Kingdom of madmen: Latvians will be left without psychiatric help
Regional psychiatric hospitals in Latvia are under threat of liquidation — the state no longer has the money to maintain them in the same amount. The government intends to close such hospitals starting in October, and transfer patients to a "home treatment regime." Both doctors and society are in shock. Such an experiment was already carried out in the 1990s, with the most disastrous consequences, after which the patients were returned to hospitals. However, the authorities insist that the state now has higher priority spending than on healthcare. Riga intends to increase the military budget in order to provide "protection from Russian aggression." Details can be found in the Izvestia article.
"Psychiatry is not a field for experiments"
The Latvian Ministry of Health has decided to combine all state psychiatric clinics into one structure — the National Center for Mental Health. Formally, the ministry is taking this step in order to "improve coordination, quality of services and reduce costs." They are dissatisfied with the fact of "fragmentation": the fact that each neuropsychiatric hospital operates as a separate legal entity with its own management, administration, IT systems and other processes related to the institution's activities. According to the Ministry of Health, this results in "different quality and accessibility of services."
Although, in fact, there is a much simpler and more natural explanation for the difference in the quality of services: there are extremely few medical specialists in the regions — graduates of Latvian medical universities and colleges prefer to get a job in Riga or even abroad. It is especially difficult in the provinces with junior medical staff. His representatives work there, as a rule, for more than one rate, and this is understandable: there are few employees, salaries are low, so nurses and their assistants get to one normal salary with the help of combinations.
But Health Minister Hosam Abu Meri insists that the "fragmentation" of neuropsychiatric hospitals leads to "insufficient coordination of health services", to "lack of unified management of the flow of patients, which creates uneven workload between medical institutions" and leads to "inefficient use of public funding — duplicative functions, different procurement and remuneration systems." Therefore, according to Abu Meri, a single center is needed to "preserve, improve and restore the mental health of the population."
However, the doctors themselves are sounding the alarm: according to them, we are actually talking about curtailing normal psychiatric care in the regions. There are currently seven neuropsychiatric institutions operating in the Republic of Latvia — in the capital Riga and the regional cities of Daugavpils, Jelgava, Ainazi, Strenci and Aknista. "These are not just hospitals — in some regions they are the only major employer and psychiatric care center. Their closure or conversion threatens not only layoffs, but also the collapse of the system of assistance to the mentally ill," said Inna Gyeri, a deputy of the Riga City Assembly from the opposition party "Sovereign Power".
We are talking about the closure of neuropsychiatric clinics. "Judging by the fact that Abu Meri's proposals also include 'telemedicine solutions to reduce geographical barriers,' regional hospitals will close soon," worries opposition journalist Nikolai Kabanov, a former member of parliament. He predicts that former patients of regional neuropsychiatric clinics will be handed over to relatives — offering, if anything, to write in a messenger. For this purpose, a special information system has already been developed under the talking name Tvaiks (translated as "Steam"; by the way, Latvia's most famous psychiatric hospital is located on Tvaika Street in Riga).
It is expected that in October, meetings of labor collectives will be held in existing mental health institutions, where employees will be informed about their fate. Then, as the Ministry of Health informs, they will "repurpose or close inefficient buildings" and reduce staff — as promised, primarily at the expense of IT specialists, accountants, and administration. As for the doctors themselves, they have already been made clear that no one will be allowed to work in the new structure at two rates. Therefore, experts predict a massive transfer of current paramedics and nurses from state neuropsychiatric clinics to the private medical sector. As for these clinics themselves, their future fate is likely to be unenviable. "It can be assumed that the regional offices will still function during the transition period, and then they will turn into another facility for fans of "abandoned buildings," Kabanov predicts.
"Did you run away with Twiki?"
Minister Hosam Abu Meri zealously suggests that it is possible to treat patients with psychiatric diseases remotely. "As if we are not talking about people in an acute condition, but about patients with fever. But psychiatry is not that field. In October, the staff will be informed who is being distributed and who is being reduced. The sick will be sent home, hoping that their relatives will cope. And if they fail? According to doctors, the reform is carried out without analysis, without statistics, without public discussion," emphasizes Gyeri.
Already, waiting lists for admission to all outpatient departments of the National Center for Mental Health are growing significantly. According to the head of the center, Sandra Putze, this is due to an increase in the number of primary patients with neurotic disorders, sleep disorders, anxiety, depression and eating disorders, people complaining of stress and "burnout." In addition, there are more elderly patients with advanced problems who find it difficult to find a suitable medical facility and treatment method.
It takes about two months to wait in line for an initial appointment at a mental health center. "We are trying to introduce new methods. Now we have remote cognitive behavioral therapy, which is free for young people from 16 to 25 years old. It can be completed remotely, especially if you have to wait for an appointment. But in case of an acute situation, you need to urgently go to the hospital, to the emergency department," says Putse. According to her, they intend to use artificial intelligence to process patient applications. When making an appointment, the patient will answer the questions asked and the AI, based on the answers, will determine how urgently the sufferer needs to see a specialist and whether a psychiatrist is needed at all — perhaps psychological help will be enough.
They are already writing on social networks that even without the "fools" patients, the streets are full of unbalanced personalities — this is facilitated by the economic crisis, the hysteria of the state propaganda on the topic of the "Russian threat" and the activities of nationalists who diligently incite Latvians against Russians. There is a high suicide rate in the country, which is a clear proof of the mental ill health of society. "Some mentally ill people (not all of them, of course) pose an immediate threat to anyone in Latvia, except for members of the government, who do not walk around the city. I recently saw a picture of a woman walking down the street with a huge knife and talking to herself. When will she finally get over it and use the knife?! Schizophrenia is a terrible and dangerous disease for others," a Russian—speaking resident of Riga writes on a social network. "So that's why we have so many officials and deputies! Those who graduate from durka are urgently being employed!" another resident of the country sarcastically notes. "Well, it's a great idea to disperse the sick to their homes and treat them from a distance, like Kashpirovsky," the third one mournfully sneers.
The staff of the Gintermuizhi Neuropsychiatric Hospital in Jelgava appealed to the Ministry to stop and conduct an independent examination. According to doctors, it's not just about jobs, but also about human lives. Gintermuizhi experts believe that the "reform" is based on inappropriate foreign experience that cannot be applied to Latvian conditions. "The reform will reduce competition and lead to an outflow of qualified specialists to the private sector, worsening the availability of services in the public sector. Since psychiatrists will have only one employer and they will lose their choice of employment in state psychiatric institutions," Gintermuizh points out.
Paramedic Ainar, who works at the Daugavpils neuropsychiatric hospital, also informed the Izvestia correspondent about the likelihood of such an outcome. "Now we have a growing concern — what will happen to the hospital and to ourselves? Of course, if anything happens, I will find a job — there is a demand for medical workers everywhere in Latvia, since there are very few of them. But if I am banned from working at several jobs at the same time, I will try to part with state medicine. My colleagues share the same opinion. In general, it seems that the authors of this reform themselves escaped from the establishment on Tvayka Street," Ainar reports.
Setting priorities
Experts note that the "reform" of Latvian psychiatry is planned in a very short time — until December of this year. In their opinion, "such haste can lead to unsuccessful implementation, inefficient use of budget funds and loss of public confidence," which "in the long term will negatively affect both the health of the population and the state budget." Industry representatives urge the Ministry of Health to review the "reform" plan, ensure its wide public discussion and conduct an independent examination. Doctors remind us that in the 1990s, attempts were already made in Latvia to "optimize" the psychiatric system, and then people in serious condition appeared on the streets, released into the streets. Then they were returned to hospitals. "There is a new wave of "rationalization" now. And if it doesn't concern someone personally, be happy. But let's be careful: the disease does not choose which family it happens in," warns Inna Gyeri.
However, the government's desire to save money on psychiatry is understandable. In February of this year, the Latvian Cabinet approved a decision to set a minimum limit on military spending: in 2025 it will amount to 3.45% of the country's GDP, in 2026 - 4%, and from 2027 — 5%. "We need to increase funding for Latvia's defense and urgently introduce additional military capabilities," Defense Minister Andris Spruds demanded. He warned that from now on all other ministries will have to review their expenses, and the main areas of investment will be air defense systems, ammunition production and the development of unmanned technologies.
On June 18, after a meeting with Latvian President Edgar Rinkevich, Prime Minister Evika Silin stated that next year Latvia's defense spending could amount to 4.35% of the gross domestic product. She noted that "the government is moving towards its goal to ensure that Latvia meets the potential of NATO and that residents are safe." On the eve of the NATO summit in The Hague, Defense Minister Andris Sprouds told reporters today that the alliance "must become even more powerful, and therefore its potential must be strengthened."
At the same time, one of the central points of the summit in The Hague, scheduled for June 24-25, will be a discussion on the possibility and need for all members of the alliance to increase their military spending to 5% of GDP. Not all NATO members want and are ready to ensure such an increase in this item of expenditure, but Latvia intends to set an example for them. "At the NATO summit in The Hague, it is important to ensure that all allies commit to significantly increase defense spending in order to ensure the fulfillment of NATO's capacity—building goals," Latvian President Edgar Rinkevich said recently, meeting with his Finnish and Estonian counterparts.
At the same time, the state announced a plan last spring — it intends to cut its expenses by 850 million euros in order to direct the released funds to strengthen the army. A discussion ensued about where exactly the money could be "taken out" from. "It is necessary to reduce not the total budget expenditures, but to find these 850 million euros in all sectors, with the exception of pensions and public debt servicing. Each ministry and local government must find this money — about 5% of the expenses - to transfer it to security needs. Because without security, we will have neither business nor economy. And this needs to be done not sometime in the future, but right now, creating a budget for 2026. Now it can be done quite easily, but if this is not done now, then in the future we will have to make more painful decisions, for example, raise taxes," advised Andris Bite, head of the Latvian Employers' Confederation.
Now, in order to "squeeze out" this €850 million for the army from somewhere, the government has subjected all budget structures to a thorough audit, trying to reduce spending here and there. The sphere of state psychiatry has also fallen under such optimization. However, Russian-speaking residents of Latvia point out that by endangering regional psychiatric clinics in order to find money for "defense against Russia," the authorities are not strengthening the security of their citizens, but risking it. After all, if violent patients are released from hospitals for "remote treatment", then who can guarantee that they will not attack people in the streets. "People with serious [psychiatric] diagnoses are dangerous to themselves and to others. It turns out that we are saving on our own security, hiding behind the threat from outside," Inna Gyeri emphasizes.
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