“To remain mentally healthy, one must be a tolerant person. The number of people suffering from mental disorders has increased in Russia The incidence of mental disorders in the world

Life drew a map of Russia's insanity. In this rating, Moscow was in fifth place from the bottom - among the most mentally healthy regions. The capital was bypassed only by the Caucasian republics.

The Ministry of Health and the main psychiatric institute of the country - the Research Center for Psychiatry and Narcology. V.P. Serbian - provided Life with statistics on the mental health of Russians. The latest available data is the results of 2015, the results of 2016 will be summed up this spring, but the leading regions hardly change from year to year. We are talking about Russians who applied for psychiatric help and, according to 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 registration was for life and the psychiatric status of 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 (as well as inpatient treatment in hospitals).

Mental health is worse in remote regions: Altai, Chukotka, YNAO, as well as in the Perm and Krasnoyarsk Territories. In the European part of Russia, Tver and Ivanovo regions stand out with a minus sign, "harsh" Chelyabinsk residents are in seventh place.

The Caucasian regions turned out to be the leaders in mental health, and Moscow (the leader in the absolute number of the mentally ill, 212 thousand) took an honorable fifth place from the bottom, next to another city of federal significance - Sevastopol. Petersburg was in the middle of the list with a score of 2,618 mentally ill per 100,000 people. Rating with the position of each region - at the end of the note.

Russia Madness Map

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

The overall number of lunatics peaked 10 years ago. Then 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 it was 4.04 million people.

In previous years, starting from 2006, the overall incidence rates decreased annually in the range from 0.2 to 1.6%. This is due to a decrease since 2005 in the primary incidence of mental disorders. The reason for this dynamic 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 - disorders of a non-psychotic nature, "nonviolent".

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, including both mild mental disorders and drug addiction. When the disorder is severe, you have to deal with it one way or another.

Boris Kazakovtsev

Inquiries about mental health by outside organizations (except for courts, investigators and medical institutions) are prohibited - otherwise a violation of medical confidentiality, says Tatiana Klimenko, director of the Narcology Research Institute, ex-assistant to the Minister of Health. She pointed out that mental health certificates are issued by mental health clinics to 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, security guards rescuers, etc.).

The number of Russians on dispensary registration, as follows from the collection of Rosstat "Health in Russia - 2015" (published once every two years), is now about 1.5 million people.

What affects mental health the most? In part, the rating of the most mentally healthy regions coincides with the sobriety rating:

A lot of mentally ill people have problems with alcohol and drugs, and many who use alcohol and drugs, of course, often have mental problems. In general, many researchers believe that problems with alcohol and drugs are mostly secondary and are the result of some kind of mental disorder. This is not necessarily schizophrenia, it can be psychopathy or other forms. After all, everyone drinks, but not everyone develops alcoholism. Of course, a social background is superimposed on the psychological and biological characteristics of the organism. Stressful situations exacerbate the pathology, so the more social problems, the more previously hidden mental disorders manifest themselves, including those due to the use of alcohol and drugs. And so the circle closes

Tatiana Klimenko

The rise in the number of mentally ill people worries doctors around the world. By 2020, according to the World Health Organization (WHO), mental disorders will be among the top five diseases leading to disability.

However, in Russia the situation is aggravated by the difficult internal situation. Poverty, alcoholism and constant stress at work make the psyche of our compatriots much more vulnerable than those of Westerners.

Experts note that compared to the 1990s, the number of clients in psychiatric clinics in Russia has almost doubled. The number of people suffering from serious mental illnesses such as schizophrenia, manic-depressive psychosis and epilepsy has increased. And neurotic disorders and depression have acquired the status of mass. They have already taken an “honorable” second place after cardiovascular diseases.

According to psychotherapist Alexander Poleev, the number of people suffering from this disease in the world is increasing by 0.1% annually. And this is a lot on a global scale. In Russia, the situation is even worse. “Now 15–20% of the world's population needs the help of psychiatrists and psychotherapists,” Lyubov Vinogradova, executive director of the Independent Psychiatric Association of Russia, told Novye Izvestia. – In Russia, this figure reaches 20-25%.

Oh times, oh manners!

For society, this trend is extremely disappointing. The growth of psychological disorders is directly related to the increase in the number of disabled people and people unable to work. At the same time, psychiatrists note that it will not be possible to stop this dynamic in the coming years. The reason lies in the difficult socio-political situation in the country.

“The problem of mental illness has a tangible historical basis,” Valentina Fedotova, head of the social philosophy sector at the Institute of Philosophy of the Russian Academy of Sciences, told NI. – Russia has experienced a global post-communist trauma, a change of consciousness, a change in social relations. And so far the population has not adapted to the rhythm of life in which we live. In our country, the situation is aggravated by such factors as alcoholism, drug addiction, food poisoning, mass poverty, and lack of work that have already become traditional. Russians are also characterized by a lack of confidence in the future. All this together leads to a loosening of the psyche.

A tense situation in society is also created by the constantly cultivated image of the enemy. Russians are beginning to see enemies everywhere: among people from the Caucasus and Asia, visitors from other regions. “The fact is that many mentally ill people find themselves in politics or become leaders of extremist organizations,” Mr. Poleev told NI. – Including they begin to cultivate the image of the enemy. They are joined by healthy people who are simply infected with these ideas.”

Mass neuroticism is also associated with more frequent catastrophes and terrorist attacks. “For example, I have noticeably increased the number of patients with a fear of closed spaces,” Mr. Poleev told NI. – Now every eighth Muscovite is afraid to go down the subway, and every twelfth is afraid to use the elevator. These fears are directly related to terrorist attacks. So, in the summer of 2006, queues lined up for psychiatrists, although the peak of exacerbations traditionally falls on autumn-spring. It turned out that during this period there were two big plane crashes - near Irkutsk and near Donetsk. Accidents where many people die, and terrorist attacks always lead to an exacerbation of mental disorders.”

Proteins in the wheel

In addition to objectively historical, there are more global reasons for the growth of mental disorders. In 10–15 years, as many discoveries are made in the world as were previously made in centuries. This puts a huge strain on the human psyche. The dynamic rhythm of life, responsibility and the need to learn a lot of information directly provoke mental disorders.

“Today, the number of patients is increasing primarily due to the uneven rhythm of life,” psychiatrist Dmitry Danilin told NI. “Sometimes it’s called the “manager’s syndrome.” In our world, everything is arranged incorrectly from the point of view that something can be achieved only through efforts that are detrimental to health. Most often, patients come to me with various depressive disorders. Many are “killed” in this regard by work.

The ever-accelerating rhythm of life, the pursuit of a long ruble, oddly enough, affects children most of all. “The most vulnerable from this point of view are children under five years old,” Vladislav Kotlyarov, a teacher at the Higher School of Psychoanalysis and Psychotechnologies, told NI. - There are statistics showing that 70-80% of babies in Russia are born with mental illness of a different nature. Later, they develop as a result of the unfavorable environment in which children grow up and are brought up. Women very quickly begin to work and send their babies to kindergartens or leave them in the care of nannies. For a child, this is an unconditional stress, because at preschool age he especially needs the care of his parents. As a result, fears, phobias, fear of loneliness appear. It's a really terrible problem."

Where are you, Dr. Freud?

The situation is aggravated by the lack of the necessary number of qualified psychiatrists. “The Soviet psychological school collapsed, and a new one has not yet been created,” Yulia Zotova, a psychologist at the Research Institute of Social Psychology and Psychology of Personality Development, explained to NI. - It turns out that there are simply not enough specialists. In Russia, life is changing at a revolutionary pace, and the population does not have the resources to adapt. The number of diseases is growing, and the number of doctors and psychologists is decreasing. Since the trend continues, and the situation at the state level does not change, the future of Russia in terms of public health is very doubtful.”

Paradoxically, but the achievements of psychiatry to some extent turned against humanity. “A few decades ago, people with serious psychiatric illnesses did not have the opportunity to start a family and give birth to children,” Mr. Poleev told NI. - These diseases go away with constant attacks of exacerbations. Now, with the invention of new drugs, we can keep a person in a fairly adequate condition. Therefore, people with incurable mental illness can now work and start a family. But such serious diseases as schizophrenia are transmitted only by inheritance. Accordingly, we ourselves provoke an increase in the number of sick people.”

exit from the labyrinth

If it is almost impossible to prevent the spread of psychiatric diseases, it remains only to deal with the consequences. So, in early January, the director of the State Scientific Center for Social and Forensic Psychiatry named after V.I. Serbian Tatyana Dmitrieva suggested creating a psychotherapist's office in each clinic. Such measures will help to recognize the disease in the early stages and, as they say, "do not start it."

“It is even better to teach general practitioners to recognize the nature of the disease,” Lyubov Vinogradova, executive director of the Independent Psychiatric Association, told NI. - The patient should be referred to a psychotherapist as gently and carefully as possible. The threat of psychological help still frightens many Russians. The stereotype is still strong that a person will be “healed to death” there.

While in large cities even top managers do not hesitate to undergo treatment in a psychiatric hospital, in the regions far from everyone will decide to make an appointment with a psychotherapist. Ms. Vinogradova believes that, along with the development of the psychiatric care system, it is necessary to develop serious programs to educate the population. People should not be ashamed to go to a psychiatrist.

The largest percentage of mental disorders of various kinds, ranging from anxiety-depressive conditions to severe forms of schizophrenia, occurs in the most developed countries of the world. First of all, these are European states.

According to WHO official data in 2006, for example, out of 870 million citizens living in Europe, they suffered from such 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 disorder - 4 million.

Mental disorders are the second most common after cardiovascular diseases. This is a huge number of disabled citizens who need constant or periodic medical supervision. Mental disorders also account for 40% of all chronic diseases in general.

The situation with ailments that lead to suicidal attempts (severe depression, etc.) is depressing. Nine of the top 10 suicide countries are in Europe. According to WHO, 150,000 people voluntarily die every year. Moreover, these are mostly young men aged 15-35 (80% of those whose suicide attempt ended in death).

The reasons for such indicators

The main reason for such a high prevalence of mental illness in developed and a priori more prosperous powers is urbanization. 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 increase in the number of women who work hard. Due to the fact that women work during pregnancy (sometimes not in the most favorable conditions), the number of intrauterine fetal injuries is constantly increasing. This greatly affects the mental abilities of children, as it is the cause of all kinds of anomalies in the development of the brain.

The third reason is the aging of the population. Due to the high standard of living and excellent medicine, life expectancy in Europe is one of the highest. At the same time, young people are in no hurry to acquire offspring, preferring to make a career and earn money. European families have 1-2 babies; more is much less. 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 last "cause" of the high level of mental disorders in Europe is their timely diagnosis and control. Regular screening of the population simply makes it possible to detect cases of these diseases more often. In less developed countries, diagnosis is at a much lower level, so it cannot be unequivocally stated that the population there is healthier. It is simply underexplored.

The mentally ill will again be treated without their consent - as was done before, in the USSR. Recently, State Duma deputies in the third reading approved a bill allowing compulsory psychiatric examination of citizens with their subsequent hospitalization in special medical facilities. The problem is really acute, and it had to be solved somehow: in the past few years, the number of Russians who experience clouding of their mind from time to time has grown at a rapid pace - by 12-15% per year. But the whole trouble is that legislators, solving one problem, created another from scratch.

According to the formula proposed by the deputies, in order to put the patient in a psychiatric hospital, a decision of the court of first instance will be enough. What this can turn into in practice is not difficult to guess: potential applicants for rich inheritances will begin mass prosecution of their wealthy relatives. Here, even a healthy person will not go crazy for long. And in order to prove that everything is in order with the head of the victim of the care of relatives, you will have to go through an unpleasant and, in general, humiliating procedure of hospitalization in the “yellow house”. What would the adoption of such an ambiguous law lead to and how justified was its appearance at all, the correspondent of Our Version figured out.

A manufacturer in his prime lost everything overnight

But first, a story. Very soon similar stories will be very, very much. So, the famous throughout the country "locomotive manufacturer", Major General Sergei Maltsov was one of the most influential industrialists of the Russian Empire. Hundreds of thousands of workers worked in the so-called Maltsovsky factory district, located on the lands of the Kaluga, Oryol and Smolensk provinces. Maltsov had his own police, his own railway, and even his own money - Maltsov. The factory owner's workers lived better than under communism: they were provided with their own three-room apartments free of charge and treated free of charge in Maltsov's hospitals. The children of the workers attended free gymnasiums. In general, in the 60s and 70s of the century before last, Maltsov, one might say, almost built his own small welfare state within the state. Relatives of the manufacturer's methods did not share, but they still did not dare to go against Maltsov, known for his tough temper. Until in 1874, the industrialist concluded an agreement with the Department of Railways for the manufacture of 150 steam locomotives and 3 thousand wagons within six years. Maltsov swelled about 2 million rubles into the business - by today's standards, this is 1.6 billion (800 current rubles are equal to one ruble in 1874). He built workshops, ordered equipment from Europe, invited craftsmen from France. And the railway department suddenly took and canceled its order - without explaining the reasons. Meanwhile, in the warehouses of Maltsov, finished products worth one and a half million rubles accumulated. The industrialist mortgaged his estates. And it was then that Maltsov's wife and children declared him crazy. Fabrikant was declared incompetent in the court of first instance and deprived of all rights to his own enterprises. The decisive factor for the judges was the fact that Maltsov created too good working conditions for his workers. In their opinion, a mentally healthy person could not act as Maltsov did. And a completely healthy entrepreneur in the prime of his life suddenly lost everything. Admit it in good faith: do you believe that modern judges will not adopt a similar logic when making court decisions, on the basis of which people will be forcibly hospitalized?

Official statistics underestimate the number of mentally ill by four to five times

Meanwhile, there are really too many crazy people in our country, and a number of doctors agree that Russian official statistics are significantly underestimated. About 15 years ago, Russia switched to the classification of diseases according to the so-called ICD-10 scheme, used in countries that are members of the World Health Organization (WHO). In this classification, the term "sluggish schizophrenia" is absent in principle, and thus all patients with this form of mental disorder are automatically recognized as healthy. But in the days of the USSR, it was precisely patients with a sluggish form of schizophrenia that formed the basis of the hospital contingent of all Soviet special clinics - up to 80% of patients.

But even if the official statistics are underestimated, as experts suggest, by four to five times, they are still impressive. A year ago, "Rossiyskaya Gazeta" published the following data: 3.7 million mentally ill people were taken on a pencil in the country. Of these, 36 thousand people are annually recognized as disabled. Every fourth Russian suffers from mental disorders in various forms, and mental disorders are a direct path not only to alcoholism and drug addiction, but also to suicide. One third of those who are on psychiatric records are those "who have been diagnosed with mental illness." That is, unequivocally sick people, the diagnoses of which the specialists do not raise any doubts. Another 2.2 million are those who regularly seek "advisory help." It seems that they are not mentally ill, but for some reason they are still prescribed to visit a psychiatrist. As for the WHO data, they are even more shocking. At least 10% of citizens in our country suffer from mental disorders, according to experts from this respected organization. This is 14-15 million people. And among them every fifth Russian teenager.

As for classical schizophrenics, according to the WHO, there are about 900,000 of them in Russia. Another 300 thousand are those whose condition doctors call "manic", patients with "uncontrollable excitement." As for the exact data on patients with other types of mental disorders - obsessions, phobias or pathological inclinations - they are not voiced by WHO specialists for some reason. They are voiced by experts from public organizations - from 5 to 7 million people suffer from such disorders.

We treat diseases - we cripple destinies

Neurosis and psychosis are the causes of every fifth premature death. And the most common mental disorder is known to many depression. Prolonged despondency and loss of interest in the outside world. It would seem that this is not a disease yet - just think, just a blues! But experts are convinced of the opposite: it is depression that is one of the key causes of disability and the main cause of suicide. By the way, today our country is the leader in the number of suicides in the Old World - 27 cases per 100 thousand people, with 5 cases in the EU countries. But the worst thing is that, according to WHO statistics, about 70% of Russians suffering from mental disorders avoid treatment.

This sad, suddenly revealed circumstance was the reason for last year's demarche of the Speaker of the Federation Council Valentina Matviyenko. It was she who initiated the adoption of a set of measures to urgently prevent the further spread of mental disorders and the adaptation of Russians affected by them. “Because of their illness, these people face misunderstanding and prejudice,” says Valentina Matvienko. “These problems have not yet been given due public and state attention.” And the deputies decided that it was time to pay this attention.

In April of this year, at the suggestion of lawmakers from the hinterland, the Constitutional Court considered the possibility of compulsory treatment of mentally ill citizens. The reason for the consideration was complaints from Krasnoyarsk and Kurgan, in which the victims of crimes were outraged by the inaction of the police, judges and doctors. And the court issued a verdict: compulsory treatment is permissible. It is only a matter of appropriate legislative initiative. The first reading of the bill on compulsory treatment took place at the same time, in April. But the haste played a cruel joke on the deputies - the bill they proposed turned out to be too crude. “One of the main problems is the violation of the rights of patients when they are recognized as incapacitated,” explained State Duma deputy Valery Seleznev. – Often this is done by relatives in order to take possession of the property of a sick person. And in order to protect patients from the claims of such relatives, the concept of “degree of incapacity” should be introduced into the law. And also to provide an opportunity for patients to confirm this diagnosis at least once every three years. Now a person is recognized as incapacitated once and for life, which gives a green light to various scammers.

There is no one to treat the sick - there are not enough psychiatrists

Perhaps now the bill adopted by the deputies will be finalized in the upper house of parliament - they say that Valentina Matvienko personally oversees this issue, so it cannot be ruled out that the future law will still thoroughly prescribe the duties of the patient and the rights of his relatives. In order to exclude, if possible, cases of fraud and judicial arbitrariness. Let's hope so, but for now let's talk about another equally pressing problem.

The fact is that, according to preliminary data, with the adoption of the law on involuntary hospitalization, the number of calls to hospitals will increase at least three to four times. But it is unlikely that medical institutions will be ready to face such an influx of patients. Judge for yourself: today in our country there are 145 psychiatric dispensaries, 123 dispensary departments of hospitals, 2 thousand dispensary departments at the Central District Hospital, 144 narcological dispensaries and 257 psychiatric hospitals. This is approximately 300-350 thousand beds. Even today, only one in four patients can undergo a course of hospitalization. And imagine what can begin with the adoption of a new law?

Doctors are already admitting that they are not ready for the influx of patients. Not only are there not enough hospital beds, there are not enough specialists. To date, about 16 thousand specialists work in the field of psychiatric and narcological care, including about 4.5 thousand psychotherapists, 5.5 thousand narcologists and 1500 social workers. Psychiatrists for all - no more than 5 thousand! All over Russia! Two years ago, Tatyana Golikova, who headed the Ministry of Health and Social Development, warned that Russian special medical institutions were staffed by about 65-70% of psychiatrists. And today the shortage of psychiatrists tends to 40-45%.

Expert Opinions

Mikhail VINOGRADOV, Russian forensic psychiatrist, professor, doctor of medical sciences, former head of the Center for Special Studies of the Ministry of Internal Affairs:

– I was one of those who insisted on the return of the old Soviet norm. At the same time, it is completely clear to me that it is still not worth returning the Soviet norm in its previous form, it needs to be adapted to today's realities. Medicine has come a long way. But the Soviet law should be taken as a basis in any case - along with the norms that made it possible to forcibly hospitalize and treat patients. Today, it must be admitted, doctors do not have the tools for involuntary hospitalization. And they should be.

And one more thing - I am still against the fact that the final decision is not for the psychiatrist, but for the judge. The patient can be quiet, not violent or yelling that he is going to kill someone. He can talk, say, about the end of the world, but the psychiatrist will understand that this person is a real danger to society. And the court may not understand this.

Sergei ENIKOLOPOV,Candidate of Psychological Sciences, Head of the Department of Medical Psychology of the Scientific Center mental health RAMS:

- Deputies are going to push through the law, which leaves a huge field for all sorts of abuses. This law will untie the hands of unscrupulous relatives, bosses, people with connections. Any person can, if desired, be declared mentally ill and treated. It would be another matter if, in addition to the returning Soviet norm, doctors would be criminally liable for making an incorrect diagnosis and sending them to compulsory treatment. Then I would see in this proposal at least some sense. The doctor would then tremble a little. Otherwise, what guarantees do we, the townsfolk, have that we will not be treated forcibly when this is not required? In addition, a huge number of patients will have a fear of turning to psychiatrists, the return of Soviet norms will only spur it on.

As for the exact statistics of the mentally ill, I can say with confidence: there are no exact statistics in this area. Since the times of the USSR, people have not advertised their mental troubles. A huge number of people are not treated by specialists, resorting to the help of healers and fortune-tellers. The most common disease in Russia and the world is depression. Russia, especially its northern part, is located in the "depressive zone". In autumn it is cloudy, it rains, in winter it gets dark early on the street. Therefore, there is a high level of suicide, alcoholism. All these are different consequences of depression. And our people are not accustomed to turning to specialists.

DISEASE HISTORY

In the Russian Empire, there was a rule according to which a court could insist on the compulsory treatment of a patient. Actually, today the deputies of the State Duma are trying to return this norm. For a long time, there was no talk at all about the compulsory treatment of persons with mental illnesses in Soviet legislation. Evil tongues claim that if such a norm existed, more than half of the Soviet leadership of that time could end up in psychiatric hospitals. The definition that lunatics must be treated forcibly first appeared in the legislation of the USSR only in 1926. Since criminal liability was not applied to people with mental disorders at that time, as a “measure of social protection of a medical nature”, it was proposed to isolate patients forcibly in hospital wards, and not in prison cells.

It is curious that the decision on sanity or insanity was also made by the court, and not at all by medical specialists. And the judge did it, of course, by eye. After all, he did not have any special knowledge in the field of psychiatry. And the judges began to conduct a forensic psychiatric examination with the participation of doctors only in 1935.

Fundamental changes took place only in 1961, with the advent of the new Criminal Code of the RSFSR. Compulsory treatment began to be applied to those who committed "socially dangerous acts, representing a special danger to society." The list of these acts included anti-Soviet agitation and propaganda, dissemination of fabrications discrediting the Soviet state and social system, desecration of the National Anthem or flag, organization and participation in riots. The decision on hospitalization was made by a commission of three psychiatrists. The consent of relatives and guardians for hospitalization of the patient was not required.

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

The Ministry of Health and the main psychiatric institute of the country - the Research Center for Psychiatry and Narcology. V.P. Serbian - provided statistics on the mental health of Russians. The latest available data is the results of 2015, the results of 2016 will be summed up this spring, but the leading regions hardly change from year to year. We are talking about Russians who applied for psychiatric help and, following 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 for life and the psychiatric status of 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 (as well as inpatient treatment in hospitals).

Mental health is worse in remote regions: Altai, Chukotka, YNAO, as well as in the Perm and Krasnoyarsk Territories. In the European part of Russia, Tver and Ivanovo regions stand out with a minus sign, "harsh" Chelyabinsk residents are in seventh place.

The Caucasian regions turned out to be the leaders in mental health, and Moscow (the leader in the absolute number of the mentally ill, 212 thousand) took an honorable fifth place from the bottom, next to another city of federal significance - Sevastopol. Petersburg was in the middle of the list with a score of 2,618 mentally ill per 100,000 people. The rating with the position of each region is at the end of the note.

Russia Madness Map

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 illness is 3-4 times lower than in central Russia and in the north." Because in the south it is not customary to go to a psychiatrist: shame on the whole village? No, Kazakovtsev answers: "A similar trend can be traced not only in psychiatry, but also in many indicators of the health of southerners."

The overall number of lunatics peaked 10 years ago. Then 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 it was 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 since 2005 in the primary incidence of mental disorders. The reason for this trend is currently being studied"— Boris Kazakovtsev. For 16 years he was the chief psychiatrist of the Ministry of Health

Dynamics of the 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 disorders. When the disorder is severe, one has to either handle otherwise"

The number of Russians on dispensary records, as follows from the collection of Rosstat "Health in Russia - 2015" (published once every two years), is now about 1.5 million people.

What affects mental health the most? In part, the rating of the most mentally healthy regions coincides with the sobriety rating:

• "A lot of mentally ill people have problems with alcohol and drugs, and many people who use alcohol and drugs, of course, often have mental problems. In general, many researchers believe that problems with alcohol and drugs are mostly secondary and are the result of some 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, a social background is superimposed on the psychological and biological characteristics of the body. Stressful situations exacerbate the pathology, so the more social problems, the more previously hidden mental disorders appear - including due to the use of alcohol and drugs. And so the circle closes"— Tatiana Klimenko