A comparative evaluation of inpatient psychiatric care in Russia and some other countries is presented. A systematic analysis of the performance of psychiatric hospitals is conducted. The process of the deinstitutionalization in Russian psychiatry is highlighted. A range of problems hindering a reform of inpatient psychiatric service of the country is singled out.
The article presents conceptual approaches to the problem of quality assurance in mental health care, which accumulate a previous national and international experience in the field of medical and psychiatric care quality, taking into account the results obtained by the authors. The article addresses juridical, ethic, economic and organizational aspects of mental health care improvement. Attention is drawn to a need in controlling system and quality evaluation based on adequate and informative criteria and quality standards and in making scientifically founded administrative decisions. Specific criteria for evaluation of mental health care quality, taking into account its main components--structure, process, results--were suggested.
The authors analyze both the demographic situation in Russia during the past years and its perspective. A number of patients with paranoid schizophrenia and with schizophrenia on the whole (all forms of disease) was estimated for the period of the coming 15 years (till 2011 yr.). The level of the patients' detection in some Russian regions was estimated by means of comparison of the calculated number of the patients (according to tables of incidence) and actually known during the same period. The proportion of registered schizophrenic patients was up to 95.7% from calculated data in Moscow, while in other regions this index was not more than 50%. A low detection of the schizophrenic patients was explained by both specificity of the organization of psychiatric care in the regions, a shortage of psychiatrists as well as by other factors.
The main trends in the organization and economic transformations in psychiatric services of Russia in 1989-1996 are analyzed: financial support of the institutions of psychiatric care, changes in the organizational structure of services, new forms and types of care. The opinion of the authorities of regional services concerning the organization and economic changes in institutions of psychiatric care are presented.
Integral economic loss of the society, connected with mental disease, were calculated by the author and presented. The author determined "direct" and "connected" state costs for psychiatric patients, and the volume of non produced national income (indirect costs) because psychiatric patients with temporal or constant disability are excluded from producing process. Financial state of psychiatric hospitals in Moscow was analysed and reserves for improvement of money spending were found out. Calculations of expenses of admission of patients with different diseases to Psychiatric Hospital N 1 by P.P. Kashenko in 1988 were performed. Principles of financing of psychiatric hospitals on the basis of clinical-statistic groups are discussed. The method of determination of prices for medical and diagnostic services to patients is presented.
The state and prospects of the development of mental health service are discussed. Special attention is drawn to the economic aspects of mental health service and financial problems, in particular. The principles of creation and utilization of financial resources for psychiatric facilities in conditions of medical insurance are given. Social and economic aspects of mental diseases and their cost for the society are considered. The conclusion is made on the priority of psychiatric care programmes among other programmes of health care, that must be solved on the state level.