The definition of normality is undoubtedly value laden; the issue of culture must be addressed, not only in the treatment process, but in evaluation and diagnosis as well.
Embedded in one's culture are beliefs and attitudes regarding spirituality, family structure, gender roles, and health care, all of which affect relationships, the choice of activity, and the preferred environment. In addition, cultural values vary tremendously and must be taken into account when planning any aspect of intervention.
The effects of mental illness reach far and beyond the afflicted individual. They touch the family, friends, and caregivers as well. How the symptoms are managed depends on a great degree on the amount of information provided by the mental health professional. In addition, the cultural perspective will often dictate the level of shame and stigma that must be overcome and how treatment will be provided by the mental health system.
Russia acknowledges their need for development in terms of their mental health system's community-based programs due to the country's diverse regional contexts. Since 1997, a series of projects were undertaken by Community Rehabilitation and Disability Studies and Moscow Research Institute of Psychiatry are working hand in hand to facilitate the country's need for more community-based programs. Projects are being implemented in Central and South Russia and Siberia regions. The joint venture introduced the ideas and most outstanding performance of community mental health rehabilitation through specialized education and developing local pilot schemes, and assisted growth of parent and consumer support associations.
The mental health system in Russia is at a premature phase of modification from an institution-based to a community-based practice. The modification is being strengthened by two factors: a rising perception that community behavior and maintenance is much more pleasing than extensive hospitalization; and, the monetary obligation to augment the proportion of outpatients getting psychiatric care, in opposition to those who are hospitalized.
With a growing quantity of people with psychiatric illnesses, the demands upon the existing system of institutionalized care are at an all time elevation. About one fourth of all inpatients in Russia have been hospitalized for more than 12 months and this speed remains fairly steady. Among the patients who were hospitalized less than 12 months, the regular length of their infirmary stay go beyond 70 days per admittance, a very extended time in association with Western nations, with yearly readmission charges relatively high at roughly 23% (Moscow Research Institute of Psychiatry statistics).
Given the nonexistence of substitute community service models, there is no choice but to relocate a considerable fraction of long-term inpatients to specialized nursing homes for chronic mental patients, resulting in a course of 'transinstitutionalization' as a replacement for the more desirable 'deinstitutionalization'. An added problem is that existing federal health policies forbid transmittal of finances from institutional services to community alternatives, and no capital has been owed to the improvement of latest community services. Such strategies limit the potential for modification in the mental health system, and will have to be altered.
The reform is progressing in the context of very limited knowledge of effective means whereby community-based services might be