"THE STATE PROGRAM OF PSYCHIATRIC CARE" EXPERIENCE OF GEORGIA

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"THE STATE PROGRAM OF PSYCHIATRIC CARE"-
EXPERIENCE OF GEORGIA

• George Naneishvili
• M.Asatiani Research Institute of Psychiatry
• Tbilisi, Georgia

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Georgia is a country in the south of the
Caucasus, between The Black and The Caspian seas.
Area 69,670 square km. Population
5,262,000. Capital Tbilisi, population
estimate 1,300,000. Until 1991 was the part of
the USSR.
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The "State program of Psychiatric Care"

• Significant socio-economic and political changes
  taking place in Georgia at the beginning of
  1990-s, had a negative effect on the existing
  structures of Psychiatric Care Service.

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The "State program of Psychiatric Care"

• Reforms in the sphere of medicine in Georgia
  taking place since 1995 have put Mental Health
  Care into the number of paramount branches of
  Public Health Care.
• In March 1995 the Parliament
• of Georgia accepted the Law of
• "Psychiatric Care", which became
• the legal basis for the Mental Health
• Care System in our country.

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The "State program of Psychiatric Care"

• One of the first steps was the decentralizing of
  the health care system management.
• Health institutions have become independent in
  management, taking on responsibilities for
  budgeting and staffing.
• Georgia has completely changed the "socialism"
  funding system into "free market" social
  insurance (state and private).

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The "State program of Psychiatric Care"

• The "State Program of Psychiatric Care" has been
  worked out and is has come into an action since
  the August 1995. The Government took the
  initiative of financing in- and out-patient
  treatment of socially more dangerous mental
  disorders
• all forms of acute psychosis, chronic mental
  diseases, all kinds of compulsory and involuntary
  treatment.

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The "State program of Psychiatric Care"

• The limitation of resources was reflected also on
  the "State Program of Psychiatric Care".
• The Government is covering all the expenses of
  treatment and care of the 30000 patients which
  are registered in different psychiatric
  institutions.

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The "State program of Psychiatric Care"

• According to these parameters the "State Program
  of Psychiatric Care" covers the expenses of only
  30 of patients requiring the psychiatric
  treatment.
• Schizophrenia
  15 805
• Affective disorders
  2 480
• Organic Symptomatic psychosis 4 157
• PTSD
  1 760
• Other psychotic disorders
  5 751
• Total
  29 953
• (2001 stat.data)

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The "State program of Psychiatric Care"

• out of the "State program of Psychiatric Care"
  are about 70 000 patients
• Somatoform disorders 28 500
• Behavioral syndromes 5
  300
• Personality disorders 21
  000
• Mental retardation 20
  100
• Total
  74 900
• (2001 stat.data)

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The "State program of Psychiatric Care"
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The "State program of Psychiatric Care"

• For the psychiatric service there are worked out
  the medical standards where the capacity of
  service is strictly defined.
• The medical standards have recommendatory
  character.

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The "State program of Psychiatric Care"

• Besides the budget itself is significantly
  deficient. According to the economical
  calculation in 2003 it was necessary 6,77 million
  US for the optimal functioning of the "State
  Program of Psychiatric Care".

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The "State program of Psychiatric Care"

• Accepting the Budget Law, the Parliament has cut
  off the assignments in 2003 to 1,5 million US.
  All these problems are cause the complication of
  caring out the real reforms.

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The "State program of Psychiatric Care"
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The "State program of Psychiatric Care"

• The existing deficit is covered by the poor
  support from some international organizations (
  IFRC, WFP, UMCOR ), Georgian and foreign
  companies and institutions.

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The "State program of Psychiatric Care"

• For today according to the State Program for
  inpatient psychiatric care in Georgia 7 hospitals
  on 1000 beds are in use . This number is not
  enough taking into consideration the existing
  reality.
• The outpatient care is held by 14 regional
  dispensaries and 3 dispensary departments, which
  are also not enough.

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The "State program of Psychiatric Care"

• For the treatment of these patients are used
  basic psychotropic medications from "Essential
  Drug List"
• Chlorpromazine,
• Haloperidol,
• Fluphenazine,
• Amytriptiline,
• Carbamazepine,
• Lithium carbonate,
• Diazepam and
• Cyclodol.

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The "State program of Psychiatric Care"

• Because of high prices, we have no possibility to
  use the modern psychotropic drugs of "new
  generation" as
• Ziprexa,
• Risperdal,
• Seroquel and etc.

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The "State program of Psychiatric Care"

• More than 70000 registered patients are not able
  to get psychiatric treatment, as they are not
  involved in the State Program of Psychiatric
  Care.
• According to the data, which are not exact, as
  minimum 150000 patients get the private treatment
  or undergo the self treatment.

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The "State program of Psychiatric Care"

• Financing of the "State Program of Psychiatric
  Care" is realized by
• "United State Fund of the Social Insurance".
• The Fund is a state structure. The whole public
  taxes are going to the "Fund", as well as the
  state finances granting for public health and
  social support.

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The "State program of Psychiatric Care"

• "United State Fund of the Social Insurance"
• makes out the contracts with psychiatric
  institutions ( in- and out- patient clinics),
  which have the appropriate licenses and pay for
  the operations, according to the Medical
  Standards of Psychiatric Treatment.

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The "State program of Psychiatric Care"

• This principle became the reason of artificial
  separation of the medical service of mentally ill
  patients.

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The "State program of Psychiatric Care"

• Having the difficulties with the payment of the
  medical services, patients which are involved in
  the "State program of Psychiatric Care" are not
  able to get
• Therapeutic,
• Neurological,
• Surgery,
• Terminological and other services.

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The "State program of Psychiatric Care"

• Because of the inability of the psychiatric
  institutions to cover these expenses from their
  poor budget.

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The "State program of Psychiatric Care"

• In those cases, when medical service is covered
  by State (belonging to the another "State
  Programs"), patients of psychiatric clinics can
  get free of charge
• Emergency Medical Aid,
• Anti-TBC treatment,
• Anti-AIDS treatment,
• Hemo-dialysis and
• Obstetrics.

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The "State program of Psychiatric Care"

• If we observe all the system of Mental Health
  Service in Georgia attentively, we will have to
  remark that on the way of making reforms there
  exist great gaps, vacuum and difficulties.

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The "State program of Psychiatric Care"

• For the last 10 years there have not been carried
  out epidemiological studies which are giving the
  real picture of the expansion of the mental
  disorders in the country.
• There are no shelters for chronic mentally ill
  patients. They are fulfilling all the psychiatric
  hospitals.

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The "State program of Psychiatric Care"

• Socio-rehabilitation services in state
  institutions and programs of NGO's have a local
  character and are feebly effecting on the whole
  picture.
• There is no institution of Social Workers. The
  question about the training professionals in this
  sphere is not yet resolved.

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The "State program of Psychiatric Care"

• There is no system of Social Care for people with
  mental health problems. In order to resolve this
  problem is necessary to create and train
  multidisciplinary groups. These groups must work
  on community level.

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The "State program of Psychiatric Care"

• The level of knowledge of psychiatrists, medical
  stuff and other professionals working in Mental
  Health System doesn't correspond with the
  contemporary demands. The existing system of
  training needs radical reforms.

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The "State program of Psychiatric Care"

• The realisation of this perspective
• plan depends on many aspects

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The "State program of Psychiatric Care"

• 1. Perfect ness of legal basis in the Mental
• Health sphere.

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The "State program of Psychiatric Care"

•    2. Optimum and adequate financing of all
  steps of reforms.

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The "State program of Psychiatric Care"

• 3. Qualitative improvement of the education
• of the professionals.
•   

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The "State program of Psychiatric Care"

• 4. Broadening of the State Program of Psychiatric
  Care. Gradual increasing of free of charge
  psychiatric service.
•   

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The "State program of Psychiatric Care"
Thank you !