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Journal article

Institutions remain dumping grounds for forgotten people

TAVANIER Yana Buhrer
Journal article citation:
Tizard Learning Disability Review, 15(2), April 2010, pp.4-14.

This article highlights a study conducted undercover in institutions for adults with intellectual and mental health disabilities in Bulgaria, Romania and Serbia. It found evidence of human rights abuses, inhuman and degrading treatment, and severe neglect. The author suggests that reform is coming too slowly to institutions for adults with intellectual and mental health disabilities in these countries, where chronic neglect, filthy conditions, and the use of physical restraints and high-dosage drugs to control behaviour remain routine. The author describes, from a personal perspective, many of the failings in the care system with the three countries, and highlights how much of the abuse is conducted behind closed doors, in an effort to hide the true extent of the problem – which, if disclosed, may have ramifications for EU grants to these countries.

Journal article Full text available online for free

Pathways to psychiatric care in Eastern Europe

GATER Richard, et al
Journal article citation:
British Journal of Psychiatry, 186(6), June 2005, pp.529-535.
Royal College of Psychiatrists

There has been almost no research into mental health services in Eastern Europe. A pathways study is a quick and useful starting point, requiring few resources. The aim was to improve understanding of prior care-seeking and treatment of new patients seen at mental health services. Pathways diagrams were drawn showing the routes of care-seeking for 50 new patients in eight centres. Patterns of care-seeking, durations and previous treatments were compared for ICD-10 diagnostic groups.  The diagnoses varied according to the organisation of services. Major pathways included general practitioners, direct access and hospital doctors. General practitioners have a limited role as ‘gatekeeper’ in centres in Albania, Croatia, Macedonia, Romania and Serbia-Montenegro, and rarely prescribed treatment, except sedatives, for mental disorders.  Findings highlight areas that require attention if aspirations for community-oriented mental health care are to be realised, particularly integration of mental health into primary care.

Journal article Full text available online for free

Mental health services for war-affected children: report of a survey in Kosovo

JONES Lynne, et al
Journal article citation:
British Journal of Psychiatry, 183(12), December 2003, pp.540-546.
Royal College of Psychiatrists

In war-affected societies it is assumed that the major mental health problem facing the population will be stress reactions. The aim was to describe the creation of a child and adolescent mental health service (CAMHS) in Kosovo after the military conflict ended in 1999, and to establish the range of problems and diagnoses that presented. Data were collected on 559 patients over 2 years, including their referring problems and diagnoses. Stress-related disorders constituted only a fifth of the case-load in year 1. A substantial number of patients were symptom-free but attended because they had been exposed to a traumatic event, and believed it might make them ill. Non-organic enuresis and learning disability were the most common diagnoses in year 2. Many patients had a complex mix of social and psychological difficulties that did not fit conventional diagnostic categories. Mental health services that only address traumatic stress may fail to meet the needs of war-affected children. A comprehensive, culturally appropriate CAMHS is needed to address a wide range of problems including learning disability. It should be developed through local actors, and build on existing local infrastructure. Services can also have an educational role in 'depathologising' normative responses.

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