Lessons from implementation of Lithuanian Mental health care reform strategy (2020-2024)

Arunas GERMANAVICIUS1,2, Ignas RUBIKAS3

1Republican Vilnius psychiatric hospital, Vilnius, Lithuania
2Vilnius university, Faculty of Medicine, Clinic of Psychiatry, Vilnius, Lithuania
3Ministry of Health, Vilnius, Lithuania

Introduction: Since 2020 new government in Lithuania has started to implement renewed Mental health (MH) care reform strategy that included various interventions for reduction of suicide mortality. It also aimed to improve other MH indicators, including care quality at all 3 levels of MH care. OECD experts were involved in performing data analysis, providing policy recommendations and creating links with other European countries to Lithuanian MH care sites as experience sharing.

Methods: we evaluated progress of implementation of this strategy using multiple analyses and multidisciplinary policy review.

Results: suicide mortality reduction target was achieved (standardized suicide rate 18.6/100’000 inhab. in 2022, in comparison to 28.7/100'000 inhab. in 2016). However suicide attempts among youth and among elderly were trending to increase. Alcohol related deaths and mortality due to unexplained causes are remaining at high levels. Due to MH care reform plan implementation, 238 in-patient beds (9.5%) were reduced in psychiatric hospitals, with additional financing of outpatient MH services. Since 2023 daycare financing has increased by 100%. WHO QualityRights standards started to be implemented with some improvement in Human rights. Shortage of MH care staff, especially child psychiatrists and adult psychiatrists, were biggest barriers for reform implementation in terms of quality of care.

Discussion: despite good results in suicide mortality, there were new suicide risk groups identified (elderly and youngsters). Strategy has not created early intervention services for children and adolescents yet, so new trends of misuse of unidentified narcotics by children and adolescents (added to vaporize devices that imitate smoking) appeared in 2022-2023.

Conclusions: 1. Lithuanian MH care reform strategy, developed in collaboration with OECD, was partly effective in shifting finances and other resources from inpatient to outpatient care. 2. Recovery approach is not yet implemented in care plans. 3. User's involvement is lacking at all levels of reform.