PSYCHIATRISTS FORUM ON EASTERN EUROPE AND THE BALKANS II

CRAIOVA DECLARATION Tudor Udristoiu Craiova, Romania EASTERN EUROPE AND BALKANS Background       Low social and economical status Low income of the people Lack of social support and health-oriented education Poor offer of health and mental health services Absence of coherent plans, regulations, coordination and flexibility in the field The mentality of authorities and people PHILOSOPHY PSYCHIATRIC CARE EPIDEMIOLOGICAL STUDIES PSYCHIATRIC NETWORK PROGRAMS ETHICS SUICIDAL RISK - Goal - Objectives - Strategy - Resources / needs - Evaluation LIVING STANDARD ANTISOCIAL RISK PATIENTS’ RIGHTS MENTALITY - STYGMA - ROMANIA EPIDEMIOLOGICAL STUDIES Bucharest (1974) Sample size – 11,729 Craiova (1980) Sample size – 1,929 METHOD  Field studies (active method)  Age > 16 yrs  Randomized sampling, representative groups  Screening by questionnaire, then psychiatric examination  Coding: 0 – no psychiatric disorder 1 – isolated psychiatric disorders 2 – disorder meeting WHO criteria  Diagnostic clusters (severity): neurotic, psychotic, mixed syndromes due to organic condition, psychopathic, alcoholism, epilepsy  Non-response less than 10 % 70 60 50 40 % 30 63.13 64.33 Bucharest 18.51 19.33 Craiova 18.34 16.33 20 10 0 Code 0 Code 1 Code 2 Comparison of the code groups 0, 1, 2 in the two samples Bucharest - 11.729 subjects Craiova - 1.929 subjects 60 50 40 Bucharest 30 20 10 0 Craiova ic tic Ps yc ho t Ne u op M Al co h Comparison of diagnostic clusters (severities) between the two samples Bucharest - 11.729 subjects Craiova - 1929 subjects Ps yc h Ep ile ps y at hi c ix ed ro ol is m ROMANIA SUICIDE    Official prevalence – 11.4 / 100,000 inhabitants / year The real value seems to be higher (local researches) There is no centralized system for evidence  There is no strategy for prevention ROMANIA FACTS Mental Health Care    Obsolete mentality (authorities, professionals, people) Excessive bureaucracy Economic limitations with accountant domination     Poor medical care for psychiatric patients Poor infrastructure Modest offer of services, both in quantity and quality Aggregation in major centers ROMANIA FACTS SOMATIC HEGEMONY  MARGINALIZATION OF PSYCHIATRY In year 2000, the costs for psychiatric care represented 3 % of the total health expenses  Life standards are better in general hospitals than in psychiatric hospitals (with more visible differences in chronic and forensic facilities) Education: - undergraduate – all the sciences addressing the brain represent all together less than 10 % of the curricula - postgraduate (residents) – out of 60 months, only 33 are dedicated for psychiatry and 27 for other specialties (internal medicine, neurology, endocrinology a.o.)  PRIORITIES     Primary prevention Rehabilitation Chronic patients care Suicide prevention Diversifying services and jobs Institutional management Evaluation means and regulations NATIONAL POLICY AND STRATEGY FOR MENTAL HEALTH Number of PSYCHIATRISTS per 10,000 inhabitants        Turkey Romania Bulgaria Hungary Macedonia (FYROM) Russia Serbia-Montenegro - 0.18 - 0.4 - 0.76 - 0.8 - 1.1 - 1.13 - 1.26 (neuropsychiatrists) CRAIOVA DECLARATION The representatives of the psychiatric societies of the area of Eastern Europe and the Balkans, taking into consideration the discussions at the World Psychiatric Association (WPA) Regional Meeting in Craiova, Romania, December 3-5, 2004, and in consonance with the works of the Institutional Program for Eastern Europe and the Balkans Having considered  The historical and cultural background of the area, within which major contributions have been made to medicine and psychiatry  The special mental health problems of the population in the area, produced by severe deprivations of psychological, biological and socio-economic nature, disasters of various kinds including manmade disasters, disintegration or weakening of the social support system, conflicts between the countries of the area, reappearance of forgotten physical illnesses, absence of mental health prevention and promotion strategies (mainly due to other priorities) and poor quality of life of the population at large.  The inadequate provision of mental health services in the countries of the area coupled with lack or inadequate development of appropriate mental health legislation, inadequate provision of mental health services in the community, poor development of outpatient, day hospital, general hospital and community-based facilities, poor integration of general medical and psychiatric services in hospital and in the community, and inadequate de-institutionalization and rehabilitation practices.  The serious deprivation of mental health professionals in a variety of domains, such as education and training, research opportunities, teaching facilities, equipment for clinical work (including basic psychopharmacological agents), all these resulting in demoralization and burn-out with serious consequences on the provision of mental health care and on the quality of life of patients and their carers. Have decided 1) To build knowledge on the realities, needs, service and training resources in psychiatry and mental health in the countries of the area. 2) To promote the organization of community-based mental health care with scientific, humanistic and holistic principles as well as emphasizing catchment-area responsibility, continuity of care and interdisciplinary practice. 3) To facilitate harmonization of educational programs in psychiatry at undergraduate and postgraduate levels, including residency training and continuous medical education. 4) To establish partnerships with governmental, intergovernmental (WHO, United Nations, World Bank, UNESCO, European Union) and non-governmental organizations in order to maximize the impact of institutional efforts. 5) To strengthen communication, organizational and functional aspects of psychiatric societies in the area and their collaboration with their governments and with pertinent components of the World Psychiatric Association, in its various activities (meetings, education, publications and research efforts). 6) To appeal to the governments of the area and international organizations to consult with national psychiatric societies in policy development and implementation concerning mental health care, professional training and research, ensuring their adequate financing commensurate with the existing WHO health economic evidence related to the global burden of disease . 7) To form a Psychiatric Association of Eastern Europe and the Balkans in order to better fulfill the above objectives. The chair of the WPA Institutional Program for Eastern Europe and the Balkans is asked to take the necessary steps to complete the establishment of this new Association. The Association will apply for affiliation to the World Psychiatric Association and will develop an operational action plan with an evaluation component. This new Association represents a useful crystallization of regional aspirations and is a step in the direction of bringing the countries in the area into a wider European and world context. Given in Craiova, Romania, on December 5, 2004 Signatures of the representatives of the psychiatric societies of Armenia, Bulgaria, Hungary, Greece, Republic of Macedonia (FYROM), Romania, Russia, Serbia and Montenegro and Turkey. STATEMENTS – DECLARATIONS Psychiatrist’s opinion • The professional carries all responsibilities, while the decision-makers don’t have any. • Transfer to the psychiatrists the responsibility of a raising number of problems that belong to other sectors or even to the whole society. • Enlarge sometimes the ethical burden of psychiatrists. • Reduced preoccupation for psychiatrist’s position and interests. • Could these statements change the fact that Romania spent in 2001 only 3% of the Health Funds for Psychiatry. DESIDERATA • Collaboration, research and mutual information. • Minimal level of expenses for Psychiatry from the budget of health care. • Minimal standard for undergraduate training in Psychiatry, Behavioural Sciences, Medical Psychology, Clinical Psychology and Sociology. • Unitary curricula for postgraduate training and continuous education in Psychiatry, based on the standards of the European Community. SHORT TERM ACTIONS • System of reporting and registering the psychiatric disorders in each country, in order to build the National Register. • System of reporting and registering the suicide. • Development of non-biological therapies, especially psychotherapy. • Therapeutic guides and protocols.