Challenges of Mental Health Care System Surveillance in Lithuania

According to the MH Action Plan 2013-2020, evidence and research are critical ingredients for mental health policy. The generation of new knowledge enables policies to be based on evidence, and the availability of surveillance frameworks enables implemented actions to be monitored.

The paper will present data from qualitative mental health care experts’ research which took place in Lithuania in 2015-2016.

The research reveals, that the culture of reflection is not developed in mental health care system. Mental health indicators currently in use mainly focus on the resources and process, such as type and number of healthcare facilities, diagnosis of people using psychiatric facilities, numbers of professionals, and suicide rates. These indicators do not capture the broad spectrum of interrelated public mental health problems and absence of interdisciplinary approach that characterizes this field. The component of the results monitoring is not integrated in usual systemic practices and is implemented on ad hoc basis. Monitoring reports are questioned on behalf of representatives of the system, perceived as critics and direct threat.

The Lithuanian mental health care system is effective while providing treatment to persons with severe mental illness. These services compose the largest part of the resources and process indicators. Outpatient services for persons with mild diagnoses remain underdeveloped and unaccounted.

The financial component is decisive for planning and development of mental health care system. As a rule, decision makers focus on short-term financial perspective and ignore the need to reform the system of mental health care itself.

High rates of suicide is unanimously acknowledged to be the most serious public health problem in Lithuania. Nevertheless, desperate and unsuccessful attempts to change this situation do not lead to evidence based solutions. Instead, politicians and practitioners develop self-stigmatizing attitudes (“we are a suicidal nation”), feelings of reconciliation or search for irrational political solutions.