Advertisement

Challenges in the Provision of Forensic Services in the Baltic States

  • Arūnas GermanavičiusEmail author
  • Māris Taube
  • Ilona Laurinaitytė
  • Ingrīda Cera
Chapter

Abstract

Baltic states’ forensic psychiatric systems acquired their structure during the Soviet occupation period as a predominantly restrictive system. During that time, forensic mental health patients from all three Baltic republics were detained at Tsherniachovsk town (formerly East Prussia, since World War II—Russia) hospital with the highest security level. General psychiatry and particularly forensic psychiatry were developing in accordance with the biomedical model and were used for the control of political dissidents. New radical changes towards European standards in forensic psychiatry started after independence of the Baltic countries since the beginning of the 1990s. With no history of multidisciplinary teamwork in mental health, psychiatrists are still dominating the field, and other professionals have very limited roles in evaluation and care. During the last decade, slight changes towards multidisciplinary team development could be observed, and care for forensic patients is getting more comprehensive, not just based on biological methods but on biopsychosocial approaches as well. However, some important elements are still missing (e.g. supported housing and assertive community treatment teams). The ongoing process of improvement of forensic care requires not only infrastructure changes from institutional to community care but also changes in the implementation of human rights principles in society. Stigma, lack of realistic policies on how to improve mental health systems and structures towards modern community care with respect of human rights and lack of financial and human resources are the biggest challenges in Baltic countries.

References

  1. 1.
    Tomov T, van Voren R, Keukens R, Puras D. Mental health policy in former eastern bloc countries. In: Knapp M, McDaid D, Mossialos E, Thornicroft G, editors. Mental health policy and practice across Europe: the future direction of mental health care. Berkshire: Open University Press; 2006. p. 397–426.Google Scholar
  2. 2.
    Felder BM. “Euthanasia,” Human Experiments, and Psychiatry in Nazi-Occupied Lithuania, 1941–1944. Holocaust and Genocide Studies. 2013;27(2):242–75.Google Scholar
  3. 3.
    Kowalewski D. Dissent in the Baltic republics: characteristics and consequences. J Balt Stud. 1979;10(4):309–19.CrossRefGoogle Scholar
  4. 4.
    van Voren R. On dissidents and madness: From the Soviet Union of Leonid Brezhnev to the “Soviet Union” of Vladimir Putin. On the Boundary of Two Worlds. Amsterdam: Rodopi; 2009.CrossRefGoogle Scholar
  5. 5.
    Üçok A, Brohan E, Rose D, Sartorius N, Leese M, Yoon CK, Thornicroft G. Anticipated discrimination among people with schizophrenia. Acta Psychiatr Scand. 2012;125(1):77–83.  https://doi.org/10.1111/j.1600-0447.2011.01772.x.CrossRefPubMedGoogle Scholar
  6. 6.
    Abdalla-Filho E, Bertolote JM. Forensic psychiatric systems in the world. Rev Bras Psiquiatr. 2006;28:s56–61.CrossRefGoogle Scholar
  7. 7.
    Saeima. The criminal law. 1998. Retrieved from http://www.likumi.lv/doc.php?id=88966.
  8. 8.
    Saeima. The criminal procedure law. 2005. Retrieved from http://www.likumi.lv/doc.php?id=107820.
  9. 9.
    Saeima. The civil law. 1937. Retrieved from http://www.likumi.lv/doc.php?id=90223.
  10. 10.
    Saeima. The civil procedure law. 1998. Retrieved from http://www.likumi.lv/doc.php?id=50500.
  11. 11.
    Saeima. Law on Forensic Experts. 2006. Retrieved from https://www.vestnesis.lv/op/2016/42.1.
  12. 12.
    Lietuvos Respublikos Seimas. The law on mental health care. 1995. Retrieved from http://www.vpsc.lt/vpsc_anglu/Law%20on%20Mental%20Health%20care.htm.
  13. 13.
    Saeima. Ārstniecības likums (The Medical Treatment Law). 1997. Retrieved from http://likumi.lv/doc.php?id=44108.
  14. 14.
    Lietuvos Respublikos Seimas. Lietuvos sveikatos sistemos 2011-2020 metų plėtros metmenys (Lithuanian health system development framework 2011-2020). 2011. Retrieved from https://www.e-tar.lt/portal/en/legalAct/TAR.0E672DF64E70.Google Scholar
  15. 15.
    Riigikogu. The Mental Health Act. 1997. Retrieved from https://www.riigiteataja.ee/en/eli/507112013006/consolide.
  16. 16.
    Kessler RC, Ustün TB. The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res. 2004;13(2):93–121.CrossRefGoogle Scholar
  17. 17.
    Lecrubier Y, Sheehan DV, Weiller E, Amorim P, Bonora I, Sheehan KH, Dunbar GC. The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry. 1997;12(5):224–31.CrossRefGoogle Scholar
  18. 18.
    van Gülick-Bailer M, Maurer K, Häfner H. Schedules for Clinical Assessment in Neuropsychiatry: SCAN, PSE 10 Interview. Bern: Hans Huber; 1995.Google Scholar
  19. 19.
    Lõokene M, Kisuro A, Mačiulis V, Banaitis V, Ungvari GS, Gazdag G. Use of electroconvulsive therapy in the Baltic states. World J Biol Psychiatry. 2014;15(5):419–24.  https://doi.org/10.3109/15622975.2013.866692.CrossRefPubMedGoogle Scholar
  20. 20.
    World Health Organisation. European health for all database (HFA-DB). 2014. Retrieved from http://data.euro.who.int/hfadb/.
  21. 21.
    Krisciunas A. Case study: Lithuania. In: Long-term care in developing countries: ten case studies. Geneva: World Health Organization; 2003. p. 217–45.. Retrieved from http://apps.who.int/iris/bitstream/10665/42769/1/9241562498.pdf.Google Scholar
  22. 22.
    Puras D, Germanavicius A, Povilaitis R, Veniute M, Jasilionis D. Lithuania mental health country profile. Int Rev Psychiatry. 2004;16(1/2):117–25.  https://doi.org/10.1080/09540260310001635168.CrossRefPubMedGoogle Scholar
  23. 23.
    Germanavičius A, Kuntelija T, Verseckienė D, Ruseckienė R, Venytė N. Šizofrenijos spektro sutrikimais sergančių asmenų gydymo ir reabilitacijos Vilniaus mieste analizė. In: Psichikos ligų klinika ir gydymas: mokslinės praktinės konferencijos darbų rinkinys. Vilnius: Presvika; 2004. p. 44–6.Google Scholar
  24. 24.
    Wilken JP, den Hollander D. Rehabilitation and recovery: A comprehensive approach. Amsterdam: Uitgeverij SWP; 2005.Google Scholar
  25. 25.
    Stein LI, Test MA. Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry. 1980;37(4):392–7.  https://doi.org/10.1001/archpsyc.1980.01780170034003.CrossRefPubMedGoogle Scholar
  26. 26.
    Tyrer P, Balod A, Germanavicius A, McDonald A, Varadan M, Thomas J. Perceptions of assertive community treatment in the UK and Lithuania. Int J Soc Psychiatry. 2007;53(6):498–506.  https://doi.org/10.1177/0020764007083868.CrossRefPubMedGoogle Scholar
  27. 27.
    Germanavicius A, Puras D, Rimsaite E, Juodkaite D. Lithuania. In: Mercer E, Rimsaite E, editors. Human rights in mental health care in Baltic countries. Latvia: Latvian Centre for Human Rights; 2006. p. 52–76. Retrieved from http://cilvektiesibas.org.lv/site/attachments/30/01/2012/HRinMHbaltics_ENG.pdf.
  28. 28.
    Germanavičius A, Mališauskaitė L, Povilaitis R, Pūras D, Rimšaitė E, Šakalienė D. Human rights monitoring in residential institutions for mentally disabled and psychiatric hospitals: monitoring report. Vilnius: Human Rights Monitoring Institute; Global Initiative on Psychiatry; Lithuanian Welfare Society for Persons with Mental Disability “Viltis”; Vilnius Center for Psychosocial Rehabilitation; 2005. Retrieved from http://www.perspektyvos.org/images/failai/human_rights_monitoring_report.pdf.
  29. 29.
    Puras D, Sumskiene E, Adomaityte-Subaciene I. Challenges of prolonged transition from totalitarian system to liberal democracy. J Soc Policy Soc Work Transition. 2013;2:31–54.CrossRefGoogle Scholar
  30. 30.
    Stankūnas M, Lovkytė L, Padaiga Ž. The survey of Lithuanian physicians and medical residents regarding possible migration to the European Union (Lietuvos gydytojų ir rezidentų ketinimų dirbti Europos Sąjungos šalyse tyrimas). Medicina. 2004;40(1):68–74.PubMedGoogle Scholar
  31. 31.
    Pocius A. A change in the supply of professionals in the healthcare sector and assessment of the demand for physicians and opportunities for their integration into the labour market. Lith J Stat. 2013;52(1):45–57.Google Scholar
  32. 32.
    The National Service of Forensic Psychiatry in Lithuania under the Ministry of Health. List of forensic psychiatric experts and their age. Internal document. 2016.Google Scholar
  33. 33.
    Pulmanis T, Japeniņa S, Taube M. Psihiskā veselība Latvijā 2014. gadā. Tematiskais ziņojums, 15. izdevums (Mental Health in Latvia in 2014: a Thematic report). Rīga: Slimību profilakses un kontroles centrs; 2015. https://www.spkc.gov.lv/upload/Petijumi%20un%20zinojumi/Sabiedribas%20veselibas%20petijumi/tz_pvl_2014_sj_tp_mt_ab_jl_final_pdf.pdf.
  34. 34.
    The Riga Centre of Psychiatry and Narcology. Annual Report 2014 (Rīgas psihiatrijas un narkoloģijas centra 2014. gada pārskats). Rīga: Rīgas psihiatrijas un narkoloģijas centrs; 2015.. Retrieved from http://www.rpnc.lv/wp-content/uploads/sites/3/2015/08/RPNC_pārskats_ar-vadibas_zinjojums_2014_konsolidēts_10_06_2015.pdf.Google Scholar
  35. 35.
    Central Statistical Bureau of Latvia. Key socio-economic indicators in the Baltic States. 2017. Retrieved from http://www.csb.gov.lv/sites/default/files/publikacijas/2017/nr_02_galvenie_socialekonomiskie_raditaji_baltijas_valstis_17_01m_lv_en.pdf.
  36. 36.
    The National Service of Forensic Psychiatry in Lithuania under the Ministry of Health. Model of forensic psychiatric care in Lithuania. 2017. Retrieved from http://www.vtpt.lt/en/about_us.html.
  37. 37.
    Šileikaitė A, Germanavičius A, Čėsnienė I. The relationships of clinical, socio-demographic and criminal factors in a sample of forensic psychiatric patients (Teismo psichiatrijos pacientų sociodemografinių ir klinikinių veiksnių bei nusikalstamo elgesio sąsajos). Health Sci East Eur. 2016;26(1):47–51.Google Scholar
  38. 38.
    Klumbiene J, Kalasauskas D, Petkeviciene J, Veryga A, Sakyte E. Trends and social differences in alcohol consumption during the postcommunist transition in Lithuania. Sci World J. 2012;2012:615183.  https://doi.org/10.1100/2012/615183.CrossRefGoogle Scholar
  39. 39.
    Rehm J, Shield KD, Rehm MX, Gmel G, Frick U. Alcohol consumption, alcohol dependence, and attributable burden of disease in Europe: Potential gains from effective interventions for alcohol dependence. Toronto: Centre for Addiction and Mental Health; 2012. Retrieved from https://amphoraproject.net/w2box/data/AMPHORA%20Reports/CAMH_Alcohol_Report_Europe_2012.pdf.
  40. 40.
    Organization for Economic Cooperation and Development. Nonmedical determinants of health: alcohol consumption. 2013. Retrieved from https://data.oecd.org/healthrisk/alcohol-consumption.htm.
  41. 41.
    Statistics Lithuania (Official Statistics Portal). Disease incidence and prevalence: number of persons diagnosed with diseases directly linked to alcohol consumption per 100 thousand population. 2017. Retrieved from https://osp.stat.gov.lt/statistiniu-rodikliu-analize?theme=all#/.
  42. 42.
    Mackenbach JP, Kulhanova I, Bopp M, Borrell C, Deboosere P, Kovács K, de Gelder R. Inequalities in alcohol-related mortality in 17 European countries: a retrospective analysis of mortality registers. PLoS Med. 2015;12(12):e1001909.  https://doi.org/10.1371/journal.pmed.1001909.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Survilaite A. Forensic psychiatric assessment of individuals with mental and behavioral disorders due to use of alcohol, who committed homicide. Eur Psychiatry. 2017;41:S154.  https://doi.org/10.1016/j.eurpsy.2017.01.2016.CrossRefGoogle Scholar
  44. 44.
    Povilaitienė I. Relatives of the first episode psychosis patients: The relationship between appraisal of illness situation, social support, and psychological distress over time. Summary of doctoral dissertation: social sciences, psychology (06 S). Vilnius University; 2011.Google Scholar
  45. 45.
    Erdmane A, Leimane-Veldmeijere I, Muciņš R, Veits U. Report on the implementation of the World Health Organisation’s mental health declaration and action plan in Latvia. 2009. Retrieved from http://zelda.org.lv/wp-content/uploads/file/REPORT-86lpp-10dec-2.pdf.
  46. 46.
    European Court of Human Rights. Case of O.G. v. Latvia. 2014. Retrieved from http://at.gov.lv/files/files/og-v-latvia.pdf.
  47. 47.
    van Voren R. Reforming forensic psychiatry and prison mental health in the former Soviet Union. Psychiatr Bull. 2006;30:124–6.CrossRefGoogle Scholar
  48. 48.
    The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment. Report to the Lithuanian Government on the visit to Lithuania carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 27 November to 4 December 2012. 2012. Retrieved from https://rm.coe.int/1680697367.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Arūnas Germanavičius
    • 1
    Email author
  • Māris Taube
    • 2
  • Ilona Laurinaitytė
    • 3
  • Ingrīda Cera
    • 4
  1. 1.Clinic of Psychiatry, Faculty of MedicineVilnius UniversityVilniusLithuania
  2. 2.Department of Psychiatry and NarcologyRiga Stradiņš UniversityRigaLatvia
  3. 3.Institute of Psychology, Faculty of PhilosophyVilnius UniversityVilniusLithuania
  4. 4.Riga Centre of Psychiatry and NarcologyRigaLatvia

Personalised recommendations