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Mental Health Care in Slovenia

Country: 
Slovenia
Partner Institute: 
Institute of Public Health of the Republic of Slovenia, Ljubljana
Survey no: 
(12) 2008
Author(s): 
Rade Pribakovic Brinovec
Health Policy Issues: 
Access, Responsiveness, HR Training/Capacities
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no yes yes no no
Featured in half-yearly report: Health Policy Developments 12

Abstract

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.

Purpose of health policy or idea

Objectives:

  • Protection of human rights of mental patients (including involuntary admissions and special methods of treatment).
  • Patient advocacy
  • Establishing an institutional and legislative framework for an integrated approach
  • Development of community mental health services

Expected outcomes:

  • National strategy on mental health
  • Improvement in human rights
  • Higher patient satisfaction
  • Better public mental health

Type of incentives

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.

Groups affected

Providers of psychiatric services (in health care and in the community), providers of social care, patients, judicial authorities

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual neutral highly controversial
Structural or Systemic Impact marginal rather fundamental fundamental
Public Visibility very low high very high
Transferability strongly system-dependent system-neutral system-neutral

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.

Political and economic background

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.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no yes yes no no

Origins of health policy idea

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.

Initiators of idea/main actors

  • Government: The MoH actively entered the debate in 2001 trying to prepare a common proposal together with MPs. The proposal was abandoned in 2004. In early 2005 a new intersectoral group started with preparations of new act which was adopted in July 2008.
  • Patients, Consumers: Patient organizations (including relatives of mental patients) have been very supportive to the idea and to the process. Main goals which they were following were human rights issues and access to community care.
  • Scientific Community: Psychiatrists were opposing legislative solutions regarding involuntary admissions because of, in their opinion, implicit distrust to their professional decisions. Psychiatrists supported the community care approach but urged to better define the role of NGOs.

Approach of idea

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.

Stakeholder positions

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.

Actors and positions

Description of actors and their positions
Government
Ministry of healthvery supportivevery supportive strongly opposed
Ministry of social affairsvery supportivevery supportive strongly opposed
Ministry of justicevery supportivevery supportive strongly opposed
Patients, Consumers
NGOsvery supportivevery supportive strongly opposed
Scientific Community
Psychiatristsvery supportiveopposed strongly opposed
Public health expertsvery supportivevery supportive strongly opposed

Influences in policy making and legislation

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.

Legislative outcome

success

Actors and influence

Description of actors and their influence

Government
Ministry of healthvery strongvery strong none
Ministry of social affairsvery strongvery strong none
Ministry of justicevery strongvery strong none
Patients, Consumers
NGOsvery strongstrong none
Scientific Community
Psychiatristsvery strongstrong none
Public health expertsvery strongstrong none
NGOs, Public health expertsMinistry of health, Ministry of social affairs, Ministry of justicePsychiatrists

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

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.

Monitoring and evaluation

Evaluation hasn't been discussed yet.

Expected outcome

See sections "Characteristics of this policy" and "Impact of this policy".

Impact of this policy

Quality of Health Care Services marginal rather fundamental fundamental
Level of Equity system less equitable system more equitable system more equitable
Cost Efficiency very low neutral 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.

References

Sources of Information

Author/s and/or contributors to this survey

Rade Pribakovic Brinovec

Suggested citation for this online article

Pribakovic Brinovec, Rade. "Mental Health Care in Slovenia". Health Policy Monitor, October 2008. Available at http://www.hpm.org/survey/si/a12/2