Challenges in mental health policy
and practice in Turkey
Prof. Dr. Mehtap Tatar
Head of Department of Health Care Management
Faculty of Economics and Administrative Sciences
Hacettepe University, Ankara, Turkey
London, 27 September 2007
MHEEN is supported by the European Commission, Directorate General for Health and Consumer
Protection
Contents
Turkish health care system and mental health
care
Mental health policy: Challenges
Mental health economics and Turkey
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Demographic and economic indicators
1995
2000
2002
2004
2005
61,763
67,420
69,388
71,332
72,005
Population aged 0-14
(in % of total)
32.9
30.0
29.5
28.8
29.2
Life expectancy at
birth, total
67.9
70.5
70.8
71.2
71.4
GDP / capita in PPP
5,561
6,814
6,550
7,529
8,141
Total population
(thousands)
8.0
6.1
3.1
9.6
8.3
THE in % of GDP
3.41
6.6
7.4
7.7
7.6
Public HE in % of THE
70.3
62.9
70.4
72.1
71.4
Growth rate 1995-2005
4
513
583
Turkey
Mexico
1.074
777
744
Poland
Korea
Slovakya
1.298
1.269
Hungary
Pertugal
Check Rep
1.886
1.835
1.797
Spain
Finland
G reece
New Zeland
2.139
2.118
2.011
Japan (2002)
2.302
2.258
2.231
Italy
Austria
UK (2002)
2.699
2.451
2.394
Australia (2002)
Ireland
Sw eden
OECD Average
2.827
2.763
2.703
Belgium
Denm ark
2.996
2.903
France
3.001
2.976
Holland
Canada
Germany
3.781
3.705
3.115
Switzerland
Luksemburg
Đceland
3.807
USA
Norway
5.635
Per Capita Healthcare Spending (2003, US$ PPP)
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General
Government
Ministry of
Health
General
directorates and
other ministerial
departments
81 Provincial
health
directorates
Hospitals
Social
Security
Organizations:
SSK
GERF
Bağ-Kur
Civil servants
(Central
budget)
PHC Units
Green Card
Scheme
Hospitals
Other Public
PHC Units
Universities
Hospitals
Private Hospitals
financial
hierarchical
Out of Pocket
Payments
Pharmacies
Private
Owners
Private
Laboratories and
diagnostic centers
Private insurance
Private physician
offices
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Burden of Mental Diseases (2003)
Percentage Distribution of the Diseases
Causing YLD
Unipolar Depressive
Disorders
8.7
Osteoarthritis
6.5
Iron-deficiency Anemia
4.1
Percentage distributions of Main Disease
Groups by DALY
Cardiovascular
19.3
Neuropsychiatric
13.3
Infections excluding HIV
11.8
Injuries
10.8
Hearing loss, adult onset
3.8
COPD
3.5
Maternal and perinatal
10.1
Cerebrovascular Diseases
2.8
Cancers
6.8
Perinatal Causes
2.8
Respiratory system diseases
6.3
Alcohol use disorders
2.3
Musculoskeletal diseases
4.5
Schizophrenia
2.3
Digestive sytem diseases
4.1
Nutritional deficiencies
4.1
Source: Burden of Disease and Cost-Effectiveness Study www.hm.saglik.gov.tr
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Mental health hospitals (2003)
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Mental health hospitals
YEARS
HOSPITALS
1991
9
1995
8
2000
BEDS
INPATIENTS
BEDS IN WARDS
4,140
26,240
-
3,772
31,828
-
8
3,627
34,863
-
2001
9
4,332
37,741
-
2002
9
4,256
29,933
-
2003
8
3,720
38,763
1,866
2004
8
3,777
38,447
2,477
Total number of psychiatric beds: 6,254
0.9 beds per 10,000 population
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Human resources
920 psychiatrists
1.2 psychiatrist per 100 000 population
1 child and adolescent psychiatrist per 500 000
2/3 of the doctors are in three big cities
Total number of the psychiatric team (including
psychiatrists, clinical psychologists, social workers, nurses etc)
is
2000
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Challenge 1: Overcoming current perceptions
and practices
in mental health care
A
sh
ifthealth problem but insufficient focus
Major public
of implementation of contemporary
No discussion and
pa
approaches: community
ra care, prevention and
di
promotion
gm
Higly institutionalized care with
isbig hospitals as
ne
places of shelter
e care
Lack of day care facilities and social d
ed
Lack of a strong PHC service and links between
other levels of care
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Challenge 2: Organizational and legal
challenges
Lack of a “Mental Health Care” Law.
Instead, multiple rules and regulations
Organizational issues
MoH
Lack of
Directorate of curative services
coordination
Directorate of PHC Services
PHC Units
Hospitals
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Challenge 3: Problems of access
Insufficient number of doctors and other staff
Unequal distribution of resources
Hospitals in five regions, problems for
inpatients
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Status of health economics in the country
Late introduction of health economics concepts –
after mid 1990s
Economists are indifferent to the health sector
After recent reforms the need to ‘manage’ the
system became more important, leading to more
emphasis on concepts such as cost effectiveness,
efficiency, etc.
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Last word
A mentality change is needed for mental
health care
Introduction of economics to mental health
care requires a more systematic approach to
health economics and capacity building must
be the first priority
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Thank you
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