7.5 Mental health
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National strategy(ies)
In 2007 the Parliament of Republic of Lithuania approved the National Mental Health Strategy. This national strategy covers a wide range of principles, priorities and recommendations. Sections (see 30.5; 30.12) focus specially on the youth and children: to improve the protection and care of children and young people with mental health through targeted preventive, treatment and rehabilitation programs aimed at increasing the resilience of children, families and communities and preventing the negative consequences of socialization. In the public health programs, the most attention should be paid to addressing the most pressing problems currently under way - prevention of children's mental health, emotional and social development disorders, proper education of parents for the education of parents, prevention of suicide, addiction and violence, and the resolution of youth health problems. The main principles of the strategy are stated as follows: 1) a special focus on human rights of mentally disabled persons; 2) modern services which meet the needs of the patients; 3) a balance within a development of a bio-psycho-social model; 4) support of principles of autonomy and participation; 5) cases of common mental health disorders should be managed by primary and other non-specialist care sectors; 6) mental health promotion and prevention of mental disorders should become an integrated part in the implementation of general health, education and social welfare policies; 7) strengthening of the role of patients and non-governmental sector. The National Mental Health Strategy acknowledges that mental health promotion and prevention of mental disorders is an integrated part in the implementation of general health, education and social welfare policies. A set of priority programmes are identified, which include programmes aimed at preventing suicides, alcoholism, drug addiction and smoking; programmes that promote mental health of children, youth and old people and programmes aimed at promotion of mental health in workplaces.
Other policy documents related to the National Mental Health Strategy include the Lithuanian health strategy for 2014-2025, which was updated in 2019 focusing on the strengthening mental health, especially suicide prevention, and children's health education. The Ministry of Health proposed to adjust the strategy, taking into account the Covid-19 pandemic and the provisions of international strategic documents. The improvements were aimed at addressing mental health problems with full capacity, anticipating tasks and ways of solving them in a complex manner. The program has been supplemented with provisions on the strengthening of psycho-emotional health and the prevention of suicides. It is planned to increase the availability of provided psychological and psychiatric assistance services, and to expand the implementation of psychological assistance.
Improving the mental health of young people
In 2022 the Ministry of Education, Science and Sports initiated the Mental Health Ambassador Program. This initiative will aim to empower young people who have experienced or are experiencing mental health difficulties, to become ambassadors for mental health in their communities and share their experiences, thus reducing social distance and destroying myths established in society.
After completing state-funded training Mental Health Ambassadors will be responsible organizing various events where they will share their experiences, providing the necessary resources and other necessary support. Representatives of non-governmental organizations that unite various groups of society, who have experience in conducting various trainings and organizing events and who want to contribute to reducing the stigma of mental health can become coordinators of mental health ambassadors.
Youth mental health topics have been included into the informal education Life Skills General Program of the Ministry of Education, Science and Sports, which will be started in 2023. The life skills program is aimed at students in grades 1-10. It will integrate - health and sexuality education, human safety, prevention of bullying, violence, drugs, alcohol, social-emotional education.
Pagalba sau is a national mental health website that provides a one-stop shop for up-to-date and reliable information about emotional health and affordable psychological support. The project is implemented by the Ministry of Health in cooperation with experts in their fields. The campaign started in 2022 with the aim of introducing as many young people, their parents, teachers or other adults as possible to different mental health topics. During the campaign young people will learn more about different mental health risk factors, get practical and actionable advice, and adults will gain valuable insights to help them deal with the day-to-day challenges of youth mental health. The platform provides comprehensive and reliable information about mental health difficulties, their recognition and free available help and services. It has also created a separate section for young people, highlighting the most relevant topics for them.
Lithuania is one of the few EU countries where a Plan to Reduce the Effects of COVID-19 on Mental Health has been approved in 2021, but, taking into account the existing mental health services accessibility gaps, more precise planning of funding for these activities and a wider range of measures for children and young people are needed.
In 2020 the Study on Youth Mental Health was carried out which showed there is a need for young persons' support system to ensure the continuity of support services for young people and their mental health monitoring and coordinating the existing network of organizations providing assistance to the individual. There is a need for professionals whose field of activity is focused specifically on youth mental health problems. The complexity of the system and the diversity of functions involved in tackling individual mental health problems among young people might also hinder the effective support to young persons.
Negative attitudes towards people with mental health ailments prevail (48.2% of the population would not want to live in the neighborhood of a person with a mental disability, and 45.2% would not want to work together). Young people avoid solving their mental health difficulties or topics related to personal mental health well-being. The study also reported that more attention is paid in Lithuania to the negative consequences of mental health (intervention), but not the causes that arise from the young person's early childhood, family, school environment etc. Particularly little attention is paid to early prevention - early parenthood education for young families, mother’s well-being during and after pregnancy, pre-school strengthening the resilience of children to mental health. Service barriers include limited access to the services a) lack of specialists (child psychiatrists, psychologists); there is no mechanisms to ensure that young people have access to quality service (sufficient number of consultations to achieve change; highly qualified specialist (eg psychotherapist) services are too expensive for young people, etc.); b) telephone support (emotional support) or e-mail. measures insufficient in emergencies (e.g., the need for a youth line increased significantly during a pandemic). Young people fear stigma related to mental health, bullying, distrust psychologist, social pedagogue. Young people do not have the ability to (i) recognize mental health problems and become aware of them and (ii) consult appropriate professionals. The general education schools do not always have the conditions to ensure the confidentiality of the visits to a psychologist. Legal restrictions also exist - a young person under 16 years of age cannot apply to a psychologist without parental consent.
Reforms aim to bring mental health care closer to communities through the establishment of mental health care centres within municipalities and the creation of an effective community-level network of social psychiatric structures, with NGOs included in service provision. The implementation of the reforms raises many challenges, however, particularly in relation to the younger population. There are no reliable statistics on the young population prevalence of mental and behavioural disorders in Lithuania because no epidemiological surveys have been carried out among the young or adult populations. Data collected by the State Mental Health Centre are only available on cases registered by the state mental health institutions.
Establishment of the Suicide prevention bureau in 2015, as a state institution for in-depth analysis of the suicide situation and root causes, as well as for planning and coordination of complex measures by involving different sectors and social partners in suicide prevention and postvention, is very important step forward in field.
Most important preventive mental health programmes for young people are implemented with the involvement of NGOs. Lithuania has been participating since 1993 in the European network of health promoting schools (ENHPS). Wide spectrum of mental health programmes are offered for teachers and other who work with young people.
Campaigns such as “Childline” and “Stop bullying” are good practice examples of successful initiatives. They aim to create safer school environments for children and promote friendly and respectful communication that does not involve humiliation and bullying. Other projects like “Teenagers in action” are aimed at encouraging involvement of youth volunteers to provide crisis interventions and education for peers. “One-day centres against risk behaviour” have been set up to reach the teenagers at greatest risk of self-destructive behaviour. There is no system of state funding, however, to guarantee sustainability of these preventive programmes.