Psychological aspects of living in Armenia

Armenia is a landlocked mountainous country between the Black Sea and the Caspian Sea, in the southern Caucasus. It shares borders with Turkey to the west, Georgia to the north, Azerbaijan to the east, and Iran and the Nakhchivan exclave of Azerbaijan to the south. As a post-Soviet state, the Republic of Armenia inherited a health system organized according to the Semashko model, with guaranteed free medical assistance and access to a comprehensive range of medical care for the entire population. The system was highly centralized, with vertical management dominating. Financial and other allocations were based on national norms and failed to take account of population health needs. Since independence, the health system in Armenia has undergone numerous changes. Following the decentralization of public services, the ownership of health services has been devolved to local and provincial governments. The population, especially those in need, has limited access to health services. Mental health services in Armenia are lacking and those available are poorly integrated into the primary care system. The current system focuses on in-patient care. There is a lack of trained social workers and other mental health professionals, which limits the potential for service provision at the community level. Essentially, psychiatric care is still exclusively provided in specialized mental health institutions, including hospitals and social psychoneurological centers. Currently, only 3% of the overall public healthcare budget is given to mental health. In turn, around 88% of the mental health expenditure is on mental hospitals. Mental health research is underdeveloped and lacks governmental support. There is, though, some research based on the interests of individual investigators or some priorities suggested by donor organizations. This tends to be focused on epidemiological studies in community samples, epidemiological studies in clinical samples, biology and genetics, policy, programs, financing/economics, and pharmacological, surgical, and electroconvulsive interventions.

Sophie Hohmann, Cecile Lefevre. Post-Soviet Transformations of Health Systems in the South Caucasus. Central Asian Affairs, Brill, 2014, 1, pp.48-70. ￿10.1163/22142290-00101005￿.