Taking care of your mental health is challenging wherever you are, but living abroad can add an extra dimension to any existing problems. We’re going to take a look at how to best safeguard your mental health in Estonia.As an expat, if you are covered by the national health insurance scheme you will be entitled to the same medical care as Estonian citizens, including some mental health treatment, or you may choose for extra peace of mind to take out private health insurance with cover for mental health issues.
Mental health care in Estonia
Underfunding has seen a decline in in-patient care and a corresponding rise in outpatient care for mental health issues. Independent organisations such as the Tallin Mental Health Centre and the Estonian Association of Psychosocial Rehabilitation provide and develop other mental health services, sometimes at regional level, but there is generally considered to be a shortage of mental health professionals in the country. Preventative care – for example, programmes regarding awareness of suicide – is not extensive in Estonia.
Mental health legislation in Estonia consists of the Psychiatric Care Act (Psühhiaatrilise abi seadus, 1997) regulating psychiatric care in Estonia. Compulsory psychiatric treatment is issued by the courts according to the Penal Code and administered in psychiatric hospitals.
The Social Care Act (Sotsiaalhoolekandeseadus, 1995) addresses social care services and provides specialised services for people with special needs, including mental health problems. However, the raising of awareness of mental health issues, including attention to early identification of symptoms of depression and the availability of high-quality services, are listed for government action.
25% of Estonian psychiatric patients are admitted to inpatient psychiatric institutions with severe disorders such as schizophrenia, or for psychosis caused by substance abuse.
Mental health care under public health insurance
Mental health issues are funded under the Haigekassa/EHIF, which covers most forms of psychiatric treatment, with a few exceptions. Forensic psychiatry, prison psychiatry and certain types of dependency treatment therapy are not covered.
Prescription medication also comes under EHIF’s remit; the system operates on a co-pay basis so you will have to pay for some of your medication yourself, but some psychiatric medication is fully reimbursed by the national scheme.
If you are worried about your mental health, your first port of call will be your GP, who may be able to give you treatment for less major mental health problems, otherwise they may refer you to a psychiatric clinic or hospital. Psychiatric out-patient care is centralised within regional centres, while acute psychiatric in-patient care is available in some of the central hospitals.
Public treatment centres include the Tallinn Mental Health Centre, the Estonian Association of Psychosocial Rehabilitation, and the Foundation Mental Health Care Centre of Tartu. Tallinn Mental Health Centre is partnered with the Estonian Psychosocial Rehabilitation Association (EPRA), who are currently seeking to increase adult mental health provision in Tallinn and improve the availability of rehabilitation services.
The Children’s Mental Health Centre in Tallinn will treat children suffering from a range of disorders – such as depression, anxiety, eating disorders, alcohol and drug abuse – if they are registered with EHIF. They have educational facilities on site, so that patients’ schooling is not suspended, and they have English-speaking staff and experience in representing British nationals. The North Estonia Medical Centre (Põhja-Eesti Regionaalhaigla) has a psychiatric clinic and also says that it has English-speaking staff. Aside from these, you may have difficulty finding English-speaking medical personnel in Estonia.
Tartu University Hospital has an eating disorders clinic and a sleep disorders study clinic.
For clinical psychology, your initial consultation will be around €70. However, you can claim some of this back under your state health insurance if you have been referred by your GP.
You may also choose to take out private health insurance, in which case there are a number of private clinics specializing in psychiatric disorders throughout Estonia.
As a rough guide, your first hour-long consultation with a psychiatrist will be in the region of €120. Subsequent 30-minute consultations will be €70.
If you feel that your condition is not severe, you may also make an appointment with a mental health nurse; this will cost you €30 and the nurse will be able to advise you on taking any issues forward with a trained psychiatrist or psychologist. Addiction counseling can be found in the private sector at around €40 for an hour-long appointment.
Some clinics offer appointments with a medical psychologist, focusing on patients who have chronic illnesses and whose mental health is being impacted as a result.
You may also have your mental health evaluated and certified in the private sector; for example, if you are applying for a gun license. This costs between €70-120.
If your mental health is reasonably robust, but you’d like to keep it that way, then you will find a number of alternative treatment centres in Estonia where you can access therapies such as massage and acupuncture. Making sure that you’re eating reasonably healthily, avoiding too much alcohol, and getting enough exercise can also contribute to your mental health.
Putting strategies in place to ensure that, as an expat, you are in a supportive environment and, if necessary, in ready contact with family and friends is also important. Isolation and stress can cause your mental health to plummet and keeping in touch with your loved ones is vital. Estonia has some beautiful countryside and keeping in contact with the natural world is also recommended to maintain your mental stability at maximum.
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