Progress and challenges in mental health reforms: a governmental view
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Progress and challenges in mental health reforms: a
governmental view
H. Hinkov, National center for public health, Sofia, Bulgaria
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General background
• Reforms in the health care sector
- NHIF
- Privatization and corporatization
- Leading philosophy of the reform
- Implications on the mental health care
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Legacy from the past and reasons for change
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General population
75000007600000770000078000007900000800000081000008200000830000084000008500000
1992 2002
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Birth rate, death rate, natural grouth
-10
-5
0
5
10
15
20
1970 1985 2000 2001 2002
birth ratedeath ratenatural growth
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Age of the population
3636.5
3737.5
3838.5
3939.5
4040.5
1990 2001
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Mental health financing
State Municipal budget NHIF private
Psych.hospitals dispensariesGroup &
individual practices
Group &individual practices
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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
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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
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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
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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
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Number of psychiatrists
• Psychiatrists (2000) 750
• Psychiatrists (2001) 646
580
600
620
640
660
680
700
720
740
760
2000 2001
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Doctors/nurses ratio
0.9
0.95
1
1.05
1.1
1.15
2000 2001
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Lack of information
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Psych.Psych. hospitalhospital Nursing homeNursing home
patientpatient
Outpatient serviceOutpatient service(Dispensary)(Dispensary)
communitycommunity
Individual Individual practicepractice
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Amnesty international reports
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The governmental answer to chalenges
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National mental health program
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Stability pact mental health project
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Mental health policy and action plan
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PHARE project
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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
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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
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New pharmaceutical products available
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Role of the NGO’s
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Professionals’ involvement
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Public attitude
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Conclusion
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