|
Social Work and Mental Health Reform in the Russian Federation: Synergies For Social Inclusion and Recovery
Dr. Don M. Fuchs
Abstract
This article reports on the results of a unique social development intervention undertaken by the Social Work Stream of the Canada Russia Disability Program (CRDP) aimed at building and strengthening efforts at mental health reform in Russia. The article describes the stream's unique intervention activities and reports on the outcomes and impacts of these interventions. It particularly highlights the synergies that were achieved by the unprecedented collaborative trans-sectoral partnerships between NGOs, Government policy makers and service providers, and universities. It concludes with a discussion of the implications of the results and suggests future directions for research and development in the area of effective mental health policy and service provision.
Introduction
Mental health concerns represent a significant social issue in the rapidly transforming Russian Society. In 2001 the Russian Ministry of Health reported that between 1990 and 2000, the number of individuals registered as disabled because of mental illness increased by 17.4 percent to reach 861 650 (Collegium of the Russian Ministry of Health, 2001). This accounts for 20 percent of all people registered as disabled in the Russian Federation. The WHO Global Burden of Disease study, reported that in 2002, Russian men had the second-highest rates of suicide in WHO European Region, with rates of 69.3 per 100 000 males and 97.2 per 100 000 in the 45 - 54 year old age group (WHO, 2004).
Jenkins et al (2007) maintain that the isolation of Russian psychiatry during Soviet times and limited funding of mental health services severely curtailed access to new evidence based practice knowledge. Consequently, most policymakers and practitioners lack the knowledge and skills required to form effective mental health policy and to deliver a range of effective medical and psychosocial treatments necessary for community-based care.
Despite the staggering social and economic impact there is little interest or priority given by public and private funders to the development of Mental Health Services in Russia. There is a great need to foster the reform of the mental health and social services to reduce the human rights abuses and foster the social inclusion of persons with disabilities within Russian Society (Penn, 2007, CCDS, 2007). These factors set the context for the social work intervention initiatives reported in this paper.
Context and Background for the Social Work Intervention of the CRDP
The CRDP in its inception phase identified three major factors indicating that Russia's disability and mental health service delivery systems were in need of extensive reform (CCDS, 2007). First, the Russian State has historically held a limited perception of people with disabilities and psychiatric disorders, viewing them as chronically ill and not as contributing members of society. As a result, the programs offered to people with any form of disability consisted primarily of financial compensation whereby individuals are provided with inadequate pensions for basic needs, such as housing and food. As the majority of Russia's disability budget went towards monetary compensation, there was no significant investment in assisting individuals to develop the skills to live independently, i.e. attend school and obtain employment. In the absence of any new knowledge of disability programs and policies and the State's ongoing focus on pensions, the State has promoted the social exclusion of people with disabilities rather than inclusion.
Second, the traditional state directed medical hierarchical approach to disability issues served as the foundational structure of the mental health and social service delivery systems. Existing services were based on the 'medical model' approach in which individuals were viewed as "sick" and in need of treatment, with little assistance provided beyond the treatment. Treatment primarily took place using outdated methods in large, under-funded hospitals or institutions with an absence of any options for community based treatment or services to promote integration into society (Jenkins, et. al, 2007, Templeman, 2004). This approach to service delivery of people with disabilities was fragmented in nature and missed key facets of a person's abilities beyond the illness or disorder. Professionals providing the services were largely unexposed to alternative views and approaches to service delivery as training in community-based mental health and social services or notions of social rehabilitation had been virtually absent in Russia (CCDS, 2007).
Third, at the base of the State's mental health service delivery approaches was the pervasive stigma towards individuals with disabilities in Russia, particularly those persons with cognitive and psychiatric impairments Society, and even family members shunned and hid their children and adults with disabilities for fear that they would be viewed and treated in a negative light (CCDS, 2007). The disgrace associated with people with disabilities had a ripple effect throughout Russia's public and private social spheres (Fuchs, 2007). As a result of this shame and secrecy, there was little opportunity for individuals and their families to share their experiences and receive much needed support and information. The government, educational institutions, and other organizations did not seek the opinions of people with disabilities, nor did they engage with each other, to learn how best individuals could be served.
In the early stages of the CRDP social development intervention a situational analysis identified several attitudes and beliefs as barriers likely to impede much needed reforms (CCDS, 2007). The first of these was reliance on a narrow model of mental disorders that focuses primarily on the medical treatment of psychiatric symptoms and underestimates psychological and environmental factors' effect on illness course and outcome. The second was therapeutic pessimism concerning the possibility of recovery from severe and enduring mental illness, and an associated belief in the necessity for long-term protective institutional care for most patients. (Jenkins, et. al., 2007). The third impediment was a hierarchical approach to clinical decision-making where the psychiatrist assumes responsibility for directing assessment and treatment activities, limiting input from other disciplines. Finally, there was an incorrect belief that proposed changes to the service structure and clinical practice would contravene existing legal or regulatory guidelines that treating mental health problems in primary care is not allowed, and that community social workers are forbidden to care for people with mental illness. Analysis of regulatory and legal documents revealed no such legal or regulatory barriers. (CCDS. 2007, Jenkins, et.al. 2007).
Building on previous partnerships developed through an earlier Canada Stavropol Project (CCDS, 1997 & 2007), the Social Work Stream of the Canada Russia Disability Program (CRDP) focused its efforts on strengthening the existing innovative, international, trans-sectoral partnerships and extending these partnerships to two other focal regions in Russia. Specifically, the stream focused on building capacity and strengthening social work education programs in its three focal regions (Stavropol, Omsk and Moscow) to foster social development and social inclusion of persons with disability.
Social Development Intervention Activities
Social Work Stream intervention activities included establishing an organizational structure which included two working groups in each region to carry out the interventions activities of the social work education and demonstration component of the CRDP. The intervention activities in each region included regional needs assessments of social work curriculum and mental health and social service resources for persons with physical and mental health disabilities. Initially it involved choosing three or more social service agency sites in each region and establishing them as multi-purpose teaching learning centres for education social service and mental professionals and for developing innovative approaches. The intervention activities involved building the capacity of academic and agency staff to educate social work students and building the university and agency for providing educational programs and developing innovative social and mental service health programs
The education component of the Social Work Stream intervention included the building of the capacity of university faculty and students, professionals, consumers, and public policy makers. It aimed to create a group of leaders, including persons with disabilities and mental health challenges in Stavropol/North-Caucuses, Moscow, Omsk and their regions-- people who were capable of developing and implementing curriculum for undergraduate, graduate or continuing professional education. Persons with disabilities and services providers participated as teachers and curriculum developers in the education of future health and social service practitioners. The stream modeled and normalized stakeholder participation in all of the social work educational programs in the focal regions.
In addition the streams activities were directed towards providing leadership to the other schools of social work in Russia as they struggled to develop their pre-professional and continuing professional education programs social workers working in the field of mental health in the rapidly changing Russian context.
Furthermore, the Social Work Stream's involvement in the demonstration component of CRDP was focused on building capacity and opportunity for the practical education of social work students and the promotion of the development of innovative community based social services. The stream accomplished this through the development of 9 Teaching Learning Multidisciplinary Service Centres (TLMSC) as demonstration sites. These sites have provided venues for field work placement sites where students have worked with agency staff to develop new consumer-focused approaches to disability services. The TLMSC's were also informed and guided through the input of consumers as well as consumer/practitioners-- working to provide multi-service and informational resources needed at the community level-- in culturally and socially acceptable, economically feasible ways. These centres provided a vehicle for the development of innovative forms of service delivery which have fostered the social inclusion of person with disability in the communities. Also they have served as a model for other agencies within the focal regions and other regions in Russia.
Initially 120 Field Instructors participated in a field instructor's course offered by the Canadian partners. This course was adapted by the Russia academics and has subsequently been offered annually to new field instructors. To date this course has been offered by the field coordinators at each of the partners University to approximately 300 Field Instructors across the three regions.
Implementing Intervention Activities
To begin the intervention process Social Work Stream working groups in each region conducted needs assessments and gaps analysis of social work programs and specializations were conducted. Over 45 academics, 4 directors, 10 agency representatives, and 10 consumer organizational representatives participated in this process. They examined their programs in relationship to the International Standards of Social Work Education and the Scope of Social Work Practice Statement of the International Association of Schools of Social Work as a basis of comparison.
The needs assessment and gap analysis identified four major common areas in all three regions that needed to be addressed:
1. The need for current relevant curriculum course content relating to social work and disability and social work and mental health.
2. The need for building the capacity of class instructors to develop and deliver social work practice courses;
3. The need to restructure social work curriculum to include more opportunity for skill development through an effective model of practical education in providing community based mental services.
4. The need to build capacity to provide practical education for social work students aimed at developing their skills in working with individual and families of persons with mental health disabilities.
Out this research a model curriculum for teaching of social work practice in mental settings was developed. It included two specializations. The specializations were designed to address these needs. Initially, 7 courses were delivered by the Canadian partners in each region to a total of approximately 1034 participants. As indicated previously, the content was adapted by approximately 40 academics and the 4 directors of the schools of social work from each region to form basis of the specializations. Over 20 Canadian academics worked with the Russian academics, students and agency based field instructors.
Results Achieved
This section examines the results achieved and the impact of these results on the social inclusion of persons with disabilities, particularly mental disabilities, locally, regionally and nationally. Data reported on project results were drawn from the following sources:
1. Program Semi-annual reports
2. Quarterly reports of education and demonstration working groups in each region
3. Organizational documentation and service statistics of participating universities and agencies
4. Surveys of regional working group chairs, members, course and field instructors, students and consumers
5. Content analysis of the documentation of the structure and course content of the specializations of the social work and disability and social work mental health.
6. Content analysis of documentation submitted by the Commission on Social Work Education Standards.
These multiple data sources provided strong triangulated evidence of the impacts and outcomes over the duration of the project and the possibility of looking at the cumulative impact of project activities sets and outputs.
Improved community-based services resulting in increased access and support for persons with mental disabilities
A major problem faced by persons with physical and mental disabilities and their families in the community is social isolation and lack of social supports particular instrumental support for their activities of daily living. Over 80 students (Stavropol 25, Moscow 30, Omsk 25) working in project groups were involved in assessing the needs of various groups of person with disabilities and assisting agencies with the development of remedial and preventive services and programs aimed at addressing the needs of at risk individuals and families. In addition over 200 students (Stavropol 70, Moscow 60, Omsk 70) became involved with agency staff of the 9 TLMSC developing and implementing programs aimed at working with children, youth and young adults with disabilities individually or in groups in all regions. These program/services assisted consumers in developing social skills and their abilities to access social and employment services and empowering them to have greater access to community resources.
In addition social work students were involved with persons with mental health disabilities in the first episode clinics, the community residences and clubhouses at the Omsk Psychiatric Centre. Twelve 12 social work students in Omsk developed a consumer led initiative where persons with disabilities produced a regular news paper for people with disabilities living in the Omsk providing news and vital information to persons with disabilities on how to access new and available services. This project received an award and on-going sustaining funding from the Ministry of Social Development.
Four (4) major collaborative projects (Omsk 2, Stavropol 1, Moscow 1) were developed between mental health and social service organizations. In Omsk, the Regional Psychiatric Centre collaborated with staff of the community based social service centres to provide services to persons with mental health disabilities and support for their families in the community. Social work students were engaged in the development and delivery of these services. In Stavropol, the regional Psychiatric Centre worked with the Family Center to provide support for families who had a parent or child with a mental health disability. In Moscow, the Moscow Psychiatric Research Institute provided individual and group treatment to persons with schizophrenia at a community based social service centre in North East Moscow. Social Work students from the centre were an integral part of the provision of these services.
At the beginning of the project social work program directors, academics and agency staff and students all were unclear about the role of social work in mental health and social service settings. There was very little understanding about the social exclusion issues faced by persons with disabilities. The focus groups and individual interviews conducted in February and April 2007 with all program directors, members of education and demonstration working groups indicated that by the completion of the CRDP they was clearer sense of the role of social work in assisting with the social inclusion of persons with disability. The CRDP evaluation outcome survey's indicated that academics felt empowered to take action to effect change in their social work curriculum. Agency staff felt empowered to develop programs and students felt they would be more likely to pursue a career in social work (CCDS, 2007).. In the Omsk regional psychiatric centre, the number of social worker graduates being hired from the social work programs has increased as did the salary of the social workers.
Increased Professional Capacity for Social Work Practice Mental Health Service Sector
One of the major intended outcomes of the CRDP was the increased knowledge of faculty, professionals, community leaders and people with disabilities in disability studies, social work and community rehabilitation models in mental health resulting in improved community-based mental health, disability and social work education.
The evaluation data from the Social Work Stream of the CRDP indicated that educators, students, and agency staff became aware current practice theories relating to social work and disability, social work and mental health
Over 1,034 participants attended the 7 Social Work Stream courses that were developed and delivered by the Canadian Partners across the three focal regions at the 4 participating universities; North Caucuses State Technical University (NCSTU) Stavropol Krai, Russia State Social University (RSSU) Moscow, Omsk State Pedagogical University (OSPU), Omsk State Technical University (OMSTU) Omsk. These courses provided an opportunity for participants predominantly, social work students, academics and agency staff to increase their knowledge relating to social work and disability and social work and mental health.
Fifteen (15) academics (Stavropol 6, Moscow 5, Omsk 4) and 2 doctoral students (Stavropol 1, Moscow 1) participated in the study tours in Canada. These individuals served as leaders in their working groups in developing and implementing the social work specializations. In addition they assisted in the process of identification of development of the TLMSCs. The academic staff, students, agency staff and representatives from consumer directed NGOs from each of the Schools of Social work reviewed the International Standards and scope of practice statement of the International Association of Schools of Social Work, and examined the curriculum content of the schools in relation to the international standards. They also reviewed The United Nations Statement on the Rights of Persons with Disabilities prior to their proceeding with development of the two specializations. All of specializations were grounded in a rights based social model of disability. They are aimed at the preparation of professionals who will be able to develop and deliver consumer focused community based social services that foster social inclusion and participation of persons with disabilities.
In addition the evaluation data indicated that educators, students, agency staff and consumers developed specializations, TLMSC centre sites for practical education and program innovation. Over 40 social work educators and 4 program directors were involved in the development of the course content in each of the specializations that were approved in the focal regions. The specializations were all adapted to address the different levels of capacity and need of the local consumer populations.
Of the 7 courses developed and delivered in Russia by the Canadian partners 3 addressed social work and disability and 3 addressed social work and mental health. Of the 37 additional courses developed by the Russia partners 30 related to working with persons with disabilities, and/or their families and/or their communities (Stavropol 9, Moscow 9, and Omsk 12). Approximately 300 participants took these courses.
In addition, 7 of the courses developed by the Russian partners focused on social work and mental health (Moscow 2, Stavropol 1 and Omsk 4). Approximately 100 students have been involved in these courses. Further, 5 academics and 6 social service providers/field instructors attended the Community of Learners courses provided by the Mental Health Stream.
All 4 participating Russian Universities have had their mental health specializations approved by their respective University Councils and Russia's Commission on Social Work Education. All four of the participating universities have begun implementing the specializations. The Social Work Stream worked with 9 social service/mental health organizations (TLMSCs) that were committed to providing practical education. Over the life of the project these settings provided practical education to over 500 students in field of social work practice with disability. All of these students participated in the development of a total of 40 service/program innovative projects that were developed in TLMSCs across the regions. These programs were adopted by the service agencies and became regularized services within these agencies service delivery structures.
Increased capacity of learning institutions to provide social work education and fieldwork practice in community-based mental health services
To assess the capacity of agency staff and social work practical educators all of the demonstration working groups in each region conducted reviews of all practical education sites that were being used by their respective university's social work programs. The demonstration working groups initially chose 2 TLMSC site per region. In addition after the project was initiated each regional demonstration working group worked with the local agency representatives to identify a TLMSC site that also was demonstration site with the mental stream. This was done in every region except Moscow which opted for an experimental program initiative for persons with mental health disabilities at the Bibirivo Community Social Service Centre.
The TLMSCs demonstrated significantly increased capacity to provide field education to students and to foster development of innovative community based mental health services. These changes have made sustainable by the demonstration working groups in each region developed their field instruction course and began offering regularized courses for new field Instructors. Also each regional demonstration working group prepared a field manual for field instructors to assist instructors to provide relevant accredited field education for social work students. Approximately 350 (Stavropol 75, Moscow 55, Omsk 220) social work students were involved in active field placement/work related to services for persons with disabilities working under the supervision of field instructors who had been trained with the new field instruction course.
Cumulative Impact of Social Work Stream
The CRDP Social Work Stream, building on the previous Canada-Stavropol project, has contributed in a significant way to defining a paradigm for social work in Russia. There is an emerging consensus in all of the focal areas on the role of Social Work in the development and delivery of community based mental health. The activities of the stream have resulted in an increased capacity for the development and delivery of community based mental health and social services in the focal regions.
The data from the regular reports and the surveys of Social Work Stream participants provide clear evidence of the following impacts:
1. Increased awareness of the role of social work education in building capacity for reform, innovation and change in delivery mental health and social services.
2. Increased awareness of the need for the integration of knowledge and skill in the preparation social work professionals which has resulted in the development of more effective educational programs for the preparation of practitioners for the provision of community based mental health and social services.
3. Increased collaboration between the schools of social work and community based mental health and social service agencies around program development and research.
4. Increased collaboration between mental health and social service agencies in the preparation of professional social workers and in the continuing education of social workers practicing in the mental health agencies.
Synergies from Unprecedented Partnerships at the Regional, Inter-Regional, National Levels
There were many unexpected outcomes that occurred both intraregionally, interregionally and trans-sectorally. Unprecedented models of intra regional collaboration between mental health and social service agencies in all three regions in providing both class room and field instruction and the development of service innovation were developed. New collaborative partnerships between consumer NGOs and the Schools of social work emerged in all focal regions. There was increased collaboration between demonstration sites and academics on the service development. Further Universities began to use agency service providers as teacher in the class room field education of students. In addition persons with disabilities were included as teachers, students and community based researchers. Finally within each region there was an increased number of accessible public buildings and the increase in number of persons with disabilities participating in development and delivery of social services and the supervision of the practical education of social services.
At the interregional level there was the unexpected development of an interregional directors' of schools of social work working group with the capacity for impacting on the development of the national standards for social work education. It has lead to development of collaborative consultation network amongst academics and the unprecedented sharing of curriculum content and resource materials for development amongst of the Schools of Social Work in the three disparate regions. In addition an unparalleled interregional trans-sectoral collaboration occurred in the provision of education and training in mental health for social work academics and agency service providers.
In an effort to consolidate the results of the project and to broaden the impact to other parts of Russia. The Social Work Stream engaged in a dissemination and communication Strategy. All of the courses that have been developed and delivered as part of in the Social Work Stream are now available in Russian on the CRDP website. All regions are making their materials available relating to the social work programs and TLMSCs site available on the CRDP website. Russia State Social University (RSSU) has produced textbooks that have been made available to all social work programs in Russia in the area of social work practice and disability. TLMSCs in Moscow, Stavropol and Omsk have been serving as models for other agencies in other parts of Russia to develop their approaches to practical education of students and service innovation.
Implications, Conclusions and Directions for Future Research and Development
Not withstanding the many difficulties, the innovative partnerships and outcomes that emerged out of the Canada Stavropol Project served as a solid base and spring board for the development of social work education standards, the social work specializations and demonstration sites in each region.
Under the leadership of the regional psychiatric centre a unique and highly effective model of trans-sectoral collaboration was developed in Omsk that greatly assisted the both the education and demonstration working groups to produce the successful CRDP Social Work Stream outcomes.
Notwithstanding the formidable challenges to the sustainability of the project the interviews with key project participants indicated a sense of empowerment and perceived ability to address the challenges using the collaborative partnership of regional working groups and the indigenous resources of the key project participants i.e. Academics, agency staff, consumer organizations and students.
In spite of these achievements and the sustained impact of the CRDP, Jenkins et al. (2007) have identified five key barriers that need to be addressed further if the Russian Federation is to foster continued reform. Addressing these barriers is necessary to shift away from hospital-centred mental health services emphasizing institutionalization. towards multi-sectoral approaches that foster community-based services supported by multidisciplinary teams that foster social inclusion of persons with mental health.
First, funding of mental health services is based on the existing number of hospital beds and bed occupancy rate, which in turn determine staff levels and other inputs. This provides perverse incentives for health-care providers to maintain existing beds and hospitalize patients with mental illness. Existing resource allocation and provider payment systems should be changed to ensure efficient providers are not penalized for downsizing capacity (Jenkins, et. al.2007).
Second, the Russian regulations stipulate periods of hospitalization for patients with mental illness. These need revising, combined with economic incentives to discourage undue delays in discharging individuals from inpatient care (McDaid, Oliveira, Jurczak, Knapp, M. 2007).
Third, downsizing the hospital sector and shifting to community-based care requires reducing or redeploying staff. This is politically difficult to achieve and requires carefully designed human resource policies (CCDS, 2007).
Fourth, because community-based services for mentally ill patients and social support for the unemployed majority of these patients are underdeveloped, it is difficult to rapidly implement lower-cost and therapeutically more effective alternatives to inpatient care. Investment is needed to develop these sectors.
Fifth, financing regulations in the Russian Federation prevent pooling of sectoral budgets and shifting funds from health sectors to social protection sectors. Financial incentives are required to encourage deinstitutionalization and develop community-based supports (McDaid et.al, 2007).
The Russian Federation has declared its commitment to mental health reform (WHO, 2005, Collegium of Russian Health Ministry, 2002). The recent merger of the federal ministries of health, labour and social protection facilitates coordinated planning, resource pooling and integration of health and social protection services to address the complex needs of people with mental illness. In the short term, the constraints identified above pose a challenge to attaining rapid and substantial improvements, but the CRDP Social Work Stream and the Mental Health Stream demonstrated that with capable leadership these changes are feasible (CCDS, 2007).
Current policies that focus on population health (Danishevski, & McKee, 2005) need to embrace mental health along with the more visible factors that have contributed to the demographic crisis in the Russian Federation (Atun, 2005, Putin 2005). Embedding mental health in primary health care services creates the opportunity to benefit from the Presidential Priority Health Project, which is injecting approximately US$ 4 billion per year to the primary health care system over three years (Aris, 2005)
The findings of CRDP have important implications for mental health care in the Russian Federation and the wider region where similar systems exist. Introducing community-based care and using existing resources more efficiently require reform of health system standards and of regulations related to planning, financing and clinical care and reform of the pre-professional and continuing professional education system. Much more research and development is needed of multi- sectoral partnerships between Universities involved in professional preparation, Government and NGOS involved in the development of policy and service delivery mechanism and consumer groups. This knowledge development is essential to building the necessary capacity and implementing the innovative effective community based models of mental health and social service delivery reform that has been initiated as part of the CRDP.
References
Aris.B. (2005). Money for health in Russia, at long last. Lancet 2005; 366: 1254-5.
Atun, R.A.. The health crisis in Russia. BMJ 2005; 331: 1418-9.
Canadian Centre on Disability Studies, (2007). Canada-Russia Disability Program Final Monograph, Winnipeg: Author.
Canadian Centre on Disability Studies, (2002). Canada-Russia Disability Program Proposal. Monograph, Winnipeg: Author
Canadian International Development Agency (2003). Russia Facts: Programming Framework Annex 1 & 2. Ottawa: Government of Canada.
Collegium of the Russian Ministry of Health. (2001). Proceedings of collegium on mental health care. Moscow: Government of the Russian Federation.
Collegium of the Russian Ministry of Health. (2002) Sectoral programme of development of reorganisation of the network of psychiatric care in the Russian Federation for the period of 2003-2008. Moscow: Government of the Russian Federation.
Danishevski, K, McKee, M. (2005). Reforming the Russian health-care system. Lancet, 365: 1012-4.
Department of International Development, (2005). Reducing Poverty by Tackling Social Exclusion. Monograph, London: British Government.
Ferguson: Beyond indigenization and reconceptualization, International Social Work, 48(5): 534-535.
Fuchs, D. Promoting Citizenship of Persons with Disabilities in James, G & Ramsy, R. (eds.) (2007). International Social Work: Canadian Perspectives. Toronto: Thompson Educational Publishing. In press.
Hokenstad, M.C. & Midgley, J. (eds.) (2004). Lessons from Abroad: Adapting International Social Welfare Innovations. Washington, D.C.: NASW.
Hokenstad, M.C. & Midgley, J. (eds.) (1997). Issues in International Social Work: Global Challenges for a New Century. Washington, D.C.: NASW.
Hokenstad, M., S. Khinduka and J. Midgley, eds (1992) Profiles in International Social Work. Washington, DC: NASW Press.
Jenkins, R., Lancashire, S., McDavid, D., Samyshin, Y., Green S., Watkin, J. & Potasheva, A., (2007). Bulletin of the World Health Organization. Vol. 85 (11). 858-866.
Korolenko, C.P., Kensin, D.V. (2002). Reflections on the past and current state of Russian psychiatry. Anthropol Med . 9: 51-63.
Mathers C, Bernard C, Moesgaard Iburg K, Inoue M, Ma Fat D, Shibuya K, et al. (2004). Global burden of disease in 2002: data sources, methods and results. Global Programme on Evidence for Health Policy Discussion Paper No. 54. Geneva: WHO.
McDaid, D, Oliveira M,D., Jurczak, K., Knapp, M.( 2007). Moving beyond the mental health care system: an exploration of the interfaces between health and non-health sectors. J Ment Health 16: 181-94.
Midgley, J. (1995) Social Development: The Developmental Perspective in Social Welfare. Thousand Oaks, CA: Sage.
Nanavatty, M. (1997) 'India', in N. Mayadas, T. Watts and D. Elliott (eds) International Handbook on Social Work Theory and Practice, pp. 245–62. Westport,CT: Greenwood Press.
Penn, J. (2007). The Development of Social Work Education in Russia Since 1995. European Journal of Social Work. Vol. 10, No. 4, pp 513-527.
Poloshij, B. & Saposhnikova, I. (2001). Psychiatric reform in Russia. Acta Psychiatr Scand; 104: 56-62.
Putin V. (2005). State of the nation address. Moscow: Federal Assembly of the Russian Federation.
Tempelmann, S. (2004). 'Social Work in the New Russia at the start of the Millennium' International Social Work 47 (1): 95-108.
Walton, R. and M. Abo El Nasr (1988) 'Indigenization and Authentization in Terms of Social Work in Egypt', International Social Work 31: 135–44.
World Health Organization (WHO) (2005). Mental health declaration for Europe: facing the challenges, building solutions. Copenhagen: Author.
WHO (2004). Mental health policy, plans and programmes (updated version). Geneva: Author.
WHO (2004). Suicide rates by country. Geneva: Author.
World Bank, (2005). Russian Federation Poverty Assessment. Poverty Reduction and Economic Management Unit Europe and Central Asia Region. Monograph, New York: World Bank.
World Bank, Europe and Central Asia Human Development Department. (2005). Dying too young: addressing premature mortality and ill health due to non-communicable diseases and injuries in the Russian Federation. Washington: Author.
Submitted by:
Dr. Don M. Fuchs, Professor
Faculty of Social Work
University of Manitoba
Winnipeg, Manitoba
R3T 2N2
Email: fuchs@cc.umanitoba.ca
Tel: 474-7879
|
