Challenges in the Provision of Forensic Services in the Baltic States

Baltic states’ forensic psychiatric systems acquired their structure during the Soviet occupation period as a predominantly restrictive system. During that time, forensic mental health patients from all three Baltic republics were detained at Tsherniachovsk town (formerly East Prussia, since World War II—Russia) hospital with the highest security level. General psychiatry and particularly forensic psychiatry were developing in accordance with the biomedical model and were used for the control of political dissidents. New radical changes towards European standards in forensic psychiatry started after independence of the Baltic countries since the beginning of the 1990s. With no history of multidisciplinary teamwork in mental health, psychiatrists are still dominating the field, and other professionals have very limited roles in evaluation and care. During the last decade, slight changes towards multidisciplinary team development could be observed, and care for forensic patients is getting more comprehensive, not just based on biological methods but on biopsychosocial approaches as well. However, some important elements are still missing (e.g. supported housing and assertive community treatment teams). The ongoing process of improvement of forensic care requires not only infrastructure changes from institutional to community care but also changes in the implementation of human rights principles in society. Stigma, lack of realistic policies on how to improve mental health systems and structures towards modern community care with respect of human rights and lack of financial and human resources are the biggest challenges in Baltic countries.