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Taking steps towards deinstitutionalizing mental health care within a low and middle-income country: A cross-sectional study of service user needs in the Republic of Moldova

Author

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  • Jona J Frasch
  • Ionela Petrea
  • Jana Chihai
  • Filip Smit
  • Matthijs Oud
  • Laura Shields-Zeeman

Abstract

Aim: The current research was conducted in the context of an ongoing reform of mental health services in the Republic of Moldova since 2014, where efforts have been devoted to creating community-based mental health services. This article presents a snapshot of the needs of mental health service users in the Republic of Moldova and helps to understand how and with which services their needs can be addressed. Methods: This cross-sectional study compared the levels of needs (CANSAS scale), quality of life (EQ-5D 3L), mental health status (MINI for psychotic disorders) and functioning (WHO-DAS) among mental health service users in the psychiatric hospital in Chisinau, Moldova. All service users resided in districts where community mental health services were being developed. Correlations between quality of life, functioning and unmet need were explored. Results: Of 83 participants, one third had a psychotic or a mood disorder. On average, participants reported needs in 9.41 domains ( SD = 4.41), of which 4.29 were unmet ( SD = 3.63). Most unmet needs related to intimacy and relation to others. The level of functioning and quality of life were reported. We found strong, negative associations between the number of unmet needs and level of functioning, as well as the quality of life. We also found that higher functioning levels were positively associated with higher quality of life. Conclusion: There were a high number of unmet needs among this inpatient population, particularly social needs and service-related needs. A continuum of inpatient and outpatient care and individual treatment plans can help address the different needs of different patients. Individual treatment plans for patients and the choice of the appropriate treatment for patients could be guided by an assessment of service users’ (unmet) needs of care and level of functioning.

Suggested Citation

  • Jona J Frasch & Ionela Petrea & Jana Chihai & Filip Smit & Matthijs Oud & Laura Shields-Zeeman, 2020. "Taking steps towards deinstitutionalizing mental health care within a low and middle-income country: A cross-sectional study of service user needs in the Republic of Moldova," International Journal of Social Psychiatry, , vol. 66(1), pages 49-57, February.
    • Handle: RePEc:sae:socpsy:v:66:y:2020:i:1:p:49-57
    DOI: 10.1177/0020764019879951
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    References listed on IDEAS

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    2. Wiley-Exley, Elizabeth, 2007. "Evaluations of community mental health care in low- and middle-income countries: A 10-year review of the literature," Social Science & Medicine, Elsevier, vol. 64(6), pages 1231-1241, March.
    3. World Bank, 2016. "Moldova Poverty Assessment 2016," World Bank Publications - Reports 26041, The World Bank Group.
    4. World Bank Group, 2016. "Poverty and Shared Prosperity 2016," World Bank Publications - Books, The World Bank Group, number 25078.
    5. World Bank Group, 2016. "Poverty Reduction and Shared Prosperity in Moldova," World Bank Publications - Reports 24734, The World Bank Group.
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