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17 July 2025 | Country Update
Plans to integrate of mental health data into e-Health -
06 May 2019 | Country Update
Increase in funding for mental health services -
17 June 2018 | Country Update
Strengthening the regulation of mental health services -
09 May 2017 | Country Update
NHIF started to reimburse mental health support provided at A&E departments of hospitals -
08 September 2015 | Country Update
Improving mental health care
5.11. Mental health care
Poor mental health has led to calls for an increase in the supply of good-quality mental health services in the country. The government responded by adopting three mental health-related programmes (2008–2010 Programme on Implementation of the National Mental Health Strategy, 2008–2010 National Family Health Programme and 2008–2010 National Prevention of Violence Against Children and Support for Children Programme) and infrastructure development. In 2012, there were 4 specialized mental health-care hospitals, 5 addiction centres and 20 departments within general hospitals that delivered both inpatient and outpatient mental health-care services. In addition, there is one independent hospital for forensic investigations. Between 1998 and 2011, the number of admissions for mental health conditions decreased by about a quarter, with 36 500 in 2011 (Health Information Centre, 2013). All inpatient mental health-care providers as well as addiction centres have their own outpatient services.
In addition, a network of community mental health-care centres has been developed since 1998. Originally these mostly were units of primary health-care centres, making it easier for GPs to refer patients and have more involvement in mental health care. Later they were separated into free-standing outpatient facilities with specialist focus on mental health, still retaining some features of primary care (similar patient registration procedures, funding by capitation).
Patients suffering from addictions are treated in five public addiction centres located in the largest cities. The addiction centres are budgetary institutions. Recently, almost all of the centres (previously national level institutions) have shifted to become the responsibility of the municipalities. While creating a network of institutions devoted to treating addiction problems is an important step in care of dependency diseases, municipalities hardly prioritize allocation of local budgets for patients with addiction problems. The centres are financed from multiple sources, including the NHIF, the Ministry of Health, local budgets and other sources; however, sustainability of these arrangements is a concern.
The number of mental health centres has steadily increased throughout the country and in 2013 reached 104. More than 70 are integrated into primary health-care centres or polyclinics, and over 30 are private providers (mostly profit-making companies); a few are associated with hospitals, and two centres are established in the parallel health-care systems of the Ministry of Defence and the Ministry of the Interior. When converting into or establishing as new independent legal entities, the centres mostly followed financial incentives to overcome unfavourable consequences of cross-subsidization with facilities to which they were being integrated.
At the beginning of 2011, the number of staff (in full-time employment) in mental health was 218 psychiatrists (including 181 for adults and 37 for children), 202 nurses, 157 social workers and 105 psychologists. Since 2002, maximum catchment population has been 20 000 for psychiatrists and mental health nurses, 25 000 for social workers and 40 000 for psychologists (as the original standard of 20 000 was not achievable because of a lack of psychologists).
Because of the large flow of patients with mild disorders to the mental health centres and lack of resources (including the staff numbers and skill mix), interventions are commonly limited to a short consultation with a psychiatrist and administration of medicines. In 2010, 19.4 visits per 100 inhabitants (639 000 in total) were registered in community level centres. In the same year, psychiatrist specialist consultations in outpatient departments of hospitals were not frequent, with a total number of 41 000 visits (1.25 per 100 inhabitants). Psychotherapeutic treatment of rather limited scope is provided by public health-care providers as secondary and tertiary consultations, as well as in individual or group courses. It is also available (particularly in the largest cities) in the private sector (where patients pay fee for service unless the provider is contracted by the NHIF).
Substantial progress has been made in the development of intensive rehabilitation for children, mostly as day-care services provided through a community-based network. In addition, crisis intervention and stabilization for children and assertive community treatment have been piloted.
In 2007–2013, the government invested €29 million in establishing 20 day-care centres in the most deprived regions, 5 crisis intervention centres in the largest cities and 5 comprehensive differentiated psychiatric centres for children and families, as well as modernization of emergency units in mental hospitals (Minister of Health, 2007a).
There are more than 20 NGOs providing services and advocacy for children, young adults and women, as well as for mentally ill or disabled patients. Moreover, there are numerous organizations supporting victims of violence. Five telephone lines (three of them paid for by the Ministry of Social Security and Labour) and four Internet support services are also working in this area.
High levels of stigma and discrimination linked to mental health problems remain in the country, which undermines seeking help, recovery and social integration.
As the mental health reform continues, new developments in the mental health data management system are foreseen. A new e-Health subsystem will be launched, which will allow mental health data to be managed digitally in one place. Under the new arrangements, data currently entered by doctors in internal information systems or on paper forms will now have to be put into the e-Health system. However, all the data contained therein will only be accessible to psychiatrists. Meanwhile, other healthcare professionals will only be able to see part of the mental health data: diagnosis, treatment provided and risk factors.
Although the public debate points out that the inclusion of still stigmatized illnesses in e-Health records could have negative consequences for the patient, the changes are being justified on the grounds of ensuring effectiveness and coordination. However, it remains possible for patients to register anonymously for a consultation for certain diagnoses, such as mild and moderate depression, neurotic disorders, eating disorders, etc.
Authors
In line with the 2014-2021 EEA “Health” financing
programme, more than 9 million euros will be allocated to implement a
set of actions on improving children’s, adolescence’s and families’
mental health in Lithuania by 2024.
The following measures are aimed to be implemented:
- Home visits by trained nurses to assist pregnant women and mothers of children under age of 2;
- Development of adolescence-focussed mental-, social- and health- care service model at municipalities level.
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Assistance to children with behavioural problems and their families, in
collaboration with the Ministry of Social Care and Labour;
- Developing methodologies for preventive services in child day-care and school settings.
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Creating a role for welfare consultants to assist people with early
symptoms of depression and anxiety, and improve accessibility to mental
health services.
Authors
References
A new legislation aimed at facilitating treatment of mental and behavioural disorders is making its way through the Parliament in June 2018. The policy aims to strengthen prevention of mental and behavioural disorders, as well as improve access to and quality of mental health services. In the draft project, the MoH suggests a number of measures, including the definition of mental health policy goals, implementation of integrated model of treatment, outlining the rights of patients with mental and behavioural disorders, as well as restricting the duration of forceful hospitalisation and treatment, as many of these key aspects of mental health care are currently not sufficiently regulated.
References
Ministry of Health (2018) http://sam.lrv.lt/lt/naujienos/seimas-svarstys-kaip-tobulinti-psichikos-sveikatos-prieziuros-reglamentavima
Ministry of Health (2018) http://sam.lrv.lt/lt/naujienos/lietuvoje-modernizuojama-psichikos-sveikatos-prieziura
In April 2017 the National Health Insurance Fund (NHIF) started to reimburse hospitals for mental health support, provided in emergency departments for patients who have suffered a mental health crisis or attempted suicide. The additional funding is for psychodiagnostic evaluation, emergency mental health support and treatment delivered by a psychiatrist or a paediatric psychiatrist. Previously, this service was not separately reimbursed by the NHIF and hospitals were reluctant to hire mental health specialists to work in A&E, while patients were referred to mental health centre without a specialist’s assessment.
Authors
References
Minister of Health of Lithuania approved a separate funding flow for the reimbursement of psychosocial rehabilitation (PSR) services from September 2015. The updated process of PSR provision is evidence-based and is aimed at reducing fragmentation and improving coverage for patients suffering from mental disorders. Now patients are entitled to 15 days of inpatient PSR care, and 12-25 visits to outpatient specialist care. PSR will be provided according to individual patient plan set out psychiatrist and involving multidisciplinary team of health professionals, including psychologist, nurse, ergotherapist and a social worker.