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Israel is a multicultural society in a state of permanent change. The population, of about 6.5 million, comprises the following religious groupings: Jews (77.5%), Muslims (15.3%), Christians (2.1%), Druzes (1.7%) and others (3.4%). The organisation of and the approaches used by the country's health services have been determined by this sociocultural plurality, and also by a continuous influx of immigrants (among whom, 882 600 and 44 200 arrived from countries of the former USSR and Ethiopia, respectively, between 1990 and 2001), as well as by the precarious security situation (the country has seen several wars with its neighbours in addition to the long-standing conflict with the Palestinians). The patterns of care of the population reflect both Western psychiatry and traditional systems. Because of such complexity, the present brief overview is necessarily selective.
Despite all the internal and external criticisms of mental health services in Libya, they remain underdeveloped across the country. The World Health Organization has made efforts to improve the country's mental health services; however, until a stable government is formed, patients with mental illness will continue to be deprived of their basic needs.
Mexico is a culturally, socially and economically heterogeneous country, with a population of over 100 million. Although it is regarded as a country with a medium–high income according to World Bank criteria, inequality continues to be one of its main problems. In addition to this, the country is going through a difficult period. Large parts of the population face economic insecurity, as a result of which feelings of despair, fear and impotence are common. It is hardly surprising, then, that mental disorders should constitute a major public health problem: depression is the main cause of loss of healthy years of life (6.4% of the population suffer from it), while alcohol misuse is the 9th (2.5%) and schizophrenia the 10th (2.1%) most common health problem (González-Pier et al, 2006).
Few countries (if any) have experienced the abundance of material welfare Norway has had for the last decades. The report of the Organisation for Economic Co-operation and Development (OECD) for 2004 places Norway on the very top of the list of ‘best countries to live in’. One might therefore expect that mental disorders would not thrive in Norway, but this is not so.
Relative to its economic indicators, Sri Lanka has a high health status. The life expectancy in the year 2001 was 70.7 years for males and 75.4 years for females. Maternal and infant mortality rates have shown a downward trend over the past half century and now are around 2.3 per 10 000 live births and 16 per 1000 live births, respectively. These trends are mainly due to the high literacy rate and comparatively large investments made in health and social welfare.
Tajikistan, in Central Asia, gained its independence in 1991, with the break-up of the Soviet Union. There followed a period of civil war, 1992–97. In 2003, 64% of Tajikistan's population was poor, which was defined as living on less than US$2.15 per day at purchasing power parity by the UN Appeal for Tajikistan (2006). The Tajik healthcare budget appropriations decreased from 4.5% of gross domestic product in 1991 to 1.3% in 2005. The average annual rate of population growth is 2.19%. The estimated 7 320815 population of the country is mainly rural (73.5%) and about 38% of the country's population is under the age of 14. Life expectancy at birth is 62 years for males and 68 years for females. The infant mortality rate is 106.49 deaths per 1000 live births.
The Republic of Niger is a large, landlocked west African country. Around 80% of its vast land mass (1 300 000 km2) is in the Sahara Desert. Its neighbours are Mali, Algeria, Libya and Chad to the north, and Nigeria, Benin and Burkina Faso to the south. The country came under French rule in the 1890s and gained its independence in 1960, but development has been slowed by political instability, lack of natural resources and drought. In 1999, voters overwhelmingly approved a new constitution, allowing for multi-party elections, which were held later that year. An ongoing rebellion in the north makes access to much of the country difficult.
Uganda is a landlocked developing country in East Africa with an estimated population of 24.8 million people (2002 census). At independence (in 1962) Uganda was a very prosperous and stable country, with enviable medical services in the region. This, however, was destroyed by a tyrant military regime and the subsequent civil wars up to 1986, when the current government took over the reigns of power.
The Republic of Hungary is a landlocked country of 93000 km2 in central Europe; it is bordered by Austria, Slovakia, Ukraine, Romania, Serbia, Croatia and Slovenia. Its official language is Hungarian. Hungary joined the European Union (EU) in 2004. About 90% of the population of c. 10 million is ethnically Hungarian, with Roma comprising the largest minority population (6–8%). Currently classified as a middle-income country with a gross domestic product (GDP) of $191.7 billion (2007 figure), Hungary's total health spending accounted for 7.4% of GDP in 2007, less than the average of 8.9% among member states of the Organisation for Economic Co-operation and Development (OECD, 2009). The proportion of the total health budget for mental health is 5.1%, which is low when compared with, for instance, the UK (England and Wales 13.8%, Scotland 9.5%) (World Health Organization, 2008, p. 118, Fig. 8.1).
Laos (officially the Lao People's Democratic Republic) is a land-locked country in South East Asia, and one of the three former French colonies of Indochina. Since 1989, when it was opened to foreigners, there has been an influx of non-governmental organisations (NGOs) and tourists. From 1998 tourist numbers have increased every year, and Laos has become the ‘must see’ destination in a travel industry that craves the exotic. It has an old and rich culture with a diverse population. The climate is tropical, with a cool dry season and a hot wet season, when temperatures reach 38°C.
Modern mental healthcare in Poland has its foundations in the 19th century, when the country was subject to three different organisational and legal systems — of the Austrian, Prussian and Russian Empires. These differences prevailed even after the First World War. Professionals lobbying for a mental health act had no success. The Second World War left mental healthcare with significant losses among its professional groups. More than half of all Polish psychiatrists lost their lives; some of them were exterminated as Jews, some as prisoners of the Soviets. The Nazi occupation in Poland had dramatic consequences for people with a mental disturbance, as Action T4 turned into genocide on the Polish territory. The majority of psychiatric in-patients were killed. After the Second World War, the mental health system had to be rebuilt, almost from scratch. Major political changes in the country across the second part of the 20th century and revolutionary changes in mental healthcare around the world influenced psychiatric services. The purpose of this paper is to describe mental healthcare in Poland today.
Serbia is located on the Balkan peninsula, which served for centuries as a vulnerable crossroads between the East and the West. At the beginning of the 1990s, some of the republics of the former Yugoslavia, including Serbia, were involved in disastrous civil conflicts. In 2006 Serbia became a sovereign republic. At the 2002 census, its population was 7 498 000.
Singapore is a modern city state and the smallest nation (land area of 699 km2) in South East Asia. Its population of over 4 million is multiracial, with the Chinese (76.8%) constituting the majority of the population, followed by the Malays (13.9%) and the Indians (7.9%). The present health system is one that stresses individual responsibility, based on a system of compulsory medical saving accounts and on market mechanisms for the allocation of scarce healthcare resources. There are both public and private healthcare sectors. Since 1985, every public sector hospital has been ‘restructured’ — to grant some degree of autonomy in operational matters, with the intention of creating competition and financial discipline, although the government still retains 100% ownership of the hospitals.
The Korean peninsula is located between China and Japan. After the Second World War, the Republic of Korea was established in the southern half of the Korean peninsula. South Korea has a total area of 98 480 km2 and a population of 48 598 175 (July 2004 estimate). The per capita gross domestic product (GDP), in terms of purchasing power parity, is US$17 700 (2003 estimate) (Central Intelligence Agency, 2004). The illiteracy rate (among those aged over 15 years) is 1.9% (0.7% for males and 3% for females) (2003 estimate). Life expectancy at birth is 75.6 years (72.0 years for males and 79.5 years for females) and the infant mortality rate is 7.2 per 1000 births (2004 estimate). The unemployment rate is 3.4% (2003 estimate). The proportion of the population aged 65 and over is currently 8.7% (2004 estimate) (Korea National Statistics Office, 2003). Over 40% of the total Korean population (i.e. some 20 million) lives in Seoul and its vicinity. South Korea is highly urbanised and modernised. Besides central government, local government is based on seven metropolitan cities and nine provinces.
The Slovak Republic is a landlocked country in central Europe with a population of over 5 million. The Czech Republic and Austria lie to the west, Poland to the north, Ukraine to the east and Hungary to the south. The largest city is the capital, Bratislava; the second largest city is Košnice. Slovakia is a member of the European Union, the United Nations, the Organisation for Economic Cooperation and Development (OECD) and the World Trade Organization, among other international organisations. The majority of the inhabitants of Slovakia are ethnically Slovak (85.8%). Hungarians are the largest ethnic minority (9.5%). With a gross domestic product (GDP) of €63.3 billion in 2009, Slovakia is classified as a middle-income country. In that year total health expenditure represented 6.7% of GDP (Pažitny, 2008), 34% of which went on pharmaceuticals, the highest share among all OECD countries (World Health Organization, 2010).
The Republic of Mauritius is a group of islands in the south-west of the Indian Ocean, consisting of the main island of Mauritius, Rodrigues and several outer islands, situated 900 km to the east of Madagascar. It has a total land area of 2040 km2 and a population of around 1.2 million. Mauritius has a multiracial population whose origins can be traced mainly to Asia, Africa and Europe. English is the official language but French remains the most widely spoken, along with the local dialect, Creole, which is derived from French. Mauritius is classified as an upper middle income country in sub-Saharan Africa by the World Bank. It has a per capita gross domestic product (GDP) of US$13 200.
Sandwiched between India and China, Nepal is a small landlocked lower-middle-income country in South Asia. Once a peaceful country, it is striving to overcome the legacy of a 10-year Maoist rebellion, a royal massacre and continuing political chaos. Nepal has been in dispute with neighbouring Bhutan over the repatriation of hundreds of thousands of refugees in several camps in Nepal. In addition, the country experiences frequent natural disasters (floods and landslides) and faces several environmental challenges, including deforestation and a population explosion in southern Nepal.
Bosnia and Herzegovina (BH) is located on the western part of the Balkan Peninsula. It has an area of 51 210 km2 and a population of 3 972 000. According to the Dayton Agreement of November 1995, which ended the 1992-95 war, BH comprises two ‘entities’ - the Federation of Bosnia and Herzegovina (FBH) and the Republic of Srpska (RS) - and the District of Brcko. The administrative arrangements for the management and financing of mental health services reflect this. The FBH, with 2 325 018 residents, is a federation of 10 cantons, which have equal rights and responsibilities. The RS has 1 487 785 residents and, in contrast, a centralised administration. Brcko District has just under 80 000 residents.
Peru is a land of mixed cultures, multiple ethnic heritages and severe economic inequities. Its history goes back thousands of years, from accounts of the first inhabitants of the continent to the impressive Inca Empire, the rich Viceroyalty of Peru and the modern republic, which boasts one of the highest economic growth rates in South America. Yet, in spite of such complex cultural development, or perhaps because of it, 21st-century Peruvians have substantial difficulties establishing a national identity and recognising each other as members of the same community.
During the Edo period in Japan (1603–1867), people with mental illness were not excluded from society. Upon the introduction of European psychiatry around the 1870s, Japanese society became more discriminatory, however. In 1900 a primary law was introduced to regulate the custody of patients. In 1919 another law was approved to facilitate the establishment of public psychiatric hospitals. In 1950 the Mental Hygiene Law was enacted to prohibit home custody. However, these regulations did not assure quality of care or protect service users' rights. Also, after the Second World War, many private psychiatric hospitals were built, but this expansion of the sector was not well thought out or well coordinated. In Japan, the government regulates the private health sector only insofar as it sets standardised fees for treatments and carries out basic quality assurance.