Mental health policy and practice across Europe: an overview

Policy in former eastern bloc countries 413
Policy in times of transition
Summarizing the evidence
It has repeatedly been affirmed that clear policy is of key importance in promoting
mental health care and that such policy should be based on evidence
(WHO 2003). Summarizing the evidence that bears on mental health policy in
former eastern bloc countries, it could be concluded that the situation is dominated
by the amazing political developments that occurred in 1989, following
several years of perestroika (political and economic restructuring). Independently
of how countries chose to proceed with reforms thereafter, health statistics
slumped, making it obvious that health crises attest not just to the unhealthy
nature of totalitarian societies. They also suggest that the capacity of posttotalitarian
societies to turn to a reality free of preconceived notions could
be damaged, and there might be a failure to grab opportunities for change
whenever they arise. What would a hypothesis about such damage look like?
During the past decade most of the mental health systems in the region have
been operating outmoded facilities and exercising beliefs about treatment, therapy,
rehabilitation and prevention that are outdated and certainly out of sync
with the values of civil society and democracy. Research into mental health
services in the region has been negligible and almost all the evidence that is
available for decision-making has come from service activity data. However, the
quality of these data is poor, largely because the lack of demand for technological
innovation had failed to drive developments in information systems.
The economic slumps and the obsolete managerial ethos within countries in
the region may account for a delay in innovation in mental health policy
but it certainly cannot explain the large-scale denial of the issue of mental
health problems within governance structures that was reported in a number of
these countries by human rights organizations and other international bodies
(Bulgarian Helsinki Committee 2001).
Most importantly, the review of the evidence on mental health policy presented
above attests to the failure of governance structures to engage with the
realities within the mental health sector by entering into constructive dialogue
with consumers, personnel, partners and other stakeholders. Governance in
most countries has not been able to develop the capacity to abide by commitments
made to mental health services and often resorts only to paying lip service
to responsibilities – a practice that is reminiscent of the hypocrisy of the
totalitarian paternalism of the past. As the years have gone by, this practice has
reinforced a mistrust of authority. In most countries the capacity to develop
coherence in stakeholder groups and mutual goals in response to deprivation
has not been improved.
Translating the evidence into policy
How does a national mental health policy face this state of affairs effectively?
Clearly, there is a compelling argument that any such policy should take full
account of the social transition that is occurring; or in other words, change by