Demografiniai nuostoliai dėl moterų savižudybių Lietuvoje 2007–2020 metais: socialinė diferenciacija ir iššūkiai psichikos sveikatos politikai

In many countries of the world, including Lithuania, suicide rates for men are several times higher than for women. Therefore, the phenomenon of men’s suicide is receiving a lot of attention in public, scientific, and political discourses. In contrast, much less attention is paid to tackling women’s suicides and women’s mental health problems. Lithuania has been among the countries with the highest suicide rates for both men and women in the world for several decades, but research on the social and demographic aspects of women’s suicide in Lithuania is lacking. This paper aims to examine the demographic losses that Lithuania suffers from women suicides and assess the socio-demographic differentiation of these losses. The empirical part of the study was based on the calculation of years of life lost methodology. The years of life lost method is acknowledged as an accurate measure for assessing the impact of specific causes of death on premature mortality. Data sources for this study were the World Health Organization, Institute of Hygiene, and Human Mortality Database. The results of our study show that the number of years of lives lost due to women’s suicide decreased statistically significantly from 376 [321; 431] in 2007 to 287 [238; 335] in 2020. In Lithuania, the total number of women suicide was the highest among the 80+ year age group, however, the number of years of life lost due to suicide was the highest among the 30-39 year age group. The change in women’s suicide rates was inconsistent and for women, the decline in demographic loss due to suicide was twice as slow as for men. Nevertheless, the number of years of lives lost due to women’s suicide was about 5 times smaller than that of men in 2020. In Lithuania, high rates of women’s suicide reflect the poor state of women’s mental health, which poses challenges to the country’s mental health policy and sustainable demographic development.ietuva jau kelis dešimtmečius patenka tarp šalių, kurių savižudybių rodikliai yra didžiausi pasaulyje, tačiau tyrimų, kuriuose būtų nagrinėjami socialiniai ir demografiniai moterų savižudybių aspektai, Lietuvoje trūksta. Šio straipsnio tikslas – apskaičiuoti demografinius nuostolius, kuriuos patiria Lietuva dėl moterų savižudybių, ir įvertinti šių nuostolių socialinę ir demografinę diferenciaciją. Empirinė tyrimo dalis atlikta naudojant prarastų gyvenimo metų skaičiavimo metodiką. Tyrimo duomenų šaltiniai: Pasaulio sveikatos organizacija, Higienos institutas ir Human Mortality Database. Tyrimo rezultatai rodo, kad nuo 2007 iki 2020 metų prarastų potencialių gyvenimo metų skaičius Lietuvoje statistiškai reikšmingai sumažėjo nuo 376 [321; 431] iki 287 [238; 335], tačiau moterų savižudybių lygio kaita buvo nenuosekli, o demografinių nuostolių dėl savižudybių mažėjimas buvo beveik perpus lėtesnis negu vyrų

Psichikos negalią turinčių asmenų globa Lietuvoje: priklausomybė nuo paveldėtos paslaugų teikimo kultūros

Vilniaus universiteto Medicinos fakulteto Psichiatrijos klinikaVasaros g. 5, tel. (+370 5) 261 10 43. El. paštas: [email protected] universiteto Filosofijos fakulteto Socialinio darbo katedraUniversiteto g. 9/1, Tel. (+370 5) 266 76 10. El. paštas: [email protected]  Straipsnyje nagrinėjama sutrikusios psichikos ir sutrikusio intelekto asmenų globa didelėse uždarose stacionariose globos įstaigose. Iki Sovietų Sąjungos žlugimo šios įstaigos ne tik globojo, bet ir izoliavo sutrikusios psichikos ir sutrikusio intelekto individus. Tvirtas šių įstaigų pozicijas to meto socialinės apsaugos sistemoje lėmė ideologinės priežastys, dominuojantis defektologijos mokslas, sukurta materialinė ir teisinė bazė, neigiamas visuomenės nusistatymas sutrikusios psichikos ir sutrikusio intelekto asmenų atžvilgiu. Žlugus Sovietų Sąjungai, stacionarios globos sistema pasirodė esanti ypač atspari permainoms – ji ne tik atsilaikė prieš bandymus veiksmingai transformuoti, bet ir sulaukė investicijų iš Europos Sąjungos fondų. Atkūrus Nepriklausomybę įvykusios permainos – darbuotojų mokymai, pastatų rekonstrukcija, paslaugų įvairovės didinimas – neatnešė institucinės kultūros, atskirties tradicijos permainų ir tik sustiprino stacionarios globos institucijų padėtį.Tai sudarė prielaidas Lietuvoje susiformuoti unikaliam sutrikusios psichikos ir sutrikusio intelekto asmenų globos būdui, kurį galima įvardyti kaip visuomenės ir valstybės raidai nepalankią ydingo sovietinio paveldo ir atsirinktų ES paramos bei vertybių kombinaciją.Pagrindiniai žodžiai: stacionari globa, psichikos ir intelekto sutrikimai, Europos Sąjunga, ideologija.Care for persons with memental disability: dependency on inherited culture of srevicesDainius Pūras, Eglė Šumskienė SummaryGoal of this article is to identify main obstacles while transforming Lithuanian system of residential care for persons with mental and intellectual disabilities from repressive and isolating Soviet tradition to individualised community care. During the Soviet times the goal of large residential institutions was to take physical care after individuals with mental and intellectual disabilities as well as to isolate them from the rest of the society. These institutions were deeply anchored in the Soviet system of social assistance, based on the principles of defectology and stigmatizing attitudes towards persons with mental health problems. After collapse of the Soviet Union this system appeared to be eminently resistant to reforms: it withstood attempts of transformation and even managed to receive investments from the European Union structural funds thus strengthening the positions of large residential institutions over modern community care. More than two decades of investments in training of staff, reconstruction of buildings, modernisation of services and other components of mental health services in Lithuania have not resulted in the change of paradigm, as institutional culture and tradition of exclusion remains still very strong.Thus, current system of care for persons with mental and intellectual disabilities in Lithuania can be defined as a combination of strong effects of former Soviet system and selectively chosen components of modern mental health policy and services.Key words: residential care, intellectual and mental disabilities, European Union, ideology

Vaikų, kurių tėvai globojami psichoneurologiniuose pensionatuose, teisės

This research is one of the components of the project funded by European Commission "Child and Adolescent Mental Health in Enlarged European Union: Development of Effective Policies and Practices" (CAMHEE). Survey of the situation that occur in the families in which parents are placed into psychiatric residential homes due to mental illness, showed that development and implementation of effective parenting programs (as well as other community-based services for families at risk) might become an effective alternative to currently prevailing stigmatizing and paternalistic approach, including the concept of "bad" (incompetent) parents and their institutionalization. Based on the review and analysis of the situations in residential psychiatric care homes, one could observe that relations of the family members with residents of care homes and dynamics of these relations are greatly influenced by specifics of Lithuanian mental health and social care systems, historically developed stereotypes, public attitudes to mentally ill persons and information which is communicated to general public. It should be noted that the tradition dating back to Soviet-era ideology - that mentally ill persons need to be separated from family, community and society, is still strong.Šis tyrimas yra viena iš Europos Komisijos finansuoto projekto „Vaikų ir paauglių psichikos sveikata išsiplėtusioje Europos Sąjungoje: efektyvios politikos ir praktikos kūrimas“ sudėtinių dalių. Šeimų, kurių nariai tėvai, turintys psichikos ligą, yra apgyvendinami stacionarios globos namuose, apklausa parodė, kad veiksmingų tėvystės programų (kaip ir kitos bendruomeninės paslaugos socialinės rizikos šeimoms) gali tapti veiksminga alternatyvia priemone dabar dominuojančiam stigmatizuojančiam ir paternalistiniam požiūriui. Remiantis situacijos stacionarios globos įstaigose apžvalga ir analize, pažymėtina, kad didelę įtaką jose gyvenančių asmenų likimui, jų santykiams su šeimos nariais, šiems santykiams išsaugoti, šeimos nariams bendrauti daro tiek Lietuvoje veikiančios psichikos sveikatos ir socialines apsaugos sistemos, tiek praeityje susiformavę stereotipai, nuomonė apie stacionarios globos įstaigas bei jų gyventojus, tiek visuomenei pateikiamos informacijos pobūdis. Pažymėtina, kad kai kur vis dar gajus sovietinių laikų ideologijos principas, jog asmuo, turintis proto negalią, turi būti atskirtas nuo šeimos, bendruomenės, visuomenės

The right to health must guide responses to COVID-19

Human rights scrutiny in the COVID-19 pandemic has largely focused on limitations of individual freedoms to protect public health, yet it is essential to look at the broader relevance of realising human rights to promote public health in the COVID-19 response

Media and political agenda setting: the case of mental health policy in Lithuania

Media has a very specific role in forming agenda of mental health policy. In their reports, journalists directly question systemic issues, trajectories of the mental health policy and respective legislation. Media also acts as a mediator between citizens and politicians rendering understanding to the latter that their electorate is scared and supports increasing means of guardianship and control. Finally, media can ignore important outcomes of mental health policy. This strategy gives an account that mental health issues are of low importance and public scrutiny is not needed. The data for the context and content analysis derived from two main sources: online news webpage (time frame covers year 2000–2011, 1353 cases) and Parliament records of official proceedings (year 1990–2010, 567 cases). Media discourse proved to have a significant influence on political agenda, since in most cases political discussions on the topic of mental health were referred to media sources. Research data suggests that media coverage as well as the political debates on mental health are characterised by general stagnation, superficial understanding and stereotypical attitudes. This overall pattern was breached during the period of 2004–2006 which was marked by significant international events, namely the EU entrance and adoption of the Mental Health Declaration for Europe. During this period the policy of mental health received considerable attention in the media, decreased media articles related to criminalisation of mental health. The research identified major players that were able to break the vicious circle in the media and political discourse around the marginalised and stigmatised subject

Lietuviškas SDQ – standartizuotas mokyklinio amžiaus vaikų „Galių ir sunkumų klausimynas“

Strengths and Difficulties Questionnaire (SDQ) developed by R. Goodman (1997) has been widely used in epidemiological studies throughout the world as a screening measure for mental health in children and adolescents. The SDQ comprises 25 items plus supplement on impact of the difficulties for the child and family. There are 5 subscales: Prosocial behaviour, Hyperactivity, Emotional symptoms, Conduct problems and Peers problems, the last four adding up to the Total Difficulties score. The design of the SDQ with both strength’ and difficulties’ items supposedly increases acceptability of the instrument on behalf of informants and make questionnaire especially suitable for studies of general population were the majority of children are healthy. Three SDQ versions (parent, teacher and self-report) were translated into Lithuanian language and psychometric properties of those Lithuanian SDQ versions are presented and analysed in this article. Representative sample of children aged 7–16 years (n = 2626) was randomly selected from 14 big town, 9 town and 20 country schools. 2447 parent versions, 2613 teacher versions and 1612 self-report versions were completed. SDQ self-report version was administered only to 11–16 year olds. Data analysis based on method of internal consistency, item inter- and intra-scale correlation, including exploratory and confirmatory factor analysis, comparison of data in clinical and non-clinical groups (62 children) and inter-rater correlations showed adequate psychometric properties of the Lithuanian SDQ. Cronbach’s alpha for the total difficulties score was in three informant reports 0.72–0.85, while the range in different subscales was 0.34–0.86. As raters, the teachers had the best internal consistency. The lowest level of alpha was in self-report version. Correlation analysis confirmed the postulated structure of the SDQ in all three versions, while the results of factor analysis had some exceptions to it. Lithuanian cut-off points were similar of those found in British sample. Applying Cohen’s criteria for the effect size between British and Lithuanian samples all the SDQ subscales felt in a low area except prosocial behaviour, emotional symptoms and total difficulties subscales in parents reports and prosocial subscale in self-report which felt in the moderate area. The present study gives further evidence of usefulness of the Lithuanian SDQ as screening instrument for research and clinical purposes.R. Goodmano (1997) sukurtas SDQ (Strenghts and Difficulties Questionnaire, toliau Galių ir sunkumų klausimynas) plačiai taikomas pasaulyje vaikų emocinių simptomų, elgesio problemų, hiperaktyvumo, santykių su bendraamžiais problemų ir socialumo formalizuotai atrankai, išverstas į daugelį pasaulio kalbų. Šiame tyrime pristatome lietuviškų SDQ tėvų, mokytojų ir vaikų versijų psichometrines charakteristikas, remdamiesi 2003 metais atlikto reprezentacinės 7–16 metų Lietuvos vaikų imties (n = 2626) tyrimo rezultatais. Duomenų analizė taikant vidinio suderinamumo metodą, koreliacinę ir faktorių analizę bei klinikinės ir neklinikinės grupės rezultatų palyginimą parodė pakankamą visų trijų lietuviškų versijų patikimumą ir validumą: nustatyta, kad geriausios psichometrinės charakteristikos yra mokytojų versijos, o prasčiausios – vaikų versijos. Lietuviškųjų SDQ versijų ribos įverčiai panašūs į britų. Skiriasi tik britų ir lietuvių tėvų atsakymai apie vaikų emocinius simptomus ir bendrus sunkumus bei socialų elgesį. Pastarąjį skirtumą patvirtina ir pačių vaikų atsakymai. Straipsnyje pristatomi rezultatai leidžia teigti, kad lietuviškas SDQ versijas galima naudoti psichologiniam įvertinimui mokslinio tyrimo ir formalizuotos atrankos tikslais

Global Health in the Age of COVID-19: Responsive Health Systems Through a Right to Health Fund.

We propose that a Right to Health Capacity Fund (R2HCF) be created as a central institution of a reimagined global health architecture developed in the aftermath of the COVID-19 pandemic. Such a fund would help ensure the strong health systems required to prevent disease outbreaks from becoming devastating global pandemics, while ensuring genuinely universal health coverage that would encompass even the most marginalized populations. The R2HCF's mission would be to promote inclusive participation, equality, and accountability for advancing the right to health. The fund would focus its resources on civil society organizations, supporting their advocacy and strengthening mechanisms for accountability and participation. We propose an initial annual target of US$500 million for the fund, adjusted based on needs assessments. Such a financing level would be both achievable and transformative, given the limited right to health funding presently and the demonstrated potential of right to health initiatives to strengthen health systems and meet the health needs of marginalized populations-and enable these populations to be treated with dignity. We call for a civil society-led multi-stakeholder process to further conceptualize, and then launch, an R2HCF, helping create a world where, whether during a health emergency or in ordinary times, no one is left behind