|Implemented in this survey?|
The Slovenian Parliament has recently adopted an Act on Mental Health. For several years mental health was on the political agenda but without improvements. The Act on Mental Health provides a legislative framework for a national strategy on mental health, it defines responsibilities of the government and of healthcare providers. The main focus stays on legal protection and on community approaches to mental patients.
New professions were introduced. These are the coordinator of controlled care (i.e. home care under supervision of the coordinator) and the coordinator of community care. Funds should be provided by health insurance for the first and through the Ministry of Social Affairs for the latter.
Providers of psychiatric services (in health care and in the community), providers of social care, patients, judicial authorities
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
Positive consequences of this policy are solutions concerning empowerment and legal security of the most vulnerable group of mental patients (i.e. those who might be involuntarily admitted) and definition of community care. On the other hand lots of expectations were put into the national strategy on mental health which should be one of the outcomes. Because of remaining controversies within the psychiatric community and between psychiatry experts and public health experts, the further developments are not easy to forsee.
Two main factors influenced the adoption of the Act on Mental Health. The first was political pressure of mental health professionals and patient groups (also through international organizations) and the other was a clear commitment of the last government.
|Implemented in this survey?|
The idea was born already some 15 years ago. Nevertheless it was only the Constituional Court which in 2003 decided on illegitimacy of current practices regarding involuntary hospitalizations in psychiatry. This decision imposed the parliament to adopt legislative changes in a one year period. Unfortunately it took another 4 years and a new government mandate to carry out this decision.
The main purpose is already described earlier. Regarding implementation, there is one year transitional period within which the Ministry of Health together with the Ministry of Social Affairs has to implement the law.
The driving forces were also described above.
The approach is not new, it follows WHO and EU recommendations as well as solutions in other EU countries such as UK, Austria, Italy, Ireland and the Netherlands.
The main actors were the Ministries of Health, Social Affairs and Justice, professional societies, public health experts, NGOs.
The approach of the idea is described as:
renewed: Legislative problems of mental health have been continously addressed since early 90s. Debate was renewed in 2004 which resulted in the Act on Mental Health in 2008.
The government, NGOs, patient groups and mental public health experts were very supportive of the idea and the process. Psychiatric societies were opposing some solutions regarding involuntary admissions, particularly those concerning responsibilities of managers in psychiatric hospitals. The latter relates to reporting obligations to the court of justice and to the follow-up of use of special methods in psychiatry. They were also critical of the relatively small responsibilites of coordinators of care and ombudsperson.
The MoH has been holding the leading role for the whole time of the process, taking also the responsibility of final decissions in case of dispute.
|Ministry of health||very supportive||strongly opposed|
|Ministry of social affairs||very supportive||strongly opposed|
|Ministry of justice||very supportive||strongly opposed|
|NGOs||very supportive||strongly opposed|
|Psychiatrists||very supportive||strongly opposed|
|Public health experts||very supportive||strongly opposed|
The process ended in July 2008 with the Act on Mental Health. There is a 1 year implementation period when also a national strategy should be prepared.
|Ministry of health||very strong||none|
|Ministry of social affairs||very strong||none|
|Ministry of justice||very strong||none|
|Public health experts||very strong||none|
The Government has to prepare a national strategy on mental health in 1 year after adoption. By-laws need to be prepared by related ministries in 6 months. Ombudspersons (responsible: Min. of Social Affairs), coordinators of controlled care (responsible: psychiatric hospitals) and coordinators of community care (responsible: municipal centres of social care - under Min. of Soc.Aff.) should be nominated in 1 year. All other activities of providers of care affected by this Act have to be harmonized in 6 months. So far there were no special incentives provided for implementation.
Evaluation hasn't been discussed yet.
See sections "Characteristics of this policy" and "Impact of this policy".
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
When implemented this policy will improve quality of care regarding human rights and patient satisfaction. It will also improve access to community care and equity. However it might lead to higher costs in case community services compete (and not complement) with institutional psychiatric services.
Rade Pribakovic Brinovec