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Mental Health Service, Research and Evaluation.
The activities of the Center in this sphere was accomplished in 3 directions:
1) the elaboration of scientific programmes in the organization of mental health services in contemporary conditions;
2) the implementation of the results of scientific studies into the practice of mental health services in Russia;
3) studies in the area of protection of mental health in the population in the form of implementing new models of services
The programme includes studies of the scientific basis in the organization of mental health services. The main proposition of this programme is that modern systems of mental health services should be based with respect to clinico-epidemiological studies in separate groups of diseases, the range of social and economical losses due to mental disorders, determination of the quality of mental health services, the availability of legal, ethical, and other standards of services.
The Mental Health Research Center elaborated the following models of out-patient services:
1) day hospital for autistic children;
2) out-patient hospital for gerontopsychiatric patients;
3) a geronto-psychiatric office in a general out-patient setting.
The made calculations (in ex-USSR for 1988-1989 for Russia for 1990-1993) made possible to assess the economical losses and to confirm the observations made by foreign and Russian specialists that the "price" of mental disorders is enormous. The direct expenditure is not only tremendous, indirect losses due to incapacity and temporary disablement are also great. On the basis of such studies theoretically was based the necessity of financial investment into mental health services.
As a result the working group stated all the necessary attributes of a transition of mental hospitals, psychoneurological dispensaries (out-patient mental services) and day hospitals to a new system of financing, according to clinico-statistical groups, i.e. grouping of hospitalized cases and their observation, methods of price formation, standards of the treatment-diagnostical process. Besides it was possible to determine the influence of different factors on the duration of hospitalization and in the out-patient clinic. The study analysed the attendance of out-patient settings. The calculation of hospital-stays was made by a special computer programme for mental hospitals and out-patient settings, which were then passed over to 6 practical mental establishments. The social after-effects of mental disorders were studied on a macro-and miscrosocial level. The consequences were studied both theoretically and from the practical point of view. From the practical standpoint a specific method was created to determine to degree of desadaptation of mental patients, on the basis of which its was possible to plan individual rehabilitation programmes, including psychotherapeutical, psychocorrective measures and psychological support.
The Mental Health Research Center took part in the elaboration for the first time of the law of mental health services. The law was put in force in 1993 with comments to the acting law. In 1994 an ethical code of psychiatrist was accepted. An analysis of the state of mental health of the Russian population and the activities of mental health services, an account of urgent measures in respect to comprehensive measures for the perfection of mental health services and the protection of mental health were elaborated in the Report submitted to the President of the Russian Federation (1994). In 1995 the programme of urgent measures in the perfection of mental health services was approved by the government of the Russian Federation. In 1998 the Mental Health Research Center in collaboration with the Ministry of Health, WHO, WPA, Russian Society of Psychiatrists took part in working out a report on the "State and Significance of Mental Health in Russia". Professor V.S. Yastrebov, the head of the department in the Mental Health Research Center, studied the system of support of mental health. He took part in the work of the European Department of the WHO, being the representative of the Russian Federation, as well as a participant of the WHO collaborative Center of audit and assessment.
During the last 7 years special work was performed with consumers of mental health services. As a result 2 associations of relatives of mental patients were organized. Its practical work was in the organization of seminars-schools for the patients and their relations. A group of self-support of mental patients was organized.
In collaboration with the international organizations GAMIAN-Europe (Global Alliance Mentally Ill Advocacy Network) in 2001 a project of questioning patients with affective disorders was performed. The goal of the project was to assess the degree of information that the patients possessed, the methods of treatment, and the character of support that the patients received. 400 questionnaires were sent to the patients, and 275 were returned fulfilled. This result is better than in most countries of Europe (the study was simultaneously performed in 11 countries. 45% of the dispatched questionnaires were sent back.) The results of the project are now being possessed in the headquarters of GAMIAN-Europe and will be known in the near future.
In December 2001 in collaboration with GAMIAN-Europe a new project "The school of leaders for groups of interdependent support" is being implemented. The project is intended to work for 2 years with the participation of workers from both sides. The goal of the project is to train leaders from the group of patients and to stimulate the appearance of 30-40 groups of interdependence support.
In 2001 the Mental Health Research Center convened a wide campaign in the organizations of the International Day of Mental Health. Special Conferences were organized, special reports for the mass media sent out.