How can the double burden be SEEn?
When addressing problems, also solutions should be proposed. In this blog we will explore the current status on policies concerning mental health problems, alcohol abuse and HIV/AIDS prevalence.
The social and economic transition in the 1990s in SEE initiated the process of new mental health policy formulation and adoption of mental health legislation stressing human rights of patients. We can observe that the know- how about modern mental health care and about the direction of needed reforms is available in documents, policies and programmes. However, this does not mean real implementation. For real implementation, a good, stable healthcare system is needed in a country. Unfortunately, in most SEE countries, this stable healthcare system is lacking. Therefore the problem arises that mental health treatment cannot be adopted, so for the lowering of the mental health burden, fundamental changes first need to be made.
A study reviewing different health care systems regarding mental health in Eastern Europe, identifies the insufficient funding from the government for training and supervision of the mental health services as the biggest problem with implementation. Therefore, the distribution of governmental funding should be arranged differently.
Setting up a stable health care system regarding mental health is not enough. More attention should also be given to creating awareness and stigma reduction, for example through government funded campaigns, ‘normalizing’ mental health.
But, mental health treatment alone is not enough…
Prevention of mental health problems should also be addressed! Regarding the high alcohol consumption in SEE (see our previous blogpost from Goos), a couple of policies are already implemented throughout the years. In 2012, the WHO Europe came up with the European action plan to reduce the harmful use of alcohol 2012–2020. Particularly for Eastern Europe recommendations are given to reduce the impact of illicit alcohol and informally produced alcohol. A strategy is described where trough computerized tracking the movement of illicit and alcoholic products are mapped. Moreover, the plan recommends for all of Europe to reduce the availability of alcohol in shops, to increase the legal drinking age from 16 years to 18 years old, to increase the tax on alcohol containing products, to create awareness of negative consequences of drinking alcohol, to forbid commercially promoting drinking alcohol, to reduce the legal blood alcohol content and to screen more commonly through breath-testing.
In 2019, the implementation of the European Action Plan is reviewed by F. Goiana-da-Sila et al.. They concluded that around 50% of the policies concerning lowering the availability of alcohol and reducing the marketing of alcoholic beverages are implemented in SEE countries. However, only zero to around 20% of the policies concerning the pricing of alcohol are implemented in the period 2012–2019. Therefore, future opportunities for lowering the alcohol consumption in SEE can be achieved by implementation of these policies. Moreover, the strategy of tracking illicit alcoholic products is not picked up by SEE countries. Since SEE countries have a high prevalence of home-brewed, illicit alcoholic products, this recommendation should be worked out properly, so regulations about this alcohol production can be set up. In addition to this, awareness about the consequences of regular, high alcohol consumption are needed to make sure these regulations will be followed.
Next to preventing mental health problems due to alcohol abuse, also the mental burden because of HIV/AIDS should be addressed. As Nina described in one of our previous blog posts, HIV affects thousands of people in SEE. Regarding policies and interventions, we found out SEE countries are still lacking. In 2017, the WHO Europe composed an Action plan for the health sector response to HIV. The action plan promotes comprehensive, combination prevention and a treat all approach. Every contributing country can apply this to their own needs. When investigating the state of HIV in SEE in our previous blogpost, we came to the conclusion that the data on HIV in SEE is questionable. Therefore screening protocols which are proven to be successful, for example in the Western Europe, should be implemented in SEE. Also awareness about the existence, prevalence, spreading, stigma and prevention should be addressed, as a common idea exists in SEE society, that HIV is already cleared out and stigma towards the disease keeps people from going to the screenings.
All in all, SEE countries are moving towards the right direction. However more incentive is needed to fully implement all policies and to improve healthcare systems. Together, the double burden of alcohol abuse and HIV/AIDS concerning mental health is SEEn.
