Mental health services in Ukraine: 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 Ukraine: 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 disturbed. 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 disability; 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 disorders, 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: Training: 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 (WHC). 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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