progress and challenges in mental health reforms: a governmental view

Progress and challenges in mental health reforms: a

governmental view

H. Hinkov, National center for public health, Sofia, Bulgaria

General background

• Reforms in the health care sector

- NHIF

- Privatization and corporatization

- Leading philosophy of the reform

- Implications on the mental health care

Legacy from the past and reasons for change

General population

75000007600000770000078000007900000800000081000008200000830000084000008500000

1992 2002

Birth rate, death rate, natural grouth

-10

-5

0

5

10

15

20

1970 1985 2000 2001 2002

birth ratedeath ratenatural growth

Age of the population

3636.5

3737.5

3838.5

3939.5

4040.5

1990 2001

Mental health financing

State Municipal budget NHIF private

Psych.hospitals dispensariesGroup &

individual practices

Group &individual practices

Number of mental health facilities

0

2

4

6

8

10

12

14

16

1 2 3

1. Psychiatric hospitals 11

2. Dispensaries 12

3. Psychiatric wards in

general hospitals 15

Number of beds

0

500

1000

1500

2000

2500

3000

3500

1 2 3

1. Psychiatric hospitals 3075

2. Dispensaries 1566

3. Psychiatric wards 1199

Number of patients per year(2001)

0

2000

4000

6000

8000

10000

12000

14000

16000

1 2 3

1. Psych hospitals 11653

2. Dispensaries 14607

3. Psychiatric wards 10549

Length of stay (days)

0

10

20

30

40

50

60

70

80

1 2 3

Psych. hospitals Psych. hospitals 7171

Dispensaries Dispensaries 30.930.9

Psychiatric wards Psychiatric wards 33.633.6

Number of psychiatrists

• Psychiatrists (2000) 750

• Psychiatrists (2001) 646

580

600

620

640

660

680

700

720

740

760

2000 2001

Doctors/nurses ratio

0.9

0.95

1

1.05

1.1

1.15

2000 2001

Lack of information

Psych.Psych. hospitalhospital Nursing homeNursing home

patientpatient

Outpatient serviceOutpatient service(Dispensary)(Dispensary)

communitycommunity

Individual Individual practicepractice

Amnesty international reports

The governmental answer to chalenges

National mental health program

Stability pact mental health project

Mental health policy and action plan

PHARE project

Changes in the legislation

1. Act for social assistance

2. Mental health chapter in the Act for health

3. More than 50 regulations to be elaborated

The current situation

1. Outpatient services private

2. Contracts with NHIF

3. Increased number of outpatient psychiatrists

4. Decreased number of beds

5. Changes in the structure of the hospitalized patients

New pharmaceutical products available

Role of the NGO’s

Professionals’ involvement

Public attitude

Conclusion