A blind spot on the global mental health map: a scoping review of 25 years’ development of mental

health care for people with severe mental illnesses in central and eastern Europe

Petr Winkler*, Dzmitry Krupchanka*, Tessa Roberts, Lucie Kondratova, Vendula Machů,

Cyril Höschl, Norman Sartorius, Robert Van Voren, Oleg Aizberg, Istvan Bitter,

Arlinda Cerga-Pashoja, Azra Deljkovic, Naim Fanaj, Arunas Germanavicius, Hristo Hinkov, Aram Hovsepyan, Fuad N Ismayilov, Sladana Strkalj Ivezic, Marek Jarema, Vesna Jordanova, Selma Kukić, Nino Makhashvili, Brigita Novak Šarotar, Oksana Plevachuk, Daria Smirnova, Bogdan Ioan Voinescu, Jelena Vrublevska, Graham Thornicroft

Just over 25 years have passed since the major sociopolitical changes in central and eastern Europe; our aim was to map and analyse the development of mental health-care practice for people with severe mental illnesses in this region since then. A scoping review was complemented by an expert survey in 24 countries. Mental health-care practice in the region differs greatly across as well as within individual countries. National policies often exist but reforms remain mostly in the realm of aspiration. Services are predominantly based in psychiatric hospitals. Decision making on resource allocation is not transparent, and full economic evaluations of complex interventions and rigorous epidemiological studies are lacking. Stigma seems to be higher than in other European countries, but consideration of human rights and user involvement are increasing. The region has seen respectable development, which happened because of grassroots initiatives supported by international organisations, rather than by systematic implementation of government policies. Read on