Mental health care reform (Lithuania)
In most former Soviet republics, mental health care systems are still highly institutionalized and biologically oriented. As Robert van Voren of the Human Rights in Mental Health – Federation Global Initiative on Psychiatry explained in his presentation at the 'Culture and reform of mental health care in central and eastern Europe' workshop run by WHO Europe in Klecany, Czechia in October 2017, catching up to global standards after Soviet psychiatry’s decades long disconnection from developments in the field has required effort and time. In some countries, the Soviet psychiatric nomenklatura managed to maintain leadership positions and keep reformers at bay by using their close connections to the former communist leadership.
While many positive reform projects took place in the late 1990s and early 2000s, reform is now at a standstill and, in some cases, sliding backwards. Stigmatization is still pervasive, and mental illness is commonly met with fear or apprehension.
In Lithuania, for example, while today’s quality of care greatly exceeds that of the Soviet era, community-based mental health services are still very limited in scope. As in almost all other former Soviet republics, the system of institutional care that isolates people with chronic mental illness or disability from society is still in place. Many young psychiatrists and other mental health professionals emigrate because of this unfavourable situation.
Corruption is also a reality, due in part to the very low salaries of mental health care professionals. Many juggle multiple jobs and fail to prioritize their poorly paid work in mental health institutions. As such, the quality of services remains low.