Lithuania moves to a new generation of mental health services
Taking advantage of the best practices of foreign countries, Lithuania is making a paradigm shift in psychiatry - from a biomedical model (treatment with drugs) to a psychosocial model that includes a broader spectrum of services. This involves the introduction of patient-centred, recovery-oriented, human rights-based mental health services, such as case management and community-based treatment of mental and behavioural disorders.
According to Aurimas Pečkauskas, Deputy Minister of Health, involuntary hospitalisations currently account for 3% of all hospitalisations.
"It is important to remember that respect for human rights is crucial in the provision of healthcare services, ensuring the patient's dignity, safety, the right to be informed and to decide on the proposed treatment, especially for people with mental health problems who need mental health care. Therefore, in order to reduce this statistic, it is necessary to take alternative ways to help and empower the patient and their environment to get well, by reducing the number of coercive measures", says Mr Pečkauskas.
In order to implement the principles of strengthening human rights in psychiatry, as set out in the Government Programme, the MoH has approved an Action Plan for the Prevention of Involuntary Hospitalisation, which provides for a comprehensive set of measures and services to help implement the principles of human rights-based personal healthcare services.
Lithuanian experience valued in Europe
Lithuania is adopting elements of the Belgian JA ImpleMENTAL project's good practice in the development of teams providing community-based mental health services, and a case management model has been applied in mental health centres since the beginning of this year.
Lithuania's experience in moving towards patient recovery measures is welcomed and seen in the context of other countries. Lithuania is one of the first countries in Europe to introduce a system of regular assessment of compliance with human rights standards in mental health and social care services and performance improvement using the World Health Organisation (WHO) QualityRights methodology.
On April 22-24 , representatives of the WHO European Region in Lithuania presented Lithuania as an example of the implementation of decentralised, recovery-oriented mental health services to mental health professionals from all over Europe at the QualityRights training.
"It is well known that mental health problems affect more than one in six people across the European Union and suicide is the second leading cause of death among young people. According to a new Eurobarometer survey, nine out of ten (89%) of the survey respondents believe that improving mental health is as important as improving physical health. This shows the importance of mental health as an integral part of health and the need to focus on early diagnosis and prevention. The JA ImpleMENTAL network comprises 39 organisations from 21 countries and more than 200 people working together, sharing their knowledge and experience in improving mental health and ensuring access to services," says Vasileia Konte, JA ImpleMENTAL project coordinator and representative of the Greek National Public Health Organisation.
Case management - patient-centred
Lithuania will start developing case manager services in nine patient-centred mental health centres from the beginning of 2024, thanks to European Union investment, for:
- schizophrenic patients with low functioning and/or low motivation for treatment;
- at risk of suicide;
- those with severe depression and low functioning and/or low motivation for treatment;
- suffering from a moderate form of depression or organic depression and any other mental and behavioural disorder;
- patients with alcohol dependence;
- patients undergoing inpatient treatment to ensure that the patient presents to the Mental Health Centre within 30 days of inpatient treatment.
According to Edith Bishop, Advisor to the Mental Health Unit of the MoH, the aim of case manager services is to ensure the provision of personalised services that are focused on the patient's long-term recovery and needs, which is why the development of an individualised support plan is a crucial part of the provision of these services.
"This plan is developed together with the patient, i.e. discussing their needs and goals and possible ways to achieve them, assessing the patient's personal strengths and motivating them to work together to maximise their recovery. Both the care plan and changes in the patient's condition are periodically discussed with the whole mental health centre team - the psychiatrist, the medical psychologist and the nurse - and together they decide what further services or treatment are needed," says Ms Bishop.
Mobile teams will provide support in the community
This year, preparations are underway for the launch of a community-based service for the treatment of mental and behavioural disorders, a new support tool for patients at high risk of re-hospitalisation or involuntary hospitalisation. It is planned that special mobile teams consisting of 10 professionals with different qualifications - a psychiatrist, 6 mental health nurses, a social worker, a medical psychologist and an occupational therapist - will start to provide this service next year. Full teams will be able to provide services to 200 patients, while half-size teams will be able to provide services to around 100 patients.
"People who often return to hospital repeatedly (including for involuntary treatment) due to their complex health conditions, who find it difficult to adhere to their treatment regimen and to apply independent living skills, will be able to receive long-term, continuous and mobile support. Services will be provided both in treatment facilities and, where appropriate, in the patient's own home and community, making it even easier for the patient to get help," says Bishop.
By 2027, the EU funding aims to set up 19 Community Based Treatment Teams (CBTs) in all Lithuanian counties, in county centres. EU investment of €3.6 million is foreseen to set up the teams (premises, vehicles, etc.). They will provide services to 2,700 patients with the most complex mental and behavioural disorders each year.