INTRODUCTION: There are relatively limited studies exploring the relationship between elderly individuals' pension income and their sense of inferiority in countries with economic hardship or financial crisis. In specific, the characteristics of shame in elderly individuals is not usually taken into account and related to financial hardship or economic crisis. AIM: This study aimed at identifying the relationship between elderly individuals' pension income, and the sense of external and internal shame of pensioners. METHOD: The total sample included 476 pensioners with a mean age 70.11 (SD=14.22). The participants in the study completed a) the Other As Shamer Scale-OAS, b) the Experience of Shame Scale-ESS, and c) questionnaire on socio-demographic information and individuals' monthly pension income.RESULTS: Multivariate analysis was applied for analysing the data.The results identified that elderly individuals with low monthly incomes have the highest level feeling of inferior (OAS) (7,04), total external shame (OAS) (19,74), feeling of emptiness (OAS) (4,15), and mistakes (OAS) (7,43).Conclusions: It could be argued that the results of this study, despite of the reasonable limitations, leads to a redefinition of views about the impact of personal salary and pension on the sense of external and internal shame.

Background The absence of economic evidence hinders current reforms of hospital based mental health systems in Central and Eastern Europe. We aimed to assess the costeffectiveness of care for people with chronic psychoses in psychiatric hospitals compared to discharging patients to the community in the Czech Republic. Methods We conducted a prospective study of people with chronic psychotic disorders and evaluated the impact associated with discharge into community services as compared to not discharging people from psychiatric hospitals at baseline in the Czech Republic. We measured utilization of services, health related quality of life, met and unmet needs, and global functioning using an adapted Client Services Receipt Inventory (CSRI), EQ-5D-5L, Camberwell Assessment of Need (CAN) and General Assessment of Functioning (GAF). Adjusting for baseline differences between the two groups, we assessed differences in societal costs in Euros (€) and QALYs over a year-long follow-up which we then used to estimate the incremental cost-effectiveness ratio (ICER). We conducted multiple sensitivity analyses to assess the robustness of our results. Outcomes In our base case scenario, we included 115 patients who were either inpatient or community services users at the baseline. The two groups were very similar in terms of their observed characteristics. The annual QALY was 0.77 and 0.80 in the group discharged to the community at the baseline compared to not being discharged (difference 0.03 95% confidence interval-0.04 to 0.1), but costs were €8,503 compared to €16,425 (difference €7,922, 95% confidence interval 4,371 to 11,472) such that the ICER reached over 250,000 € per QALY. This is considerably above levels that are conventionally considered to be costeffective and the estimated probability that discharge to the community was cost-effective was very high. None of the sensitivity analyses changed these results qualitatively. Interpretation This study provides economic evidence for deinstitutionalization by showing that discharge to community care is cost-effective when compared to care in psychiatric hospitals in the Czech Republic. Thus, it adds to the human rights-and clinical-based arguments for mental health care reforms in Central and Eastern Europe.

Implementing a modern concept for psychosocial rehabilitation aimed at progressing the recovery of people with complex mental health problems can improve the quality of care in longer term inpatient settings.

Background The overall objective of the study is to improve the mental health of the age group below 18 years through the investigation of the intra-and inter-sectoral cooperation between local suppliers and to make the intensity and quality of collaborations measurable. In this paper, based on Hungarian and international literature, we aim at describing the current and future optimal cooperation between the members of the mental health care system and examine the possibilities for documenting and measuring cooperation. Methods Semi-structured interviews were recorded with the leaders or representatives of 12 public educational institutions, six social and six health institutions involvement of the relevant experts (N = 24). Results The function of the institutions belonging to these systems, as well as the daily work of the professionals working there, have a signi cant impact on the mental health of children in either positive or negative directions. After exploring the current situation, the cooperation of local suppliers and inter-institutional relations can highly increase the mental health improvement of the youth. Conclusion According to the results, the developing progress can be more effective through organising the different forms of care, sectors and professionals together to achieve a common goal.