Mental health policy and practice across Europe: an overview

chapter
seventeen
Mental health policy in
former eastern bloc countries
Toma Tomov, Robert Van Voren,
Rob Keukens and Dainius Puras
Introduction
This chapter attempts to provide an evidence-based contribution to mental
health policy in some of the former eastern bloc 1 countries. The difficulties
associated with such a task are formidable and first need to be stated.
General health versus mental health reforms
The medical literature in health policy focuses on policy content rather than
policy processes and power structures, and employs methods developed within
public health disciplines (Walt 1994). From this perspective, the current health
policy concern in former eastern bloc countries is general health care reform or
the replacement of free health care by paid services. To that end, most ‘transition
countries’ attempt, firstly, to improve the availability of care by enhancing
the gatekeeping role of primary care services, and secondly, to sustain quality of
care by introducing structured clinical practices – thus enabling evaluation.
Mental health poses problems for both these priorities – for the first, there is
the issue of treatment adherence, while the therapeutic alliance requirement
poses problems for the second. Neither adherence nor alliance yields to impartial
analysis. Both make technological solutions somewhat misleading because such
solutions necessarily disavow individual uniqueness when handling relationships.
Not surprisingly therefore, these pertinent problems are often left out of
the public agenda of mental health reforms.
However, when a real problem is prevented from entering the agenda at
the content level of policy it still penetrates at the level of process and power