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Ukraine: a psychiatrist’s point of view. Reports, thoughts, articles (1999–2004)
Y. Yur’yev

MENTAL HEALTH AND GOVERNMENTAL REFORMS (CHILE, UKRAINE)

Y. Yur’yev

* Publication details:
Yur’yev, Y. (2004). Mental health and governmental reforms (Chile, Ukraine). In: Yur’yev, Y. Ukraine: a psychiatrist’s point of view. Reports, thoughts, articles (1999–2004), pp. 116–123. Dnipropetrovsk: Porogi.

General Director of WHO took the decision to devote the World Health Day of the year of 2001 to the mental health problems. It was the first event of the kind in the history of WHO. The top-priority goal of the latter lay in the necessity to contribute to the spreading reduction of those disorders, which have not yet to be treated.

Enclosure A (long-termed tasks concerning the ways of mental health improvement) contains the following proposals to the governments and ministries: to increase the budget sums allotted on psychiatry and narcology; to develop the reforms and reorganization, as well as to promote the services expansion and perfection; to put into practice different programs in this sphere. It was also offered to conduct the professional surveys on the scope of integration and cooperation of different services, and educational, propagandistic, partnership and informational activities.

The national both mental health and general health state is one of the key factors of the successful movement of a country in its historical development and one of the basic causes of unsuccessful governmental reforms. Thus the World Consortium of investigations on the mental health policy was created by the World Health Organization, Global Forum and World Bank (with the USA, Great Britain and Australia as its members).

The main issue of this Consortium was to learn the ways of national programs originating in the field of mental health of the states with different ethnic and cultural and socio-economical characteristics.

Unfortunately, the accumulation rate of the mental and behavioral disorders among the Ukrainian population made up 5% for the period of 1999–2000.

The following forces have influenced negatively on the human psyche in Ukraine for the last decade: ecological situation deterioration; increase in the number of socially conditioned and stressful factors, as well as man-caused accidents and natural disasters scale growing (S. I. Tabachnikov et al., 2001).

The aim of the study: comparing of the socio-economical processes, dynamics of the behavioral and mental infringement activities and the systems of mental services in different countries, experiencing deep reforming in their certain historical period.

Chile

Population: 14.3 million people (1999).

Administrative regions: 13.

National produce: $59.1 billion.

Urban population: about 80%.

Industry: mining, metallurgy, machine building, oil processing, petrochemical, food industry, light industry, electricity and shipbuilding, etc.

Agriculture: plant cultivation (corns, potatoes, beans, sugar beets, etc.), cattle breeding, fish breeding and fishing, fruit cultivation and grapes growing (it occupies the third place in Europe by the sales volumes of wine, yielding to France and Italy only).

Capital: Santiago (6 million people).

Leading religion: Catholicism (85% of population are catholic).

Governed by the militaries from 1973 to 1996.

External debt for the period of the late 1997 totaled $26.8 billion.

Annual national produce growth was 6% for the last 10 years.

Poverty: wide expansion of poverty has gone down from 38.6% in 1990 to 21.7% in 1998.

Unemployment: increased from 7% in 1988 to 10% in 1999, now it is slowly going down.

Malnutrition: over the last years, there has been a very successful nutritional program for poor people. Currently, only 0.6% of 6-year-old children are undernourished.

Low rate of divorces. High level of literacy — 90%.

General health policy

Effective maternity programs, immunization services and child health surveillance were launched in 60s and have successfully been developed at present.

Early oncological pathology detection. Water purification and sanitation.

High blood pressure detection and prevention.

Nowadays there is an impact on mental services.

Mental diseases prevalence statistics:

Diagnosis:      
Schizophrenia (F20–29) 103 on 10,000 people
Manic depression (F30–31) 110  
Depression (F32–33) 697  
Dementia (F00–03) 440  
Mental retardation (F70–79) 160  
Drug abuse (F10–19) 704  

Primary Aid Structure

271 urban outpatient clinics.

30 community family mental health centers, staffed with multidisciplinary teams: psychologists, psychiatrists, physicians, nurses and social workers (especially in Santiago and other cities).

111 psychologists have been enabled into these teams.

160 rural outpatient clinics.

101 outpatient departments in small general hospitals.

1106 rural health stations (our model of medical attendant emergency stations) with only a nursing aid and once a week visit by a professional team (physicians and nurses).

The level of liaison between mental health services and other key agencies (e.g. social services, criminal justice system, schools and workplaces) is very scarce, mainly aimed at patients’ revelation and their referral to mental health institutions.

The Chilean mental hospitals data have not been cited.

The General Health Reform is being discussed now.

In 1993 Chile officially approved a national policy on mental health and psychiatry mutuality, and the national mental health plan was adopted in January 2000 that was the result of long and laborious work of the professional team, authorities and non-governmental organizations. It is based on the facts of wide expansion of mental illnesses, caused by social and economical disasters, unsatisfied demands, obvious invalid preventive treatable and rehabilitative measures and an evident gap in the mental health treatment provision compared to the rest of health services.

The problem of the suicide reducing was paid a great attention to.

The following priorities on mental health and psychiatry prevention and treatment of posttraumatic stressful disorders, depression, schizophrenia and phobic anxiety disorders, as well as Alzheimer illness, dementia, alcohol, drug and tobacco abuse.

Ukraine

Population: 49,291,200 people for the period of 1.01.2001.

National Produce: makes up 127.1 billion hrivnyas (1999).

Administrative regions: 24 and Crimea Autonomous Republic.

Industry: mining metallurgy, machine building, metalworking, mining and electricity, aerospace and electronic industries, machinery construction, oil processing and petrochemical industry, shipbuilding and others.

Agricultural: plant cultivation, cattle breeding, fish-breeding, fruit cultivation, grapes growing

Capital: Kyiv (population about 3 million people).

Main religions: Orthodox (the leading position), Protestantism, Judaism, Muslim, Greek Catholicism.

Ukraine experienced the period of totalitarian governing and its consequences has begun to influence all the forms of governmental activity and to define the people behavior nowadays.

The unemployed — 2,937,100 people (1998).

High level of divorces — 51% (1999).

According to the Health Ministry statistics, the share of healthy people among the adult population of Ukraine fell down from 62.5% to 15.15%, and as for the people who took part in the liquidation of the Chernobyl Atomic Station disaster consequences — from 78.2% to 8.4%.

Table 1

Sickness Rate Structure (mental and behavior disorders of Ukrainian population on 100,000 people)*

  1990 1995 1998 1999 ±% 1999 to 1990
absol. index absol. index absol. index absol. index
Total 128,915 248.0 135,586 255.0 145,204 289.0 132,506 265.8 +2.8
Psychic infringements of psychotic nature 19,935 38.0 21,861 39.0 24,940 50.0 20,703 41.5 +3.8
Schizophrenia 5,976 11.5 6,136 11.0 6,606 13.0 5,579 11.2 –6.6
Dementia 4,963 9.6 5,905 11.5 6,794 14.0 7,341 14.7 +47.9
Psychic infringements of non-psychotic nature 94,402 182.0 99,273 189.0 102,354 204.0 94,159 188.9 –0.25
Mental retardation (of all kinds) 14,578 28.0 14,451 27.0 17,910 35.0 17,644 35.4 +21.0

* Ukrainian Psychoneurology Bulletin, 2001, 1, 9.

The quantity of mental patients in Ukraine ran up 1,202,549 people by the end of 2000, besides 700,000 patients with alcohol and about 70,000 drug abuse were registered.

The high rate of suicides (20.6 — on 100,000 population in 1990; 28.3 — on 100,000 population in 1995; 29.1 – on 100,000 in 1999) (Annual Statistics of Ukraine).

The total quantity of invalids with mental diseases was 247,454 people by the end of 2000 (in 1990 — 208,425).

Table 2

Ukrainian psychiatric hospitals network*

Hospital/beds 1990 1995 2000
quantity of mental hospitals 90 89 88
beds in them 65,065 9,025 46,144
quantity of in-patient hospital 104 104
beds in them 6,031 5,545
quantity of dispensaries 37 35 34
with in-patient hospitals 26 23 22
beds in them 3,750 3,530 2,923

* Archives of Psychiatry (Kyiv), 2001, 4, 5–10.

In the article by V. Moskalenko et al. “Mental health as a part of further nation development” (Archives of Psychiatry (Kyiv), 2001, 4) the changes in structure of mental and behavioral disorders expansion were noticed for the last ten years.

Thus, if the absolute quantity of patients with psychic infringements of the non-psychotic nature was 429,813 people in 1990, it was registered 519,029 people in 2000 (these data were taken from the dispensary group). There have been no changes in the number of patients with psychic infringements of the psychotic nature for this period: 341,237 people (1990) and 345,840 people (2000)

Global characteristics and tendencies

Chile Ukraine
1. Prolonged historical period of national awareness oppression 1. Just the same
2. Monotheism (Catholics are 85%) 2. The leading role of the Orthodox Church (struggle between Moscow and Kyiv patriarchies)
3. Militarization of economics 3. Predominance of military industry, remained from the USSR
4. Prevalence of raw material mining in economics 4. Plunder of national wealth
5. Predominance of poor people 5. Strengthening of division process into the rich and poor
6. Slow democratization process in the society (closed system) –//–
7. Aggravation of the environmental situation –//–
9. Aggravation of the population’s mental health state (quantity of alcohol and drug abuse people growth, increase in organic pathology, depressions and suicides) –//–
10. Medical service centers concentration in great cities –//–
11. Mistrust to medicament treatment and traditional medicine 11. Intensification of the process of mistrust to medicament treatment and its expensiveness
Differences
1. Stable growth of economics 1. Long period of stagnation
2. Safer ecosystem 2. Broken ecosystem
3. Leading role of Catholicism 3. Active implementation of different religious cults
4. Least developed, but quickly developing health services system. Higher trust level to alternative (folk) medicine 4. Powerful, but inertial system. Higher trust level to traditional medicine. Well-developed, but not respondent to society’s changes system of mental health
5. Reforming was launched in 1993 5. Law of Ukraine “About Mental Health”, February 22, 2000; President’s Decree “About the conception of development of the health service of Ukrainian population (December 7, 2000)

Summary:

References

  1. Alarcon, R. D., Aguilar-Gaxiola, S. A. (2000). Mental health policy developments in Latin America. Bulletin 2000 of the World Health Organization. International Journal of Public Health, 483–491.
  2. WHO activity in the field of mental health. Mental Health Day (2001). Social and Clinical Psychiatry, 1, 104–106.
  3. Tabachnikov, S. I. et al. (2001). Problems in socio-rehabilitative psychiatry in Ukraine [Article in Ukrainian]. Medical Investigations (Kharkiv), 1, 1, 6–8.
  4. Moskalenko, V. F. et al. (2001). Mental health as a part of further nation development Archive of Psychiatry (Kyiv), 4, 5–10.
  5. Report 1999. Ukraine. Development of people. Project “Constant people’s development in Ukraine”.

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