The Organization of Mental Health Care in the USSR: Past and Present

Abstract

Because of the incidence and the considerable social and economic cost associated with mental disorders, they constitute a serious problem in contemporary clinical and social medicine. One of the most important aspects of this problem is the organization of care of the mentally ill adequate to ensure early detection, diagnosis, treatment, and rehabilitation. A retrospective glance at psychiatric services reveals a number of critical stages in their development. The first major stage was F. Pinel's rescue of patients from chains and the creation of psychiatric hospitals so that patients were no longer confined in monasteries. Inpatient care was, for a long time, the only way of coping with the mentally ill, until the second critical stage ushered in the development of psychiatric care. This took clinical psychiatry beyond the walls of hospitals and created a system of nonhospital psychiatric services (in our country, in the form of outpatient clinics). Finally, in the last decade we have witnessed intensive growth and expansion of mental health services within the framework of primary health care (in our country, through district and municipal polyclinics). A.V. Snezhnevsky called these critical stages the three revolutions in the organization of mental health care. The last few years have seen extensive development of mental health services. In a number of countries, this has taken the form of large-scale experiments in establishing new models of service and a