 Challenges in Psychiatry and Psychiatric Services in Mongolia
Abstract
Professor Ayushjav Bayanhuu MD
President of Mongolian Psychiatric Association
Mongolia is a developing country with low income. The socio-economical changes in the 90s have created additional challenges in medical services and new psychosocial problems. In 2000 the Mental Health Law has been adopted and a National Program on Mental Health was introduced in 2002. However, very limited resources are available and most of the budget is allocated to the hospital based psychiatric care.
The main challenge has been to reorient and reform the psychiatric services. Since l997 we have started to decentralize it. Community based services and psychosocial rehabilitation were introduced and basic Mental Care was incorporated into Primary Medical Care. Both general medical and specialized trainings are reoriented according to the new requirements. We are trying to increase public awareness on the mellta1 health care and to increase the participation of all stakeholders.
We are facing further challenges such as improving Menta1 Health Care in rural areas, to take into focus children’s Mental Care, to develop professional psychotherapy and counseling, to conduct quality and wide scale surveys in order to obtain reliable data and there are many other issues. Studying the experience and innovations in the Mental Health Care in other countries and seeking assistance from relevant international organizations certainly does help us and there are a1ready good results from it.
Recent activities
Mongolia
● Decentralization and reorientation
If there were only few specialized institutions in the capital city, now in every province Health Center there is at least one psychiatrist who provides Mental Health Care (MHC).
We have successfully started to incorporate Primary MHC into General PHC. 65% of FGP and sum (village) doctors are providing PMHC, and 45% of them participated in the PMHC training programs.
CBS (Community Based), so called ”GER” –project has been expended to the other areas such as Erdenet and Khovd in addition to the current 2 in Ulaanbaatar. We have planed to organize 3 more such "GER" rehabilitation centers next to the regional hospitals.(inter provincial centers)
● Training
There has been a training provided on PMHC for 288 FGP (Family General Practitioner)s and nurses according a specially developed curriculum
Wide seminar for the psychiatrists from the province Health Center on reorientation of MHC and the new tendencies such as CBS Mental hea1th)
We are trying to Organize psycho-social rehabilitation: life skil1s, self-care, cooking, skil1s to spend effectively the leisure (handy-craft, vegetable growing, DIY) and other vocational training
For the families and relatives training on communication and care for the mental1y ill people, which. we believe helps to lessen the stigma towards the people with the mental problems and disorders.
● Promotion
Since 2000 every year MMHA is conducting wide promotion activities before and during the International day of Mental Health (1st of December). For instance, during the last time (2005) we have organized a press-conference and 8 km marsh under the motto "Lets protect our mental health!" which had finish at the Government house. Many domestic and international NGO has participated and more 300 peop1e were present and around l.5 mln tugrigs (1500 USD) was raised. Apart it we have collaborated with the media as TV and national news papers and has delivered to the public materials on different mental health topics such as prevention of over-stress, mental disorders, fighting tobacco, alcohol and drug abuse, tolerance towards people with mental problems. Promotional films on stress, depression and alcohol abuse were created and distributed to a1l provinces. Also lecture were organized in schools. colleges and universities as well as pamphlets were distributed in place of public concentrations (markets, cinema ). Healthy mind newspaper every quarter has been published and distributed among the public.
This is important in implementation of the International Guidelines especially regarding the primary prevention of Mental Disease.
● Remarks
Despite the fact that legislative basis for the MHC has been created and even a program has been approved, the support from the Government is not as much as is should be, the main work especia1ly regarding the public education and awareness and CBS is being done by MMHA. And as a Non-Government Organization it is not being supported by the Government financially and technically.
Cooperation with the other countries of the Zone such as exchange of innovative projects and ideas. short term training of young psychiatrisis.
We wou1d like to develop further the cooperation with WPA and its Zone 17 member countries and wil1ing to participate in the activities organized by the Zonal Committee
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Ministry of Health, (2003) No.013
ICP:No.040657