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Balancing community and hospital care: a case study of reforming mental health services in Georgia.

Makhashvili N, van Voren R - PLoS Med. (2013)

View Article: PubMed Central - PubMed

Affiliation: Global Initiative on Psychiatry, Tbilisi, Georgia.

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Until recently, the state allocated about US$8–11 per day for patients admitted to institutions (2008–2010) and US$7–8 per day for outpatient treatment... This was hardly enough to cover salaries, heating, and food, which resulted in ineffective care... Georgia has yet to complete the fundamental transformation from the old Soviet mental health care structure into a humane system that meets basic human rights standards... In searching for innovative, locally appropriate, and implementable models, new projects and activities were developed by mental health NGOs such as Global Initiative on Psychiatry and the Georgian Association for Mental Health, following World Health Organization, and other international – recommendations... State standards regarding these new initiatives were adopted (e.g., regarding psychosocial rehabilitation and child day care service), and after they were proven to be effective and appropriate, these initiatives were replicated and integrated into the existing state health care system... These include the translation and publication of modern mental health literature into Georgian; the opening of the Mental Health Resource Center at Ilia State University in Tbilisi; a wide range of intensive trainings, workshops, and conferences; and the organization of exchange visits and research activities... Several stages can be discerned in the process of reforming Georgian mental health care services... In 2008 the introduction of a new funding model for hospital care gradually led to a reduction of the number of inpatients... However, these reforms still did not go far enough... reiterated the importance of mental health care... The stated goal of this strategy is to improve the population's health by reducing disease burden and mortality by 2015... Research is being carried out by a group of Georgian psychiatric experts to identify the most relevant topics in child and adolescent mental health care... This plan should include concrete strategies and activities to overcome financial and geographic barriers to accessing care, the development of a chain of well-coordinated community-based services, the integration of mental health into primary care, and the integration into the general care mental health care program of several domains such as prison mental health, psychotrauma care, and juvenile delinquency... The World Health Organization argues that the development and implementation of such a plan could have “a significant impact on the mental health of the population concerned".

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Beds in psychiatric hospitals (selected Commonwealth of Independent States countries).
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pmed-1001366-g001: Beds in psychiatric hospitals (selected Commonwealth of Independent States countries).

Mentions: In 1995, Georgia adopted a mental health care program (as part of a new general health care program) in which people with mental disorders on the national psychiatric register under the Ministry of Labour, Health and Social Affairs received free-of-charge services and treatment at both hospitals and outpatient clinics [5]. Six psychiatric institutions with an average of 1,000 beds provided hospital care (30.27 beds per 100,000 population). However, these mental health care reforms were accompanied by a significant decrease in funding for hospital beds, without providing any alternative outpatient care. This was a general trend in post-Soviet countries, as illustrated in Figure 1, which shows that there has been an almost five-fold reduction in the number of psychiatric beds since 1995, because of insufficient financing of mental health services [6]. Unfortunately, this decline in hospital services in Georgia was not counterbalanced by the development of outpatient and community-based services.


Balancing community and hospital care: a case study of reforming mental health services in Georgia.

Makhashvili N, van Voren R - PLoS Med. (2013)

Beds in psychiatric hospitals (selected Commonwealth of Independent States countries).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539945&req=5

pmed-1001366-g001: Beds in psychiatric hospitals (selected Commonwealth of Independent States countries).
Mentions: In 1995, Georgia adopted a mental health care program (as part of a new general health care program) in which people with mental disorders on the national psychiatric register under the Ministry of Labour, Health and Social Affairs received free-of-charge services and treatment at both hospitals and outpatient clinics [5]. Six psychiatric institutions with an average of 1,000 beds provided hospital care (30.27 beds per 100,000 population). However, these mental health care reforms were accompanied by a significant decrease in funding for hospital beds, without providing any alternative outpatient care. This was a general trend in post-Soviet countries, as illustrated in Figure 1, which shows that there has been an almost five-fold reduction in the number of psychiatric beds since 1995, because of insufficient financing of mental health services [6]. Unfortunately, this decline in hospital services in Georgia was not counterbalanced by the development of outpatient and community-based services.

View Article: PubMed Central - PubMed

Affiliation: Global Initiative on Psychiatry, Tbilisi, Georgia.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Until recently, the state allocated about US$8–11 per day for patients admitted to institutions (2008–2010) and US$7–8 per day for outpatient treatment... This was hardly enough to cover salaries, heating, and food, which resulted in ineffective care... Georgia has yet to complete the fundamental transformation from the old Soviet mental health care structure into a humane system that meets basic human rights standards... In searching for innovative, locally appropriate, and implementable models, new projects and activities were developed by mental health NGOs such as Global Initiative on Psychiatry and the Georgian Association for Mental Health, following World Health Organization, and other international – recommendations... State standards regarding these new initiatives were adopted (e.g., regarding psychosocial rehabilitation and child day care service), and after they were proven to be effective and appropriate, these initiatives were replicated and integrated into the existing state health care system... These include the translation and publication of modern mental health literature into Georgian; the opening of the Mental Health Resource Center at Ilia State University in Tbilisi; a wide range of intensive trainings, workshops, and conferences; and the organization of exchange visits and research activities... Several stages can be discerned in the process of reforming Georgian mental health care services... In 2008 the introduction of a new funding model for hospital care gradually led to a reduction of the number of inpatients... However, these reforms still did not go far enough... reiterated the importance of mental health care... The stated goal of this strategy is to improve the population's health by reducing disease burden and mortality by 2015... Research is being carried out by a group of Georgian psychiatric experts to identify the most relevant topics in child and adolescent mental health care... This plan should include concrete strategies and activities to overcome financial and geographic barriers to accessing care, the development of a chain of well-coordinated community-based services, the integration of mental health into primary care, and the integration into the general care mental health care program of several domains such as prison mental health, psychotrauma care, and juvenile delinquency... The World Health Organization argues that the development and implementation of such a plan could have “a significant impact on the mental health of the population concerned".

Show MeSH
Related in: MedlinePlus