[Development of child mental health services in Lithuania: achievements and obstacles].
In 1990, political, economic and social changes in Lithuania introduced the possibility to develop for the first time in nations's history an effective and modern system of child mental health services. During the period between 1990 and 1995 a new model of services was developed in the Department of Social pediatrics and child psychiatry of Vilnius University. The model included development of child and adolescent psychiatric services, as well as early intervention services for infants and preschool children with developmental disabilities. The emphasis, following recommendations of WHO and existing international standards, was made on deinstitutionalization and development of family-oriented and community-based services, which have been ignored by previous system. In the first half of 90's of 20th century, new training programs for professionals were introduced, more than 50 methods of assessment, treatment and rehabilitation, new for Lithuanian clinical practice, were implemented, and a new model of services, including primary, secondary and tertiary level of prevention, was introduced in demonstration sites. However, during next phase of development, in 1997-2001, serious obstacles for replicating new approaches across the country, have been identified, which threatened successful implementation of the new model of services into everyday clinical practice. Analysis of obstacles, which are blocking development of new approaches in the field of child mental health, is presented in the article. The main obstacles, identified during analysis of socioeconomic context, planning and utilization of resources, running of the system of services and evaluation of outcomes, are as follows: lack of intersectorial cooperation between health, education and social welfare systems; strong tradition of discrimination of psychosocial interventions in funding schemes of health services; societal attitudes, which tend to discriminate and stigmatize marginal groups, including disabled children and dysfunctional families; lack of evidence-based decision making in the process of health care reform and reform of social infrastructure.
Pūras
Dainius
D
VU Socialines pediatrijos ir vaiku psichiatrijos klinika, Vytauo 15, 2004 Vilnius. dainius.puras@mf.vu.lt
D000367:Age Factors; D002648:Child; D002660:Child Guidance; D002662:Child Health Services / Q000458:organization & administration*; D018166:Health Care Reform; D006801:Humans; D008097:Lithuania; D001523:Mental Disorders / Q000534:rehabilitation / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D011634:Public Health / Q000639:trends*; D014944:World Health Organization