Health system factors impacting on delivery of mental health services in Russia: Multi-methods study

ObjectiveTo evaluate how the regulatory environment and health system organisation, financing and provider payment systems influence the delivery of mental health services in the Sverdlovsk region of the Russian Federation.MethodsA multi-methods study was conducted including analysis of routine data and key informant interviews supplemented by analysis of published literature, legal and regulatory documents, ministerial orders and reports.ResultsMental health care services are still largely provided in hospitals, although the need for more community-based and rehabilitation services is widely recognised. Resource allocation and provider payment systems remain largely unchanged from Soviet times and favour large inpatient institutions, creating incentives for hospitals to maintain a large number of beds and staff. Community-based social services and human resources remain limited, especially in the areas of social work, housing support and vocational rehabilitation, but co-operation across sectors at local level is growing.ConclusionIn Russia, the pace of reform in the mental health system will be helped if financial resource allocation mechanisms and provider payment systems are also reformed, so that resources follow individuals regardless of where they are treated. Such major health system shifts can only be achieved through changes at the Federal level and require major political will. Additional transitional funding is also required to help develop the necessary alternative community-based services. The nature of mental health disorders mean that this is not a problem faced within the health system alone, greater attention needs to be placed also on how to maximise the cross sector benefits especially with the social protection and employment sectors.