Sunday, November 20, 2011

Coming Out of the...Padded Room

Lately I’ve been thinking of how the stigma of mental illness resembles the shame and secrecy that many gay people carried in the past. As more and more people "came out of the closet" the stigma slowly receded and now gay couples have the right to marry in some states and to serve openly in the U.S. military. In my opinion, today it is more acceptable to tell a co-worker that you’re gay than to tell them you have a mental disorder.

Those of us who have been diagnosed with a mental disorder such as bipolar disorder, schizophrenia or even obsessive compulsive disorder are hesitant to reveal our illness to our supervisors, co-workers and even friends and family. Fear of being judged and treated differently keeps us in silence. Sensational news stories featuring violent crimes carried out by a mentally ill person reinforce the tendency to stay quiet.

Yet according to a rigorous health survey conducted by the U.S. Centers for Disease Control in 2004, an estimated 25 percent of adults in the U.S. reported having a mental illness in the previous year. That means in a room of four people, one of you likely has a mental illness. It could be your teacher, your doctor, your taxi driver or your best friend and you may have no idea.

Professionally, it is especially difficult to admit that you’re living with a mental illness. I wonder “Will it prevent me from getting that promotion? Will I be given less challenging projects? Will I still be invited to Happy Hours? Will people whisper and talk about me behind my back?” Fear of being ostracized, judged and labeled prevents me from coming out to colleagues.

We want to be treated the same as anyone else. Sure we have our faults and weaknesses. We wouldn’t be human without them. But honestly I think I am a better employee, friend, manager and daughter since my diagnosis. Today I appreciate the importance of taking care of myself – eating nutritious foods, getting enough sleep, working out my problems with friends or a trusted therapist instead of keeping them bottled up inside. And if we don’t stand up and speak out, society will continue to equate mental illness with insane criminals and deranged homeless people living on the streets instead of with successful and competent professionals succeeding in The judgment and fear will be perpetuated indefinitely and change will evade us for years to come.

Jagannath Lamichane started his own NGO - the Nepal Mental Health Foundation - to fight for the rights of the mentally ill in his native country, Nepal. I made his acquaintance on Facebook two years ago when he first embarked on his life’s mission and I recently had the pleasure of meeting him in person. As we sat in an empty diner in Arlington, Virginia watching the spring rain pour outside, he reminded me of our obligation to come out and tell our stories. “That’s the only way the stigma will begin to melt away,” he said. I voiced my hesitation to speak openly about my mental illness among colleagues. “Are you gonna say it in 10 years when it won’t matter anymore?” he asked without judgment. “Or will you say it now?”

I will say it now.

The Bazelon Center for Mental Health Law

Founded in 1972 by a group of lawyers and mental health professionals, the Bazelon Center for Mental Health Law is a nonprofit organization devoted to improving the lives of people with mental illnesses through changes in policy and law. Focusing on policy advocacy, litigation and public education, the Bazelon Center fights for the rights of people living with mental disorders specifically addressing community integration, self determination, success for all children, access to services and access to courts. Their programs and litigation zero in on housing, employment, education, public systems, health care, the judiciary and more.

Their website also provides useful information on legislation currently being considered in the 112th Congress. The Garrett Lee Smith Memorial Act Reauthorization of 2011 would renew and expand existing provisions with the "goal of increasing suicide prevention programs in communities and college campuses across the country. The bill also promotes the development of effective strategies and best practices related to youth suicide prevention."

The Mental Health on Campus Improvement Act is also under consideration. The bill would "assist colleges and universities in successfully attending to the gro mental health needs in colleges and universities by improving access to mental and behavioral health services on college campuses."

It is important to exercise our power as citizen advocates by calling and writing our Congressional Representatives and Senators and urging them to support legislation that will improve mental health programs and policies in the U.S. The Bazelon Center's website offers a wealth of information to help us do just that. Visit for more information.

To find contact information for your Senator of Representative visit

Saturday, November 19, 2011

Movement for Global Mental Health

The Movement for Global Mental Health is a coalition of individuals and institutions committed to collective actions that aim to close the treatment gap for people living with mental disorders worldwide, based on two fundamental principles: evidence on effective treatments and the human rights of people with mental disorders.

Visit or visit to read a recent article in The British Journal of Psychiatry.

Saturday, November 5, 2011

International Master in Mental Health Policy and Services-Application Deadline is January 2012

The International Master in Mental Health Policy and Services is addressed to health professionals willing to develop public health skills in the area of mental health.
The Master aims to provide general training in areas related to:
■ Formulation, implementation and evaluation of mental health policies,
plans and programmes.
■ Organization and evaluation of mental health care and related services.
■ Formulation and implementation of Mental Health Service research.
■ Mental Health Law and Human Rights.

The International Master in Mental Health
Policy and Services (MHPS) aims at creating an international critical mass of
knowledgeable professionals able:
■ To effectively contribute to improving
Mental Health Policy and Services in their
own countries or in international settings.
■ To promote human rights and human
rights driven legislation.

Applicants from Low and Middle Income countries are encouraged to apply. For more information please visit

Thursday, October 20, 2011

SPOTLIGHT on the Nepal Mental Health Foundation

The Nepal Mental Health Foundation is the first of its kind in the country and the effort is spearheaded by one man, Jagganath Lamichhane. Jagganath is remarkable in his dedication to the cause of mental health education and reform in his native land, despite having the door closed on him by almost all international and multi-national NGOs.

According to the NMHF website, mental health is the highly overlooked and neglected dimension of public health in Nepal. Despite the fact that mental illness is one of the most prevalent health conditions in world, around 90% of the people in the Low and Middle Income Countries (LAMICs) like Nepal do not get treatment. In Nepal, less than 0.20% of health care expenditures by the government are directed towards mental health.

There is no mental health policy and no human rights review body with the authority to inspect mental health facilities and to impose sanctions on those facilities that persistently violate patient's rights.

For mental health treatment, there is scarcity of resources, inequities in their distribution and inefficiencies in their utilization. Resources included are policy and infrastructure within countries, mental health services, and community, human, and financial resources. Research shows that over 80% of mental disorders are preventable and treatable, but in LAMICs like Nepal only 10% of the population gets access to care and treatment.

According to government resources, Nepal, a country of 27.1 million people, there are approximately 40 licensed psychiatrists, 5 clinical psychologists, and only 108 public inpatient psychiatric beds, mostly concentrated in the capital city Kathmandu.

Nepal Mental Health Foundation (NMHF) is the mental health consumer based human rights organization. Stigma erodes the confidence of mentally ill people and their families to seek treatment and to believe that mental disorders are valid and treatable health conditions. Their mission is to establish the importance of mental health and to make society aware that it is as important as physical health to the overall well-being of individuals, societies and countries.
The Foundation has three major goals:
Nepal Mental Health Foundation works towards achieving major three goals:
• To increase public understanding and awareness on mental health based on scientific researches.
• To reduce the stigma and discrimination against people with mental illness.
• To advocate for mental health policies and human rights of mentally ill people in the country and around the world in collaboration with national and international partner organizations.

Please visit their website at

Sunday, October 2, 2011

The Field of Hope

iFred (International Foundation for Research and Education on Depression) is working to eliminate the stigma of depression since the launch of the Field of Hope in Ghana in 2009. This creative and unique initiative is designed to shine the spotlight on depression in Africa, and to raise money for depression reseach and advocacy efforts worldwide. Africa was chosen to host the field to highlight and educate just how poorly the disease is understood.

iFred has also chosen the sunflower as the international symbol for depression, and has launched a major ad campaign showing the relationships of sunflowers to depression survivors. According to their website:

"•A recent study by Rutger’s, the State University of New Jersey, showed that flowers have an immediate positive impact on happiness (100% of time, both males and females), that they have a long-term positive effect on moods, and that they make intimate connections. The study also said sunflowers are said to enhance alertness, as yellow light waves stimulate the brain.
•A recent study by Texas A&M also found that placing flowers and plants in offices led individuals to be more creative, better problem solvers, and more productive.
•A sunflower is the color yellow, often associated with joy and happiness.
•Sunflowers flourish with sun and light. Humans do as well.
•Sunflowers and depression both have lifecycles.
•Sunflowers grow from a small seed and can get bigger, as can a depressive episode when left untreated."

For more information on iFred, please visit and or email:

Saturday, October 1, 2011

International Diploma on Mental Health Law and Human Rights

ILS Law College, University of Pune, India, in partnership with the World Health Organization launched the first ever one-year International Diploma in Mental Health Law & Human Rights in 2008. Based on materials and tools developed by WHO, the diploma provides the law students with essential knowledge and skills for a career in the area of mental health, human rights and legislation. The fourth class is currently underway at ILS.

This unique Diploma is designed to appeal to a wide range of people interested in mental health including health workers, legal professionals, policy makers, and service users and family members.

The main objectives of the Diploma are: to equip students with the knowledge and understanding of international human rights standards for people with mental disorders; to apply these standards to mental health legislation; to understand the role of legislation in promoting and protecting the rights of persons with mental disorders; to understand how mental health policy and services can work to improve the human rights of people with mental disorders; and to equip the students with a broad contextual knowledge of the law and apply the same in the process of drafting, amending and implementing mental health legislation.

It is expected that the Diploma will equip the students to undertake advocacy work in this area and equip them with the knowledge and skills to actively support countries to drafting and amending mental health laws in line with international human rights standards such as the UN Convention on the Rights of Persons with Disabilities.

The course begins with a 2 week onsite session at the ILS Law College at the University of Pune, India, with another one week at the end of the course for exams and project presentations. In between students are required to complete online lectures, study exercises, essays or other homework assignments. In addition, students will complete 1 extended essay (4000-5000 words each) and a research project (15000 words). The cost is 5500 Euros and scholarships are available. Please visit for more information. For more information on the host institution, ILS Law College, please visit

Friday, September 16, 2011

NAMI (National Alliance on Mental Illness)

For three decades, NAMI has established itself as the most formidable grassroots mental health advocacy organization in the country. Dedication, steadfast commitment and unceasing belief in NAMI's mission by grassroots advocates have produced profound changes. NAMI's greatest strength is the dedication of our grassroots leaders and members. We are the families, friends and individuals that serve to strengthen communities across the country.

Due in large part to generous individual, corporate, and foundation donations, NAMI is able to build on its success and continue to focus on three cornerstones of activity that offer hope, reform, and health to our American community: Awareness, Education, and Advocacy.

If you are in need of immediate help, please call the NAMI HelpLine: 1-800-950-NAMI. This resource is an important tool when crisis beckons! Save it in your phone just in case it's needed one day.

Visit for more information on this very important organization.

Tuesday, August 16, 2011

Bring Change 2 Mind is a not-for-profit organization created by Glenn Close, the Child and Adolescent Bipolar Foundation (CABF), Fountain House, and Garen and Shari Staglin of IMHRO (International Mental Health Research Organization).

The idea of a national anti-stigma campaign was born of a partnership between Glenn Close and Fountain House, where Glenn volunteered in order to learn about mental illness, which both her sister and nephew suffer from.

The main goals of Bring Change to Mind are to:
1. Provide people who have misconceptions about mental illness quick and easy access to information that combats stigma.
2. Provide people who have mental illness, and those who know them, quick and easy access to information and support.

This is the first effort of this magnitude in U.S. history. Ron Howard generously donated his time in directing our first PSA that features Glenn Close and her sister, Jessie Close. John Mayer generously donated his song, Say, which serves as an anthem for this movement.

The campaign has the support of major mental health organizations, including Active Minds, the American Foundation for Suicide Prevention (AFSP), International Mental Health Research Organization (IMHRO), the Jed Foundation, Mental Health America (MHA), National Alliance on Mental Health (NAMI), NARSAD, National Institute of Mental Health (NIMH), and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Please visit for more information.

Saturday, July 2, 2011

SPOTLIGHT on Treatment Advocacy Center (TAC)

The Treatment Advocacy Center is a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illnesses. The Treatment Advocacy Center promotes laws, policies, and practices for the delivery of psychiatric care and supports the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses, such as schizophrenia and bipolar disorder.

The Treatment Advocacy Center is engaged in a wide-range of activities and projects aimed at increasing treatment for people with severe mental illnesses. Over the next twelve months key initiatives will focus on:

*Seeking to bring assisted outpatient treatment and other treatment reforms to several key states
*Implementing Laura's Law in California
*Expanding the Treatment Advocacy Helpline
*Building a larger and better equipped army of treatment advocates across the U.S.

For more information, please visit the organization's website at

Sunday, June 12, 2011

Faces and Voices of Recovery

Faces & Voices of Recovery is a national 501(c)(3) non-profit organization committed to organizing and mobilizing the millions of Americans in long-term recovery from addiction to alcohol and other drugs, our families, friends, and allies to speak with one voice. The organization is working to change public perceptions of recovery, promote effective public policy in Washington, D.C. and in all 50 states, and demonstrate that recovery is working for millions of Americans. It is our mission to bring the power and proof of recovery to everyone in the nation.

Faces & Voices of Recovery is a national network of over 20,000 individuals and
organizations joining together to speak out and support local, state, regional and national recovery advocacy by:
• Being a national rallying point for recovery advocates
• Linking advocates to organizing, policy, and research support
• Building advocacy skills through hands-on training and technical assistance
• Improving access to policymakers and the media

Organizational activities include:
• Creation of the first ever “Recovery Bill of Rights,” a declaration stating that all Americans have a right to be free from addiction and to build new lives. Part of this effort is a call for federal, state, and local officials to implement public and private policies to get individuals and their families the help they need
• The Online Advocacy Action Center which harnesses the power of the Web to keep
recovery advocates informed and make activism easier than ever
• A multi-faceted, one-stop recovery Web site with information for activists, families, and those in long-term recovery on how to get involved in their communities
• The Addiction Recovery Insurance Equity Campaign, working to end discrimination against people with addiction
• The Recovery Voices Count Campaign, an effort to register voters, educate candidates and get-out-the vote
• A bi-monthly advocacy eNewsletter and quarterly publication called Rising!
Faces & Voices of Recovery is supported in this effort by a growing membership, foundations, government agencies and the many friends of addiction recovery around the nation.

What Can You Do?
There are many ways that you can take action and be a face and a voice for recovery. The level of action that you take will depend on the stage of your recovery and your personal circumstances. If you don’t want to be public about your recovery, you can work as an advocate behind the scenes, providing financial and other support to our growing national movement. The important thing is, there’s something that you can do to support recovery today!

Speak out as a person in long-term recovery or as a family member. Use our Recovery Messaging or Power of Our Stories video to practice ways of talking about recovery and what it’s meant to you. Use our Advocacy with Anonymity brochure to learn how to tell your story without violating the traditions if you are in recovery using a 12-step program. Share your story with friends, neighbors, co-workers and policymakers.
Educate yourself and others about Faces & Voices’ campaigns and the issues that are important to the recovery community. We have advocacy tools for you to use for specific campaigns like sample letters to the editor. Use our Recovery is a Reality powerpoint and ask to talk to PTA, Rotary Club, inmates at your local jail, Medical Society or other group. Subscribe to our eNewsletter for electronic updates.
Hone your advocacy skills by participating in webinars and trainings. Faces & Voices and allied organizations host trainings that you can use to increase your effectiveness as an advocate. Educate your elected officials about pending issues. You can use our Online Advocacy Action Center to send emails to federal policymakers about national issues of importance to the recovery community. Invite your mayor, council member, state and federal elected officials to attend your events and activities.

Join a local, regional or state-wide recovery community organization. Coming together with others to speak with one voice as an organized constituency increases the effectiveness of your advocacy voice. If there isn’t an organized recovery community organization where you live, we can help you get one started!
Stay in touch with recovery advocates in your regional through Faces & Voices’ regional listservs. There’s a lot going on in communities around the country and we can learn from one another about new strategies and campaigns to get the word out about actions to take to support long-term recovery.

Information taken directly from the organization's website at

Saturday, May 28, 2011

Mental Health Month Blog Party

In honor of Mental Health month, the American Psychological Association hosted a Mental Health Blog Party on May 18, 2011 to spread the word on mental health. Visit for links to amazing and often hilarious posts on mental health issues.

Wednesday, April 13, 2011

SPOTLIGHT on Time to Change

In England, a collaborative effort has been launched by three major mental health charities - Mental Health Media, Mind, Rethink and will be evaluated by the Institute of Psychiatry at King's College in London. The effort is funded by the English public, through the National Lottery Fund and Comic Relief, who have made this vital work possible. Their mission is to inspire people to work together to end the discrimination surrounding mental health. The project is funded with £16m from the Big Lottery Fund and £2m from Comic Relief, and evaluated by the Institute of Psychiatry at King's College, London. The project features local community projects, a national high-profile campaign, a mass-participation physical activity week, legal test cases, training for student doctors and teacher, and a network of grassroots activists combating discrimination.

Time to Change is England’s biggest ever attempt to end stigma and discrimination and improve well-being. The program will measure their success by evaluating their impact on the experience people actually have of discrimination, with the aims of:
1.) Creating a 5% positive shift in public attitudes towards mental health problems
2.) Achieving a 5% reduction in discrimination by 2012
3.) Increasing the ability of 100,000 people with mental health problems to address discrimination
4.) Engaging over 250,000 people in physical activity
5.) Producing a powerful evidence base of what works

It will be interesting to follow this project and monitor its results. Stakeholders in the U.S. and other countries could potentially use such a model in the future for a major national public education campaign.

Please visit their channel at and visit the Time to Change website at

Saturday, March 12, 2011

'In The Rooms' online networking for people in recovery across the globe!

In The Rooms - an Online Social Networking Site for the Recovery Community

Join 'In The Rooms'- the webs newest and most comprehensive social networking site for the worldwide Recovery community. In The Rooms provides resources for people seeking help or treatment; for people in recovery; and for friends, family and allies of those in recovery. You can join online meetings and affinity groups; browse the library for articles; connect with other resources for Recovery; and take an active role in promoting recovery.
Join here:

Thursday, February 3, 2011


The Center for Mental Health Services' National GAINS Center was founded in 1995 and serves as a national focal point for gathering and disseminating information about effective services for people with co-occurring disorders involving mental health and substance abuse problems in contact with the criminal justice system. The GAINS Center operates under the auspices of the United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA). The TAPA (Technical Assistance and Policy Analysis) Center for Jail Diversion and the Center for Evidence-Based Programs in the Justice System, funded by the Center for Mental Health Services (CMHS) in 2001 and 2004 respectively, make up the National GAINS Center.

The GAINS Center's work focuses on expanding access to community based services for adults caught up in the criminal justice system and diagnosed with co-occurring mental illness and substance use disorders. Emphasizing the provision of consultation and technical assistance to communities, the Center aims to achieve integrated systems of mental health and substance abuse services.

To accomplish this, the GAINS Center has developed a comprehensive plan of information dissemination, knowledge application and technical assistance strategies to further the implementation of evidence-based programs in the justice system. The GAINS Center supports and engages in creative initiatives and collaboration with public and private organizations to effectively address the evolving needs of state and local planning and coordination.

Examples of the GAINS Center's work includes:

1.) Consumer Perspectives Exhibit, In Our Own Words: Our Experience with Mental Illness in the Criminal Justice System is a museum quality exhibit featuring consumers and peer specialists involved in the development and implementation of jail diversion programs, participants in jail diversion programs, participants in drug courts, and other individuals with histories of justice involvement. This exhibit has been displayed since 2008 in various locations around the country including the National CIT Training Conference in 2008. If you are interested in contributing to the exhibit or hosting the exhibit, please contact Latrease Moore at the National GAINS Center, (518) 439-7415 ext. 280 or

2.) CMHS Jail Diversion and Trauma Recovery Program: Priority to Veterans 2008
Combat veterans are returning from Iraq and Afghanistan with PTSD and other mental illnesses. Many of these veterans suffering with mental health issues won't be diagnosed and therefore will not receive treatment untreated, resulting in a arrest and incarceration. Communities struggle with providing adequate supports to ensure that these veterans successfully reintegrate back into community life. In an effort to counteract this, SAMHSA awarded six Jail Diversion and Trauma Recovery Program grants in the fall of 2008 to support local implementation and statewide expansion of trauma-informed jail diversion programs for people with post traumatic stress (PTSD) and other trauma-related disorders. Grants were awarded to organizations in Vermont, Georgia, Arizona and other states and the CMHS GAINS Center will provide support by assisting states with infrastructure development, offering aid in program design, action planning, and overcoming barriers among many other areas of technical assistance. For more information, please visit the GAINS Center website.

Saturday, January 15, 2011

Russia: An Overview of Modern Mental Health Challenges

Russia is a country of unimaginable distance, stretching 11 time zones from Europe to the Pacific Ocean, with a population of only 140 million. According to World Bank criteria, Russia is a lower middle income country with almost 100% literacy rates, yet the average life expectancy at birth is 65.94 years. Much of Russia’s population lives in poverty, victims of a huge disparity between rich and poor. The elderly, disabled, children, and people living with HIV bear much of the poverty burden with poor access to services and discrimination.

The proportion of health budget to GDP is 5.4%, but there are no budget allocations for mental health and there is no information on expenditures on mental health care. The Ministry of Health has a mental health policy, which was developed in 1992, focusing on promotion, prevention, treatment and rehabilitation. A national mental health program was developed in 1995 and a specific program came up with recommendations on structural reorganization of psychiatric care in 1997, but there were limited funds to implement the recommendations. There has been a reform process across the country, focusing on lowering the number of beds in psychiatric institutions and creating outpatient clinics. Funding is the biggest barrier to reform.

According to the WHO Mental Health Atlas, mental health is part of the Russian primary health care system and some primary care providers do receive mental health training. A social rehabilitation system exists and there are community care facilities in place, including rehabilitation units in industrial firms and residential homes for around 125,000. Day care facilities are available for 15,000 people and home care is provided in some cases. There are 11.5 total psychiatric beds per 10,000 populations, with 10.1 of those in psychiatric hospitals.

Although the economic situation has improved in the past, this has not reached the most vulnerable, those who do not have access to suitable medical care. And despite the Russian government’s increasing cash reserves, little investment in infrastructure (health or otherwise) has been initiated by the country’s leaders. The Russian people face health and mental health care challenges resulting from natural and manmade disasters, drug and alcohol abuse, street children, refugees, and the legacy of political psychiatry.

Natural and Manmade Disasters

Tragedies resulting from manmade and natural disasters produce victims in need of mental health care in every corner of the globe. Plane crashes, floods, forest fires, industrial accidents and acts of terrorism such as the Beslan school incident in 2004 are all examples of such disasters in Russia. The Russian Ministry of Emergency Situations (EMERCOM) oversees response to such disasters, but lacks a comprehensive strategy for carrying out mental health care in crisis situations. The International Federation of the Red Cross is working with the Russian Red Cross disaster management division to increase its capacity as related to integrating psychosocial support as a standard deployable component of disaster response. This program will be based on the experience gained in this field in the aftermath of the Beslan tragedy.

Drug and Alcohol Abuse
Russia also faces a serious illegal drug problem where several million people are believed to be drug users. HIV has spread rapidly among injection drug users in Russia since the early 1990s and more than 10 percent of injection drug users are believed to be living with HIV. A 2007 Human Rights Watch Reports characterized treatment offered at state drug treatment clinics as very poor, concluding that drug addicts are left virtually to their own devices in their battle with this serious disease. The growth of HIV and Tuberculosis is epidemic and Russia occupies the second place in Europe with regard to rising rates of HIV infection, much of which can be contributed to illegal drug use.

It could be argued that alcoholism has always been Russia’s biggest health problem and some studies indicate that 30% of its men and 15% of women are addicted to alcohol.In 2007 it was estimated that 40,000 die annually from alcoholism and that every fifth crime in the country is committed under the influence of alcohol. Soviet leaders recognized this, but efforts at prohibition failed. Addiction was viewed as a crime under Soviet rule and people could lose their jobs or apartments or be locked up in a psychiatric hospital if they sought treatment. Though there are programs to treat alcoholism, there is not really a prevalent “society of recovery” in Russia, although Alcoholics Anonymous is active in the country. AA first came to Russia in 1986 and has spread throughout the country with over 300 groups in 100 cities and towns at last count. Drug and alcohol abuse is a critical and pressing mental health disaster that needs more attention from the Russian government.

Street Children
Street children refers to children under age 18 for whom ‘the street’ (abandoned buildings, industrial wastelands) has become home and source of livelihood, and who are inadequately protected or supervised. Official statistics state that the number of homeless children is 700,000, but experts estimate the population of street children much higher in the realm of 1 to 3 million. A 2007 study found that 37% of street youth in Russia were infected with HIV.

This epidemic of homeless and diseased children is a crisis in Russia and outreach, prevention, access to care, and crisis intervention services need to be expanded to impact this tragedy. The non-profit organization, Doctors of the World, spearheads an effort to bring attention to the social, behavioral and medical factors contributing to this epidemic and are partnering with private foundations (Ford Foundation, MAC AIDS Fund), corporations (Johnson and Johnson), USAID, and local government and non-profit organizations to provide vital services to this population. More collaborative effort, capacity building, and funding are needed to truly make a difference in the lives of the majority of Russia’s street children.

There is also a crisis situation resulting from the war between Georgia and Russia in August 2008. Although most of the original 30,000 refugees have returned to South Ossetia in Georgia, many remain living with relatives and in hospitals in the Vladikavkaz area in Russia. Russia has specific mental health programs for refugees and disaster victims. These programs, like the one assisting refugees in need of treatment to minimize the psychological effects of the war, are carried put by EMERCOM. The Russian Red Cross and the International Federation have both contributed financially to this program focused mainly on psychosocial support and the International Committee of the Red Cross is coordinating the operation. However the operation is scheduled to end on February 28th, 2009 so the need may go unmet in the future.

Political Psychiatry – Past or Present?
During Soviet rule, psychiatry was used to treat and imprison healthy, sane people who spoke out against the government. Authorities used psychiatric hospitals as prisons and subjected patients to electric shock, electromagnetic torture, radiation torture, forced drugging that caused long lasting side effects. Such methods were employed to isolate political prisoners from the rest of society, discredit their ideas, and break them physically and mentally.
This practice supposedly ended with the dissolution of the Soviet Union, but there have been reports in this decade about alleged imprisonment of people "inconvenient" for Russian authorities in psychiatric institutions. Larisa Arap, a Russian writer who spoke out against mistreatment of children in psychiatric clinics, was forcibly confined at a psychiatric clinic in 2007. There have been many reported cases of political psychology and the International Helsinki Federation for Human Rights said in 2004 that people are being institutionalized in psychiatric hospitals unlawfully. “Not only did punitive psychiatry exist during the Soviet period, and not only does it exist today, but unfortunately there are no grounds to hope that it will disappear in the foreseeable future.”

There are approximately ten NGOs focusing on mental health advocacy, promotion, prevention and rehabilitation in Russia and religious organizations also provide social support. The Russian Orthodox Church is especially active in the drug abuse field and has several psychiatric hospitals in St. Petersburg. The Russian Red Cross is also very active in the mental health field. Of the six national priorities, two involve psychosocial components. The first goal involves the mitigation of the psychological consequences of disasters. The second goal is to increase the organization’s capacity to provide psychosocial support by expanding this component from disaster response to other areas involving health care and social inclusion.

Within this brief overview, it is easily demonstrated how dire the situation in Russia is with regards to mental health care. Mental health is intertwined with all aspects of physical health, as well as social and behavioral issues. Many sectors of vulnerable populations with urgent needs overlap one another. For example, there are street children abusing drugs and alcohol infected with HIV and/or Tuberculosis. By addressing mental health issues along with one of the critical health issues, it is possible that the other issues could be resolved with minimal effort.

Looking at mental health challenges in Russia like natural and man-made disasters, drug and alcohol abuse, street children, refugees and the legacy of political psychiatry, it is apparent that Russia, like most other countries, is suffering from the absence of a strategic and effective national mental health plan. Although some steps have been taken to reform the psychiatric system, funding and capacity have not been provided to do so. Many local and international NGOs are active in the Russian mental health community, but it will really take a concerted effort by the Russian government to make a meaningful and significant positive impact on the mental health of its citizens. It is time for the Russian government to invest not only in natural resources like oil and gas, but in their most precious resource – the Russian people.