Boris Mendelevich: “Psychiatry hasn't found proper attention and receives insufficient funding for many years”

Deputy of the State Duma Boris Mendelevich about how the coronavirus will change the national project Healthcare

The State Duma Committee on Health Protection held a meeting of the working group on monitoring the national project Healthcare on 21 July. State Duma Deputy from Tatarstan, Doctor of Medical Sciences, psychiatrist Boris Mendelevich, as the head of this group, specially for the readers of Realnoe Vremya prepared the author's column shortly after the meeting.

The new conditions in which the entire Russian healthcare system has found itself has required new solutions and made certain adjustments. We saw not only the capacities of our healthcare but also the need to change its content, its functional and organisational structure, and to build the logistics of the entire system. This is why it was decided to hold a meeting so that all relevant departments and participants understand the direction and where to go in the implementation of national projects.

Pandemic and national projects

For obvious reasons, during the pandemic, much emphasis was placed on the development of the infectious service. At the same time, a number of other areas have been overshadowed, and even for the most objective reasons, these areas require a revision of the indicators. In particular, today representatives of the regions have raised the issue of developing the export of medical services, which is a priori impossible in the conditions of border closure. The construction and repair of medical facilities is also quite relevant. In particular, in a number of cases, construction has been suspended in the regions, and somewhere a medical facility that had been planned for repairs was put back into operation due to a large number of patients.

Besides, at the same time, about 500 billion rubles were invested in healthcare. Quite a large part of the money was spent on new ambulances, which is probably the most important part of primary health care. In addition, ventilators and other modern equipment have been purchased, which will serve for many years to come.

At the same time, a number of indicators, in particular the structure of total mortality, are not subject to change and it is important to work more effectively in this direction.

COVID-19 — a catalyst for new directions?

In connection with the pandemic, the issue of modernising approaches to the organization of infectious services has become acute. Yes, the Russian ministry of healthcare is currently preparing changes that will become a separate project within the framework of the national project Healthcare — the project “fight against infectious diseases”. But, in addition to physical health, it is equally, and perhaps more important to maintain mental health. And now, in my opinion, it is time to discuss the possibility of including another project “Mental health of citizens” in the national project. Mental disorders are the second most important cause of chronic diseases (after cardiovascular diseases). Depression and cardiovascular diseases in Russia have a direct link, especially among women who, in addition to the usual reasons for depression, have depression on the background of hormonal changes after pregnancy and childbirth.

Mental disorders are the second most important cause of chronic diseases (after cardiovascular diseases). Depression and cardiovascular disease have a direct link. According to the data we have, it is depression that is diagnosed in about 47% of patients after strokes. Today, about 1 million people are registered with a psychiatrist who are disabled due to the presence of a mental illness.

Mental health is the foundation of a person's physical and social well-being. However, psychiatry for many years hasn't found find proper attention in the modernisation programmes of the ministry of healthcare and undeservedly does not receive adequate funding.

At the meeting, I once again expressed this idea and found support from representatives of relevant departments, in particular the FOMS (Federal Compulsory Medical Insurance Fund) and the regions. They supported this initiative, noting that more emphasis should be placed on the nation's cognitive health. In particular, internal research was conducted in Nizhny Novgorod Oblast, which showed an increase in cognitive disorders in people with severe lung damage. Experts once again noted that the new coronavirus will leave a serious mark and it must be overcome here and now.

What about figures?

In general, the implementation of the national project Healthcare now has a leading position in comparison with others. But here it is very important to look not only at quantitative but also qualitative indicators for each direction, so as not to get an average. One of the main issues is the increase in mortality. For example, according to Roszdravnadzor, the top three regions for increasing mortality include Moscow (+17,2%, or 11,375 cases), Moscow Oblast (+15,2%, or 7,572 cases) and St. Petersburg (+14,3%, or 4,673 cases).

Another issue discussed was the treatment of diseases of the circulatory system, the increase in mortality from which on average in the country increased by 1,8% (plus 8,663 cases). Based on statistics on mortality due to diseases of the circulatory system, we can conclude that in the first 5 months of this year, the dynamics was quite positive. However, operational monitoring for June and July shows an increase, but the data will still be adjusted. At the same time, it should be understood that even within the framework of the national project, the state allocates quite large funds for the purchase of medical equipment, equipping offices, and even in such conditions, not all regions have signed the necessary contracts yet!

Among the positive trends, we can note that according to Roszdravnadzor, there is a decrease in mortality from neoplasms. On average, the national rate decreased by 3,4%, which is 5,483 cases! But we must understand that the data will be updated during the year and it is too early to rejoice. In particular, it is now very important that all medical institutions comply with safety rules, as well as the timing of medical care. This is what can save a huge number of lives!

Of course, it is impossible to mention all the issue discussed within column limits. Therefore, I am ready to answer them here in the comments or on the pages of my social networks!

By Boris Mendelevich

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