Mental illnesses in Russia: what is happening. In Russia, the number of people suffering from mental disorders has increased. The number of mentally ill people by country of the world.

Highest percentage mental disorders of various kinds, ranging from anxiety and depression to severe forms of schizophrenia, occur in the most developed countries of the world. First of all, these are European states.

According to official WHO data in 2006, for example, 870 million citizens living in Europe suffered from the following ailments:

Depression and anxiety disorders- 100 million;

Chronic alcoholism - more than 20 million;

Alzheimer's disease and other types of dementia - about 8 million;

Schizophrenia - 4 million;

Bipolar disorder - 4 million;

Panic disorders - 4 million.

Mental disorders are the second most common after cardiovascular diseases. This great amount disabled citizens who require constant or periodic medical supervision. Also, mental disorders account for 40% of all chronic diseases in general. [С-BLOCK]

The situation with illnesses that lead to suicidal attempts (severe depression, etc.) is depressing. 9 out of 10 countries with the highest rates of suicide are in Europe. According to WHO, 150 thousand people voluntarily take their own lives every year. Moreover, these are mainly young men 15-35 years old (80% of those whose suicide attempt ended in death).

Reasons for such indicators

The main reason for such a high prevalence mental illness in developed and a priori more prosperous powers, urbanization is considered. The frantic pace of life in megacities and high levels of stress lead to a constant increase in the number of patients with chronic depression, alcoholism and other dangerous conditions.

The second reason is the growing number of women working hard. Due to the fact that women work during pregnancy (sometimes not in the most favorable conditions), the number of intrauterine injuries to the fetus is constantly increasing. This greatly affects the mental abilities of children, as it causes all sorts of abnormalities in brain development.

The third reason is the aging population. Due to the high standard of living and excellent medicine, life expectancy in Europe is one of the longest. At the same time, young people are in no hurry to have offspring, preferring to pursue a career and earn money. In European families there are 1-2 children; more - much less often. As a result, the population of Europe is rapidly aging, and this leads to an increase in the percentage of senile mental disorders in relation to all other diseases.

In other countries

The final “reason” for the high levels of mental disorders in Europe is their timely diagnosis and control. Regular examination population simply allows cases of these diseases to be detected more often. In less developed countries, diagnostics are at a much lower level, so it cannot be said unequivocally that the population there is healthier. It's simply underexplored.

According to WHO, from 75 to 80% of patients with mental health problems live “incognito”. They get sick, but due to the poor level of medical care, no one knows about it. In many underdeveloped countries, it is generally not customary to consult a doctor due to mental illness. For example, in Eastern European countries it is customary to “treat” severe chronic depression with alcohol.

In most African countries, too small a percentage of the population lives to old age to suggest any prevalence senile dementia(Alzheimer's disease, etc.). And the medical care there is so bad that a person can die in the prime of life from appendicitis. There is no talk of any diagnosis of mental illness.

Belongs to the most serious problems problems facing all countries, since at one time or another such problems arise in at least every fourth person. The prevalence of mental health problems in the European Region is very high. According to WHO (2006), of the 870 million people living in the European Region, about 100 million experience anxiety and depression; over 21 million suffer from alcohol use disorders; over 7 million - Alzheimer's disease and other types of dementia; about 4 million - schizophrenia; 4 million with bipolar affective disorder and 4 million with panic disorder.

Mental disorders are the second most important cause of disease burden (after cardiovascular diseases). They account for 19.5% of all years of life lost as a result of disability (DALYs - years of life lost due to illness and premature death). Depression, the third leading cause, accounts for 6.2% of all DALYs. Self-harm, the eleventh leading cause of DALYs, accounted for 2.2%, and Alzheimer's disease and other dementias, the fourteenth leading cause, accounted for 1.9% of DALYs. As the population ages, the number of people with such disorders is likely to increase.

Mental disorders also account for more than 40% of all chronic diseases. They are a significant reason for the loss of healthy years of life due to disability. The most important single cause is depression. Five of the fifteen major factors influencing the burden of disease are mental disorders. In many countries, 35-45% of absenteeism is due to mental health problems.

One of the most tragic consequences of mental disorders is suicide. Nine of the world's ten countries with the highest suicide rates are in the European Region. According to the latest data, about 150 thousand people voluntarily die each year, 80% of them are men. Suicide - presenter and hidden reason deaths among young people, it ranks second in age group 15-35 years (after road accidents).

V.G. Rothstein et al. in 2001, they proposed combining all mental disorders into three groups, varying in severity, nature and duration of course, and risk of relapse.

1. Disorders that force patients to be monitored by a psychiatrist throughout their lives: chronic psychoses; paroxysmal psychoses with frequent attacks and a tendency to transition into continuous flow: chronic non-psychotic conditions ( low-grade schizophrenia and conditions close to it, within the framework of ICD-10, diagnosed as “schizotypal disorder” or “mature personality disorder”) without a tendency to stabilize the process with satisfactory social adaptation; states of dementia; moderate and severe types of mental retardation.
2. Disorders requiring observation during the active period of the disease; paroxysmal psychoses with the formation of long-term remission; chronic non-psychotic conditions (sluggish schizophrenia, psychopathy) with a tendency to stabilize the process with satisfactory social adaptation; relatively mild variants of oligophrenia; neurotic and somatoform disorders; vaguely expressed affective disorders(cyclothymia, dysthymia); AKP.
3. Disorders requiring observation only during acute condition: acute exogenous (including psychogenic) psychoses, reactions and adaptation disorders.

Having identified the contingent of those in need of psychiatric care patients, V.G. Rothstein et al. (2001) found that about 14% of the country's population actually needs mental health services. While, according to data official statistics, only 2.5% receive this assistance. Due to this important task for the organization of psychiatric care - determination of the structure of care. It must have reliable data on the true number of people in need of mental health care, on the socio-demographic and clinical-epidemiological structure of these contingents, giving an idea of ​​the types and volumes of assistance.

The number of patients in need of help is a new indicator, “the current number of mentally ill people.” Determining this indicator should be the first task of applied epidemiological research aimed at improving mental health care. The second task is to obtain, on the basis of the “current number of mentally ill people”, as well as on the basis of a study of the clinical structure of the corresponding contingent, a basis for improving treatment and diagnostic programs, planning the development of psychiatric services, and calculating the personnel required for this, Money and other resources.

When attempting to estimate the “current number of sick people” in a population, it is necessary to decide which of the commonly used indicators is most adequate. Selecting one indicator for all mental health problems is inappropriate. For each group of disorders, combining cases that are similar in severity, course and risk of relapse, a different indicator should be used.

Taking into account the characteristics of the identified groups to determine the “current number of persons with mental disorders» offer indicators; life prevalence, year prevalence, point prevalence, reflecting the number of people suffering from a given disorder at the time of the survey.

• For patients of the first group, life prevalence reflects the number of people who experienced this disorder ever during your life.
• For patients in the third group, year prevalence reproduces the number of persons in whom the disorder was noted over the past year.
• For patients with the second group of disorders, the choice of an adequate indicator is less obvious. Prytovoy E.B. et al. (1991) conducted a study of patients with schizophrenia, which made it possible to determine the period of time after which the risk of a new attack of the disease becomes the same as the risk of a new case of the disease. Theoretically, it is this period that determines the duration of the active period of the disease. For practical purposes this period is prohibitively long (it is 25-30 years). Currently, active clinical observation is stopped if the duration of remission for paroxysmal schizophrenia is 5 years. Taking into account the above, as well as the experience of psychiatric institutions in the duration of observation of patients with other (non-schizophrenic) disorders included in the second group, we can choose the prevalence over the last 10 years (10-year prevalence) as a satisfactory indicator for it.

To estimate the current number of people with mental disorders, an adequate estimate of the total number of people with mental health disorders in the population was necessary. Such studies have led to two main results.

• It has been proven that the number of patients in the population is many times greater than the number of patients in psychiatric services.
• It has been established that no survey can identify all patients in the country, so their full number can only be obtained through a theoretical estimate. The material for this is current statistics, the results of specific epidemiological studies etc.

Prevalence of mental illness in Russia

Analyzing WHO materials, national statistical and clinical-epidemiological materials, O.I. Shchepin in 1998 identified trends and patterns in the spread of mental illness in the Russian Federation.

• The first (main) pattern is that the prevalence rates of all mental illnesses in Russia have increased 10-fold over the past 45 years.
• The second pattern is relatively low level and a slight increase in the prevalence of psychosis (actually mental or psychotic disorders: an increase of only 3.8 times over the entire 20th century, or from 7.4 cases per 1 thousand people in 1900-1929 to 28.3 in 1970-1995). The most high levels prevalence and growth rates are characteristic of neuroses (increased by 61.7 times, or from 2.4 to 148.1 cases per 1 thousand people) and alcoholism (increased by 58.2 times, or from 0.6 to 34.9 cases per 1 thousand people).
• The third pattern is high rates of growth in the prevalence of mental underdevelopment (30 times, or from 0.9 to 27 cases per 1 thousand people) and senile psychoses(20 times or from 0.4 to 7.9-8 cases).
• The fourth pattern is the greatest increase in prevalence levels mental pathology noted in 1956-1969. For example: 1900-1929 - 30.4 cases per 1 thousand people. 1930-1940 - 42.1 cases; 1941-1955 - 66.2 cases; 1956-1969 - 108.7 cases and 1970-1995 - 305.1 cases.
• The fifth pattern is that the prevalence of mental illnesses is virtually the same in both the economically developed countries of the West and in the Union of Soviet Socialist Republics (an increase of 7.2 and 8 times between 1930 and 1995). This pattern reflects the universal human essence of mental pathology, regardless of the socio-political structure of society.

The main reasons for the increase in the number of mental disorders in modern world, according to WHO experts, - increasing population density, urbanization, destruction natural environment, the complication of production and educational technologies, an avalanche-like increase in information pressure, an increase in the frequency of emergency situations (ES). deterioration physical health. including reproductive, an increase in the number of brain injuries and birth injuries, intensive aging of the population.

The above reasons are fully relevant for Russia. Crisis state society, drastic economic changes with a decrease in people’s living standards, changes in values ​​and ideological ideas, interethnic conflicts, natural and man-made disasters, causing population migration, breaking life stereotypes significantly affect mental condition members of society, generate stress, frustration, anxiety, insecurity, and depression.

In close connection with them are socio-cultural trends affecting mental health, such as:

• weakening of family and neighborhood ties and mutual assistance;
• a feeling of alienation from state power and the management system;
• the increasing material needs of a consumer-oriented society;
• spreading sexual freedom;
• rapid increase in social and geographic mobility.

Mental health is one of the parameters of the population's condition. It is generally accepted to assess the state of mental health using indicators characterizing the prevalence of mental disorders. Our analysis of some social significant indicators made it possible to identify a number of features of their dynamics (based on data on the number of patients who applied to out-of-hospital institutions psychiatric service RF in 1995-2005).

• According to statistical reports from treatment and preventive institutions of the Russian Federation, the total number of patients who sought psychiatric help increased from 3.7 to 4.2 million people (by 13.8%); the overall incidence rate of mental disorders increased from 2502.3 to 2967.5 per 100 thousand people (by 18.6%). The number of patients who were diagnosed with a mental disorder for the first time in their lives increased in approximately the same proportions: from 491.5 to 552.8 thousand people (by 12.5%). The primary incidence rate increased over 10 years from 331.3 to 388.4 per 100 thousand population (by 17.2%).
• At the same time, quite significant changes have occurred in the structure of patients according to certain social characteristics. Thus, the number of people of working age with mental disorders increased from 1.8 to 2.2 million people (by 22.8%), and per 100 thousand people the number of such patients increased from 1209.2 to 1546.8 (by 27.9%). During the same period, however, the absolute number of working mentally ill people decreased from 884.7 to 763.0 thousand people (by 13.7%), and the number of working mentally ill people decreased from 596.6 to 536.1 per 100 thousand population (by 10.1%).
• During this period, the number of patients with disabilities due to mental illness increased very significantly: from 725.0 to 989.4 thousand people (by 36.5%), i.e. in 2005, among all patients, almost every fourth person was disabled due to mental illness. Per 100 thousand people, the number of disabled people increased from 488.9 to 695.1 (by 42.2%). At the same time, the decline in the rate of primary disability due to mental illness, which began in 1999, was interrupted in 2005; it began to increase again and amounted to 38.4 per 100 thousand people in 2005. The share of working disabled people fell from 6.1 to 4.1%. The share of children in the total number of mentally ill people recognized as disabled for the first time in their lives increased from 25.5 to 28.4%.
• With a fairly moderate increase in the total number of mentally ill people, the number of hospitalized patients has increased slightly. In absolute terms: from 659.9 to 664.4 thousand people (by 0.7%), and per 100 thousand population - from 444.7 to 466.8 (by 5.0%). At the same time, the increase in the number of hospitalized patients occurred exclusively due to patients with non-psychotic mental disorders.
• The number of mentally ill people committing public crimes has increased. dangerous actions: from 31,065 in 1995 to 42,450 in 2005 (36.6% increase).

Thus, for 1995-2005, with a moderate increase in the total number of patients with mental disorders who applied for specialized assistance, the patient population itself became “heavier”: both due to a significant increase in the number of patients with disabilities due to mental illness, and due to a significant reduction in the number of working mentally ill people.

A map of Russia's madness has been drawn. In this ranking, Moscow was in fifth place from the bottom - among the most mentally healthy regions. Only the Caucasian republics bypassed the capital.

The Ministry of Health and the main psychiatric institute of the country - Research Center for Psychiatry and Narcology named after. V.P. Serbian - provided statistics about mental health Russians. The latest available data are the results for 2015; the results for 2016 will be announced this spring, but the leading regions remain almost unchanged from year to year. We are talking about Russians who sought psychiatric help and, based on the results of the study, are under dispensary observation with various diagnoses.

Previously, this was called “psychiatric registration”, but in the medical environment it has a clearly negative Soviet connotation - then the registration was lifelong and psychiatric status any citizen was, in fact, public. According to the law “On Psychiatric Care...” a similar concept is now called “dispensary observation” and it can be prescribed compulsorily (like inpatient treatment in hospitals).

Mental health is worse in remote regions: Altai, Chukotka, Yamal-Nenets Autonomous Okrug, as well as in the Perm and Krasnoyarsk territories. In the European part of Russia, the Tver and Ivanovo regions stood out with a minus sign, with the “severe” Chelyabinsk residents in seventh place.

The Caucasus regions turned out to be the leaders in mental health, and Moscow (the leader in the absolute number of mentally ill people, 212 thousand) took an honorable fifth place from the bottom, next to another city of federal significance - Sevastopol. St. Petersburg was in the middle of the list with a result of 2,618 mentally ill people per 100 thousand people. The rating with the position of each region is at the end of the note.

Map of Russia's madness

Boris Kazakovtsev, head of the department of epidemiological and organizational problems of psychiatry at the Serbsky Center, noted that “in the south, in the Caucasus, mental morbidity is 3-4 times lower than in central Russia and the North.” Because in the south it is not customary to go to a psychiatrist: a shame on the whole village? No, Kazakovtsev answers: “A similar trend can be seen not only in psychiatry, but also in many indicators of the health of southerners.”

Overall numbers of crazy people reached their peak 10 years ago. At that time, mental illness was recorded in just over 4.25 million people. Since then, the number of mentally ill people in Russia has been falling, and at the end of 2015 there were 4.04 million people.

• “In previous years, since 2006, overall incidence rates have decreased annually in the range of 0.2 to 1.6%. This is due to a decrease in the primary incidence of mental disorders since 2005. The reason for this trend is currently being studied.”— Boris Kazakovtsev. For 16 years he was the chief psychiatrist of the Ministry of Health

Among mental disorders, a quarter, 1.1 million people, suffer from psychosis and dementia (of which over 500 thousand people have schizophrenia), another quarter of patients (900 thousand) have a diagnosis of " mental retardation“, and 2 million people have non-psychotic, “non-violent” disorders.

Dynamics of distribution of mental disorders (number of patients in absolute numbers)

• “4 million people are those who applied. But in fact, according to some data, including foreign ones, we have about 14 million mentally ill people, this includes both mild mental and drug addiction disorders. When the disorder is severe, it has to be one way or another address differently"

Inquiries about mental health by third parties (except courts, investigators and medical institutions) are prohibited - otherwise a violation medical confidentiality, says Tatyana Klimenko, director of the Research Institute of Narcology, ex-assistant to the Minister of Health. She pointed out that mental health certificates are issued by mental health centers to the citizens themselves, and employers can only require such certificates from representatives of professions from Order 302-N of the Ministry of Health (teachers, educators, doctors, elevator operators, crane operators, submariners, miners, catering, transport sector, security guards , rescuers, etc.).

The number of Russians registered with dispensaries, as follows from the Rosstat collection “Healthcare in Russia - 2015” (published once every two years), is now about 1.5 million people.

What affects mental health the most? The rating of the most mentally healthy regions partly coincides with the rating of sobriety:

• “Very many mentally ill people have problems with alcohol and drugs, and many who use alcohol and drugs, naturally, often have mental problems. In general, many researchers believe that problems with alcohol and drugs are mainly secondary and are a consequence of some kind of mental disorders. This is not necessarily schizophrenia, it can be psychopathy or other forms. After all, everyone drinks, but not everyone develops alcoholism. Of course, the psychological and biological characteristics of the body are influenced by the social background. Stressful situations aggravate the pathology, so the more social problems, the more previously hidden mental disorders appear, including those due to alcohol and drug use. And so the circle closes"— Tatiana Klimenko

Every person suffers from a mental disorder at least once in their life. Recently, a schizophrenic was arrested in Moscow for killing and eating his drinking buddy. A few days earlier, another man had been running around a gas station with a knife at night, stabbing everyone he met. Psychiatrists admit: it is possible to prevent exacerbations in mentally ill people only with the help of relatives, and those living alone end up with doctors after they have done something wrong, writes “Criminal Ukraine”.

Doctors also claim that at least a quarter of the population suffers from mental illness throughout their lives, but most patients do not consult a psychiatrist even if they have obvious symptoms.

...Parts of the body of Ilya Egorov, who was killed and dismembered by Nikolai Shadrin, who was registered with a psychiatrist, were collected in different areas capital all last week. Finally, last Saturday, a head was found in Filevsky Park, and Shadrin himself was detained in his apartment while he was preparing Yegorov’s liver for dinner. The lawyer tried to attribute the cannibal's actions to his illness, but the court arrested Shadrin for two months. The judge did not take into account either the cannibal’s statement that “people” were to blame for what he had committed (the accused did not explain which ones), nor his memory disorder: Shadrin could not say what he had already been convicted of.

The crime could have been prevented if Shadrin, who suffered from schizophrenia, had been admitted to the hospital without waiting for an exacerbation. However, in modern Russian conditions this is impossible, explains Lyubov Vinogradova, executive director of the Independent Psychiatric Association: in order to be admitted to a hospital, a person must “commit some action - physical aggression, running around with an ax.” Other citizens can only hope that they will not find themselves in the wrong place at the wrong time. What happened to workers at a gas station on Butyrskaya Street in Moscow. On the night of May 11, a bald, two-meter man with a knife came there, killed two and seriously wounded two more gas station workers, and (this was filmed by surveillance cameras) calmly left without stealing anything.

There are 1.67 million people registered with psychiatric patients in Russia. These are those who have been diagnosed with mental illness. Another 2.16 million people are listed as applying for advisory assistance": it's formal healthy people who, nevertheless, are forced to go to a psychiatrist. According to the World Health Organization (WHO), the situation is much worse: at least 10% of Russians (14–15 million people) suffer from mental disorders. The most common disorder is depression, the symptoms of which are persistent sadness and loss of interest in everything.

WHO experts say that depression is one of the leading causes of disability and main reason suicides, of which Russia is all last years is among the leaders (27 per 100 thousand population per year versus 4–5 in Western Europe). About 20% of Russian adolescents aged 14 to 19 years have mental disorders, and over a million older Russians suffer from various forms senile dementia.

According to WHO estimates, there are about 900 thousand patients with schizophrenia in Russia; another 250–300 thousand are characterized by “ manic state" - uncontrollable excitement. Obsessions (when a person becomes fixated on a thought or action), phobias (fear of something, such as heights, enclosed spaces) and pathological attractions (satisfying sexual needs in a perverted way, such as pedophilia) are also common.

According to WHO forecasts, at least a quarter of adults will experience some kind of mental disorder at least once during their lifetime.

WHO experts confirm: 35–45% of cases of absenteeism are associated with manifestations of mental disorders. At the same time, there are widespread myths in society that “persons with mental problems violent, dangerous, poor, stupid and incurable." According to WHO, up to 70% of Russians suffering from mental disorders do not receive help or treatment, and neuroses and psychoses are the cause of at least 20% of premature deaths in the country.

According to the World Health Organization, there are now about 450 million people in the world with mental disorders and disabilities. According to experts, the number of people suffering from dementia will grow at an unprecedented rate in the coming years.

According to forecasts, over 35 million people will need medical help next year due to the development of degenerative brain diseases. And this number is expected to double every 20 years. Therefore, by 2030 the number of such patients could reach 65.7 million, and in 2050 - 115.4 million people.

Only a small proportion of this mass of people will receive the necessary treatment.

The problem of rising mental illness in the coming years will be most acute in low- and middle-income countries. This can be explained by the lack of qualified medical personnel and specialized clinics.

“Bagnet” decided to check how true the world statistics are for Ukraine and whether the number of mental patients is growing in our country.

In the main psychoneurological clinic of the country - the capital's hospital named after. Pavlova - they said that in Ukraine the number of mentally ill people is already for a long time remains at the same level. This is approximately 1 million 200 thousand people.

“Surprisingly, since the onset of the global crisis, 5-7% fewer patients are admitted to inpatient departments for treatment than in previous years. Although it would seem, according to logic, everything should be the other way around. We expect that in the future fewer and fewer people will be treated in hospitals. And the majority of patients with mental disorders live and will live in the “ordinary world.” This contributes to their speedy recovery,” Mikhail Ignatov, deputy head physician of the Kyiv City Psychoneurological Hospital No. 1, explained to Bagnet.

According to him, official WHO data on the number of mentally ill people living on the planet are underestimated.

“In fact, the number of people who suffer from one or another mental disorder is 10% of the entire world population. This is much more than official data. It’s just that many chronically ill people are unaware of their illnesses, do not want to be treated, etc.,” Ignatov believes.

Workers at regional mental hospitals were reluctant to make contact. For example, in the Kharkov and Zhytomyr regional clinical psychiatric hospitals, a Bagnet correspondent was told that it is not their practice to give comments and interviews to the press.

The Transcarpathian regional mental hospital confirmed Ignatov’s information - the number of patients remains at a “stable” level. Every year, about 3 thousand patients are admitted to the local hospital for treatment. In general, about 33 thousand citizens suffering from mental disorders are permanently registered.

Head physician of the Crimean Republican Clinical psychiatric hospital No. 1 Mikhail Yuryev said that the number of patients in Crimea is “usual” and that he has not heard anything about an increase in the number of crazy people.

Mr. Yuriev responded to all further clarifying questions with awkward arguments about Honduras, which was apparently close to him due to his profession.

The “interview” had to be stopped.