Since 2018, the Ministry of Health has made mental health one of its priorities. The ministry developed a two-year ‘Plan for Improving Access to Mental Health Care’, but its implementation was unsuccessful – there were many plans, but no money.
In addition, in March 2020, the pandemic disrupted the usual order. Two years later, based on negative experience and working together with various experts in the field, as well as following the recommendations of the World Health Organisation, the ‘Plan for Improving the Organisation of Mental Health Care for 2023-2025’ was developed.
Māris Taube, President of the Latvian Psychiatrists’ Association, considers it a success: “I would say that the plan has been drawn up in such a way that there are things we can do, and that is positive. In the past, there used to be a list of needs – everything that was needed was listed, and in the end it turned out that none of it could be done.”
One of the main focuses of the plan is early diagnosis, which in turn provides for timely treatment and rehabilitation. It is equally important to develop outpatient and community-based services, i.e. services that are located away from hospitals and can be accessed while continuing to work, socialise and study in the usual environment, as far as possible.
In Latvia, such state-funded assistance is provided by the Children and Youth Resource Centre established by the Children’s Clinical University Hospital Foundation, which offers support programmes for adolescents at risk of addiction and with mental health problems in 11 branches in nine Latvian cities.
The plan provides for the centre to operate a psychological support hotline and improve access to a ‘mood disorder programme’ in the regions.
The centre’s director, Anete Masaļska, says new branches should be opened:
“For example, in the Latgale region, we have Rēzekne and Daugavpils. But Latgale is huge. For example, it would be good to have a branch in Jēkabpils, or in Gulbene, because people are unable to travel. If we calculate, for example, Jēkabpils–Rēzekne, it is about 100 kilometres. And to travel a hundred kilometres in one direction, then back in the other direction, and do that three or four times a week – it’s not possible.”
However, no new branches have been opened in the last two years, and there are no plans to do so in the near future. Even if premises could be found, there is no one who would work there.
Currently, when applying for one of the centre’s programmes, the waiting list is between one and four months.
The longest queues are in Rīga and Daugavpils. In 2023, the Children and Youth Resource Centre’s programmes provided assistance to approximately 12,000 teenagers, but last year the number was almost 14,500.
Latvia lacks psychiatrists
In total, there are currently 266 registered psychiatrists in Latvia. Fifty-four doctors specialise in child psychiatry. Some of them are certified in both specialities. However, less than a third of them work full-time in the public sector. Most either work part-time or see patients in shorter shifts at several locations. In recent years, in response to the shortage of specialists, the Ministry of Health has increased the number of residency places in psychiatry.
Three years ago, nine doctors were able to study the speciality at public expense; now the number is 16. If this support continues at the same pace, the queues for psychiatrists will decrease in a few years.
Lack of understanding about the role of mental health professionals
Historically, mental health care policy in Latvia has focused on institutions and psychiatrists. Due to a lack of understanding in society about the roles of different mental health professionals, people who could benefit from a consultation with a general practitioner also turn to psychiatrists.
The World Health Organisation (WHO) emphasises that psychiatrists should focus on moderately severe and severe patients, says WHO representative Marta Krivade.
“There should be so-called “gatekeepers”, such as primary health care or psychological services, who can then sort out these needs. Very often, this may be a general practitioner who can help, and the person does not need to go to a psychiatrist,‘ says the expert. “On the one hand, of course, in terms of stigmatisation, it is good that psychiatrists are directly accessible and that you don’t have to ask for a special referral. On the other hand, we also see – and this is said by psychiatrists themselves and the Psychiatrists’ Association – that sometimes a person comes to a psychiatrist who has, for example, complications because they have experienced some upheaval in their romantic relationships. In this case, a psychiatrist may not be the right person to help them. They may need the help of a psychologist or psychotherapist, or perhaps even a general practitioner.”
The current plan period comes to an end
The current plan period will end at the end of this year. It is estimated that approximately 70% of the plan has been implemented so far. An additional €32 million was needed to implement it over three years.
However, no money was found in the health budget. Therefore, professionals from the public sector, in close cooperation with the Ministry of Health and the National Health Service, were able to secure funding from the state budget to achieve the most important objectives. To date, two methodological centres have been opened to develop a unified mental health care system throughout Latvia, and early intervention services have been developed for both children and adults, enabling the timely detection of mental health disorders and the initiation of the necessary therapy.
New, effective medications have also been introduced, a psychiatrist hotline has been set up, the number of residency places in psychiatry has been increased, and a mobile team has been established to provide home care for patients. However, the more awareness there is in society about mental health and the more services are available, the greater the demand will be.
In some cases, children have to wait up to a year to see a state-funded specialist in child psychiatry, says child psychiatrist Ņikita Bezborodovs:
“The name of the plan is the service accessibility improvement plan. Many of the activities have been carried out. Has this resulted in a reduction in waiting lists for these services, for example? Not at all. The waiting lists are only getting longer.”
In order to reduce waiting lists, the public sector needs to attract more specialists and think about how to ease the burden on existing staff.
In response to a question about the next plan, the Ministry of Health says that although the main problems have been identified, work on it has not yet begun. How quickly a new plan will be developed depends on political will.
Although much of what the Ministry of Health has planned has been implemented, patients and specialists still face systemic problems on a daily basis. The availability of mental health care services in Latvia is slowly improving, but significant changes require greater political will, cooperation between different sectors and more active systemic public education, starting in schools.