A journey through Russian mental health care: A review and evaluation

摘要

Mental health disorders are among the leading causes of disease and long-term disability globally and, therefore, are one of the greatest challenges for public health. Modern approaches to mental health care (MHC) promote the reduction of inpatient bed numbers in favor of flexible community and outpatient services; however, the implementation of these policies requires significant cultural, conceptual, and structural changes. After the collapse of the Soviet Union in 1991, and the inevitable repercussions in Russian MHC that followed, major public sector and social transformations occurred. The purpose of this article is to understand the development of Russian MHC after this collapse—the main tendencies, priorities, and directions; what was neglected; and how differing levels of transformation affected the system. Two main coordinated systems have been used to support the research aims: European models of care and the Soviet model. To fully understand the current situation of MHC in Russia, an analysis of relevant policy documents, special programs, laws, and scientific literature was conducted. The results indicate that on a discursive level the MHC delivery system in contemporary Russia is developing towards more modern models and principles. However, there has been a fairly constant "tendency to ignore" some important topics: stigma, social inclusion, independent living of patients, etc. Furthermore, it seems that the Russian MHC system is still dominated by psychiatrists, and cooperation with other specialists in state care and health professionals from private practices and NGOs is not common.