MENTAL HEALTH CARE REFORM IN LITHUANIA: THE MAIN TRENDS AND FINANCING Ona Davidonienė State Mental Health Centre

MENTAL DISORDERS IN LITHUANIA (per 100 000) Data of State Mental Health Centre of Lithuania

SUICIDES IN LITHUANIA 1930-1940 AND 1986-2001 (per 100 000)

SUICIDES IN URBAN AND RURAL AREAS IN LITHUANIA 1930-1940 AND 1980-2001 (per 100 000)

GROWTH OF DRUG ADDICTION MORBIDITY IN LITHUANIA (per 100 000) Data of State Mental Health Centre of Lithuania

MENTAL HEALTH CARE REFORM Pre-reform state Reform target In-patient treatment In-patient treatment Reform Outpatient treatment Outpatient treatment

MENTAL HEALTH ACTS AND PROGRAMMES Mental Health Care Act (1995) (http://www.vpsc.lt). (Amendments made in 2001). Narcotic and Psychotropic Substances Control Act (1998) (http://www.vpsc.lt). State Programme on Mental Disease Prevention (1999) (http://www.vpsc.lt). National Drug Control and Drug Use Prevention Programme (approved in 1999). State Alcohol Control Programme (approved in 1999).

MENTAL HEALTH CENTRES STAFF IN LITHUANIA 1 January, 1999 1 January, 2000 1 January, 2001 1 January, 2002 49 55 59 61 Specialists for mental health Psychiatrists 102,25 105,5 117,25 123,0 Child psychiatrists 26,25 36,0 39,0 40,36 Nurses 125,75 147,5 156,25 165,15 Social workers 14,5 65,25 98,0 108,5 Psychologists 3,0 26,5 57,25 66,6 Specialists for addictions 36,75 30,5 34,75 34,25 22,25 44,5 39,75 40,85 6,5 20,5 23,0 25,8 2,5 7,0 10,25 12,35 Data of State Mental Health Centre of Lithuania

PRESCRIPTION COVERAGE OF PSYCHOTROPICS IN LITHUANIA Schizophrenia, schizoaffective disorders (F20; F25) Amisulpride Clozapine Olanzapine Risperidone Flupentixol Fluphenazine Haloperidol Trifluoperazine Zuclopenthixol Lithium Trihexyphenidylum

80 % coverage Schizotypal and delusional disorders (F21 - F29) Amisulpride Olanzapine Risperidone Haloperidol Fluphenazine Trifluoperazine Zuclopenthixol Flupentixol Citalopran Fluvoxamine Lithium Amitriptyline Paroxetine Trihexyphenidylum Fluoxetine Sertraline Moderate and severe affective disorders (F30.2; F31.1-F31.5; F32.1-F32.3; F33.1-F33.3) Citalopran Fluvoxamine Fluoxetine Amitriptyline Paroxetine Sertraline Haloperidol Trifluoperazine Lithium Mirtazapine Reboxetine Trihexyphenidylum Dementia (F00 (G30); F01-F03) Amitriptyline Donepezil Melperone Haloperidol Trifluoperazine Lithium Memantine Tiapridal Trihexyphenidylum

50 % coverage Organic psychotic disorders (F06) Citalopram Fluoxetine Fluphenazine Fluvoxamine Haloperidol Mirtazapine Paroxetine Trifluoperazine Sertraline Lithium Trihexyphenidylum

EUROPE (NORTH AND SOUTH) – N5A ANTIPSYCHOTIC MARKET Source : IMS Health WinEI Q1/02 (Actual Exchange Rates) Countries and Panels included :- UK; HOLLAND; SWEDEN; POLAND; DENMARK; IRELAND; CZECH REP; GERMANY; FRANCE; SPAIN; ITALY; SWITZERLAND; AUSTRIA; GREECE; PORTUGAL; BELGIUM

NORTH AMERICA – N5A ANTIPSYCHOTIC MARKET Source : IMS Health WinEI Q1/02 (Actual Exchange Rates) Countries and Panels included :- USA; CANADA

LITHUANIA – N5A ANTIPSYCHOTIC MARKET

ATYPICAL ANTIPSYCHOTICS PRESCRIPTION GROWTH OVER TIME *Market Definition = N5A1 Atypical Antipsychotics Markets = USA, UK, Canada, Netherlands, Germany, Italy, Japan Source : IMS Health MIDAS Dataview MAT Q1 2002

PRESCRIPTION MARKET SHARE VS. MAIN COMPETITORS *Market Definition = N5A1 Atypical Antipsychotics Source : IMS Health MIDAS Dataview MAT Q1 2002

PRESCRIPTION COVERAGE EXPENSES IN LITHUANIA

IN-PATIENT PSYCHIATRIC TREATMENT IN LITHUANIA Data of State Mental Health Centre of Lithuania

TOTAL NUMBER OF BEDS IN MENTAL HOSPITALS IN LITHUANIA Data of State Mental Health Centre of Lithuania

NUMBER OF DISABLED DUE TO SCHIZOPHRENIA AND MENTAL RETARDATION IN LITHUANIA Data of State Mental Health Centre