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WHO World Health Organization |
The United Nations and WHO have declared 2001 as the Year of Mental Health and as the theme of the World Health Day on 7th of April
We have started to understand the psychobiology of depression, aggression, self-destructive behaviour, helplessness, existential emptiness and other emotions. We are learning how adverse psychological and social environment can create long-lasting vulnerability and how environmental factors can find their way into the human genome. We start to learn how to integrate «humanistic», psychosocial and existential knowledge into «biological» medical science recognising that there neither is a brainless mind nor a mindless brain.
Recent developments in stress research, psychosomatics, psycho-immunology, neuro-psychiatry and neuro-philosophy are in the frontline of scientific development. Russia has had a long tradition of holistic methodology involving biological, psychosocial and spiritual dimensions of life, and therefore, can continue to have an important role to play. The psychosomatic knowledge and clinical practice created in this country should spread elsewhere.
We live in a time of increasing burden and distress caused by helplessness, loss of control and identity, social exclusion, lack of coherence and meaning, and existential emptiness and stress. Mental ill health, depression and suicide, and the consequences of aggressive behaviour and destructive life styles, have become some of THE greatest health care burdens economically and in terms of suffering.
In many countries of Eastern and Central Europe decreasing life expectancy and increasing premature mortality have become a matter of great public concern. They have led some of the societies to depopulation and to a dramatically bigger societal burden. In many countries including Russia, aggressive, risk taking, destructive and self-harming behaviour can be seen as one of the main causes leading to death at an early age. Premature mortality due to self-destructive behaviour especially among men is one of the most sensitive indicators for societal distress and transition. Women seem to be more protected, and they have an ability to cope and control their life and to find a meaning in it.
In the post-traumatic societies of warfare and internal conflicts we experience a strong need for reconciliation, rebuilding peace and reconstructing civil society. There cannot be peace without mental health, nor mental health without peace. Problems of aggression, self-destruction, violence, suicide, demoralization and abuse need to be tackled urgently. Also here Russia has a special role.
Multidisciplinary and multisectoral action, which will increase self-control and coping abilities, is required to counteract demoralization. In order to tackle this challenge, stronger and continuous awareness and support must be put on mental health. Public and political respect for ethical standards, scientific progress, and clinical skills need to be promoted. WHO has been preparing a ministerial level conference on mental health in Russia to raise public awareness and catalyze action. It continues to call for European assistance for the attempts to relieve the situation of disadvantaged, mentally ill and vulnerable persons in the country.
In its role as a health conscience towards governments and decision makers the World Health Organisation stresses mental health as a human right and underlines community based care close to the individual. WHO has made the reduction of suicides as one of its main goals. To put this into practice WHO and its partners in Russia must develop a new approach.
The United Nations and WHO have declared 2001 as the Year of Mental Health and as the theme of the World Health Day on 7th of April.
The Common message voiced in every country is:
– mental health can be promoted by wise political action based on scientific evidence;
– the impact of political and societal action on mental health must be better considered;
– no country can afford to neglect the investment in mental health;
– mental ill-health is underestimated, under-recognized, and under-treated, due to stigma, taboo and lack of knowledge;
– heavy burden (“stress”) can afflict anybody, but mental damage is also preventable, treatable and the patients can be re-integrated into society.
WHO plans to celebrate a major European event during this day in Moscow. We hope to give more importance to mental health. The Ministry of Health of the Russian Federation and main psychiatric institutions in Moscow and Petersburg, such as the Psychiatric Institute of the Academy of Medical Science, Psychiatric Institute of the Ministry of Health, State Research Centre of Social and Judicial Psychiatry named after Serbsky, and the Bechterew Institute, have already agreed to move forward. On the WHO side, activities will be coordinated through the Office of the Special Representative of Director General in Russia. We also welcome and encourage the involvement of all other UN agencies in Moscow for a joint action.
Dr. Wolfgang Rutz
Regional Adviser
for Mental Health
WHO Regional Office for Europe, Copenhagen, Denmark
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The World Health Organization, Special Representative of the
Director General in Russia Dr. Mikko Vienonen and WHO 
HIV/AIDS
and Sexually Transmitted Infections Coordinator Dr. Nikolai Mashkilleyson visited
in January the vast Central Siberian Krasnoyarski “krai” (region), which is
bigger than France and Germany together. It has a population of about 3.5 million.
The meeting with Governor Lebed and discussions and field visits organized by the regional health administration were warm and cordial. Even the record frost of minus 50 degrees had loosened its grip to only near zero temperatures.
Nevertheless, the health situation is serious with about 3,500 new tuberculosis cases last year and 120 people dying of this serious disease. In Western Europe, for a population of this size one could expect to see hardly more than 10 percent of this number. The figures in Krasnoyarsk are higher than the Russian average.
Also, HIV infections are soaring and urgent measures are needed to stop the spread of this deadly infection. Last year 740 new HIV infections were detected in the Krasnoyarski krai and currently 100-150 new cases are diagnosed every month. At present 1100 HIV-infections are registered in the krai, but the real figure is estimated to be five to ten times higher.
WHO considers the high level commitment of the regional and local health administrations, including the penitentiary system, to be the most important prerequisites when these epidemics are tackled.
WHO is presently in the process of reviewing possibilities and identifying donor partners for a joint health programme and considering whether to open a WHO satellite office in Krasnoyarsk.
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On January 19, 2001 a Meeting of the High Level Working Group on Tuberculosis (HLWG) was held at the Ministry of Health of the Russian Federation. The Russian Ministries of Health and Justice, the Russian Academy of Medical Science, the Sechenov Moscow Medical Academy, the World Health Organization and the Council of Europe joined their efforts at this unique high-level forum to combat the tuberculosis (TB) epidemic in Russia.
Dr. Mikko Vienonen, Special Representative of the WHO Director General in Russia chaired the meeting, where the following issues were discussed:
HLWG Annual Report presented by Dr. Wieslaw Jakubowiak, WHO TB Program Coordinator in the Russian Federation, gave comprehensive information on WHO activities on TB control in the RF including activities of thematic working groups, and recommendations on how to strengthen the legal basis for the HLWG in order to enhance the effect of TB control;
The latest developments of the TB World Bank loan project were presented by Dr. Nikolay Seredin from Russian Health Care Foundation;
Dr Richard Zaleskis, WHO/EURO, informed of the Global Drug Facility Project and briefed all on the key steps of the application procedure, requesting WHO/Russia to provide technical assistance in this process.
Despite the actions undertaken to implement the Federal Target Program “Urgent Measures for Tuberculosis Control in Russia for 1998–2004” and the development of cooperation between the Russian institutions and the international organizations, the epidemiological situation of TB is obviously not completely under control.
The Russian Government has requested that WHO supervise and
monitor the TB component of the proposed World Bank
Project. The proposed World Bank loan envi-sages approximately US$100 million
for reinforcing TB control in Russia by improving TB control services and the
management of drug resistance, both in civilian and prison populations.
According to the WHO Global Tuberculosis Control Report 2000, Russia ranks eleventh among the 22 high-burden TB countries in the world, and in 1999 there were over 124,000 new cases of TB here. The TB mortality rate also increased from 15.4/100,000 in 1998 to 20/100,000 in 1999. Additionally, there is an intense TB epidemic occurring in the prison system in Russia. TB rates in Russian prisons are significantly rising and threaten to become a continuous source of infection to the civilian population (the TB notification rate in prisons is 54 times higher than in the civilian population. Similarly, the TB mortality rate is estimated to be nearly 30 times higher than in the civilian population).
The lack of anti-TB drugs and the use of non-standardized and sub-optimal therapies have resulted in frighteningly high numbers of multi-drug resistant (MDR) TB, both in the civilian and prison populations. Today in Russia, it is extremely difficult to cure patients with MDR TB due to the lack of second-line drugs, sufficient laboratory support and adequately trained staff.