correctly classify mental disorders;
 provide medical and corrective psychological treatment
  where the involvement of a psychiatrist is not required;
 timely and correctly (in a psychologically acceptable form
  and in line with applicable ethical standards) refer patients
  to a psychiatrist for counseling;
 maintain community outreach efforts to prevent mental
 arrange for provision of care to a mental patient jointly with
  a psychiatrist, FMC nurses, specialized mental facility
  nursing staff, psychologists and social workers.
      Training of primary care
     specialists in mental care:
 courses in psychiatry and mental therapy for
  family doctors at post-graduate departments
  of medical academies;
Training and methodological materials:
 Clinical practice guidelines on mental care for
  family doctors (information and screening
  package) AIHA 2000
 Clinical practice guidelines on detection,
  treatment and rehabilitation standards for
  depressive disorders (being developed).
        Further work on mental care
        guidelines for family doctors
Add sections on:
 psychiatry-related legislation;
 patient interviewing techniques;
 assessment of risk factors triggering mental disorders and
  suicidal tendencies;
 guidelines for family doctors on the appropriate course of
  action where a mental disorder has been detected as
  provided for in psychiatry legislation;
 sexual disorders;
 work with terminal-phase patients.
Elaborate sections on:
 depression and anxiety modules;
 non-pharmaceutical treatment   techniques.
  Clinical practice guidelines on
  mental health to be developed
        for FMC and WHC:
 Family doctor guidelines on mental health
  among the elderly.
 Family doctor guidelines on children’s
  mental health.
 Guidelines on women’s mental care for
  family doctors and women’s health centers
  Expected results of mental care
  reform and integration into the
       primary care system:

 enhanced attention towards patients and focus
  on community needs;
 resource savings;
 improved skills and increased confidence of
  primary care personnel;
 timely detection and effective treatment of
  minor and moderate mental disorders,
  prevention of suicidal attempts.
      Consequences of inaction:
 increased number of primary care patients
  with untreated mental disorders receiving
  somatic treatment with no effect;
 dissatisfaction of patients compelled to
  contact mental institutions (due to limited
  accessibility of primary mental care);
 inefficient operation of mental care units;
 lack of a focus on prevention in mental care
  efforts of health institutions.

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