Integrating mental health into primary care in Arkhangelsk County, Russia: the Pomor model in psychiatry

Abstract

BackgroundPrimary health care is still peripheral in the identification and treatment of mental health and substance use disorders in the Russian Federation. However, the development of primary health services has been given priority. A long-standing collaboration between Arkhangelsk County and northern Norway on mental health service development in Arkhangelsk has promoted the integration of mental health into primary care.AimTo develop a model for mental health integration into primary care adapted to the conditions in Arkhangelsk County.Methods(a) Situational assessment, (b) development of a model for systematic cooperation between GPs and specialists, (c) initial evaluation of the model, (d) implementation and dissemination of the model.ResultsA local studies revealed major shortcomings in GPs’ diagnostic and treatment skills and in their collaboration with specialists in psychiatry. In order to promote better communication between GPs and specialists in this desolate and sparsely populated geographical area, an information communication technology (ICT)-based competence centre was established at a specialised community mental health centre in Arkhangelsk city (APND). Through a network including APND and involved primary health care centres, GPs gained access to specialists’ expertise when required in their work with psychiatric patients. GPs assess all patients’ mental health condition and treatment responsibility for patients in need of mental health care is divided between GPs and specialists according to problem severity. APND has the formal responsibility for ensuring that this collaboration with the health centres is established and practiced. Training in diagnostics and conversation skills ensures basic professional competence in the GPs. Initial evaluation showed that patients, GPs and specialists were satisfied with their experiences. The model is currently under implementation in 50% of the districts of the county.ConclusionOur cooperation has led to the development and implementation of a model for mental health care integration into primary care in an area with major geographical distances. Further improvements will be based on systematic evaluation of experiences with the model.

Socio-demographic, behavioural and psycho-social factors associated with depression in two Russian cities

“…We found strikingly strong associations with a factor from each domain – gender, financial constraints, problem drinking and recent life events. This is particularly relevant in Russia where psychiatric services have been traditionally focused on delivery of care from specialist outpatient psychiatric dispensaries or inpatient hospitalisation ( Füredi et al., 2006 ; Gurovich, 2007 ; Jenkins et al., 2007 ) while depression is not commonly assessed or treated within primary care services ( Gurovich, 2007 ; Jenkins et al., 2007 ; Rezvy et al., 2019 ; Sorgaard et al., 2013 ). Our findings are consistent with a bio-psycho-social model of depression and indicates the need to take a holistic approach in prevention and treatment of depression integrated within the health care system.…”

Prevalence of symptoms, ever having received a diagnosis and treatment of depression and anxiety, and associations with health service use amongst the general population in two Russian cities

“…Seeking treatment privately is also an option for those who can afford it. Assessment and treatment within primary care is rare [15,16,18,19]. However if those with depression and anxiety are more likely to attend general health care services this may equate with missed opportunities for care.…”