10 October is celebrated as World Mental Health Day. To mark this occasion, the Mental Health 2030 Coalition has prepared and submitted proposals to the Lithuanian authorities calling for fundamental changes in mental health care. This is not the first time that a coalition of NGOs and individual expert members has stressed the need for a breakthrough in Lithuania’s mental health system.
While the ministries responsible for health, social issues and education have made significant efforts in recent years to promote mental health, the necessary changes in the mental health system itself have not yet been achieved. The systemic gaps identified long ago are not being addressed in the provision of support to children and adults with mental health problems, and the network of secondary-level non-residential services is not being developed. These vital services must be given priority, with adequate funding and the possibility of sustainable development of social innovation.
The World Health Organisation published a strategy paper in 2021 which explicitly advised governments to change the priorities that have dominated psychiatric development for decades and to invest more in quality and new services, breaking away from the constraints and traditions of over-medication. We propose to build on this document in order to implement and ensure sustainable development of mental health in Lithuania. This needs to be done through the development and strengthening of the secondary level of non-hospital continuing services. Unfortunately, this proposal has so far been ignored, with funds continuously channelled through the usual channels.
The Coalition recommends that effective measures should be taken to stop the historical and repeated phenomenon whereby a significant number of patients are still being treated with psychotropic drugs, even though there is no indication for such treatment. This flawed practice, which is widely spread due to trends in medical training and biased information to the public and politicians, is doing considerable harm: in most cases of mental disorders, various psychosocial interventions, rather than medication, should be the treatment of first choice. Expenditure on developing and maintaining these services must be planned accordingly.
Lithuania’s mental health care system is particularly ineffective in tackling mental health problems of children and adolescents, which is why the Coalition’s proposals include a separate section on these problems. It explains why effective follow-up support for children and adolescents with mental health problems is often inaccessible, what services need to be developed and how to make a real difference.
Another part of the Coalition’s proposals focuses on the establishment of human rights principles in the Lithuanian mental health system. In order for Lithuanian psychiatry to move away from over-reliance on institutional care, excessive hospitalisations and restraints (use of coercion), it is necessary to develop a network of new quality services, and this must be done by developing innovative services primarily in non-primary and non-hospital centres.
Given the particular importance of public mental health in the current era, and recognising that many important issues transcend the boundaries of individual ministries, it is proposed to re-establish the State Mental Health Commission under the Government of the Republic of Lithuania, as foreseen in the Mental Health Strategy approved by the Seimas in 2007.
