A Psychiatrist Told About The Failure Of The Belarusian Ministry Of Health

• 23.02.2026, 9:54

"Pretty words" in government programs do not guarantee anything.

The Ministry of Health has abdicated its responsibility by crossing out specific indicators on suicides, alcohol and drug use, write "White Coats".

Belarus formally continues the "five-year" approach to healthcare: one state program replaces another, goals are declared by beautiful words, and efficiency is measured by tables.

The state program "People's Health and Demographic Security" was in effect for 2021-2025. It had at least three clear numerical benchmarks directly related to mental health and addictions: a decrease in suicide deaths, a decrease in alcohol consumption, and an increase in the coverage of rehabilitation for people with substance dependence.

A new program, "Health of the Nation" for 2026-2030, was launched on January 1, 2026. There have been important changes, about which we should tell you.

The main intrigue: in the "table of evaluation criteria" of the effectiveness of the new program in the field of mental health, there is essentially only one measurable indicator left - the coverage of people with addiction to psychoactive substances by rehabilitation measures. We do not find indicators on suicides and alcohol consumption in the target indicators of the new program.

Why is it important not only for specialists, but for society in general? Because mental and substance use disorders in Europe are one of the main reasons for the loss of healthy years of life (i.e. it is the cause of life with limitations, when a person seems to be alive, but cannot study, work, build relationships or die prematurely). This is shown in the research materials of the Global Burden of Disease project in the European region.

In addition, people with severe mental disorders on average live 10-20 years less - not because the diagnosis "in itself" instantly kills, but because the stigma and poor access to conventional medical care lead to neglected hypertension, late diagnosis of cancer and other quite "mundane" causes of death. This is directly recorded by the WHO.

"White Coats" talked to psychiatrist Vladimir Pikirenya about how to measure the effectiveness of psychiatric care, why "beautiful words" in state programs do not guarantee anything, and how Belarus differs from its neighbors.

- How would we assess the situation with psychiatry in Belarus in recent years and how it was reflected in the plans and goals set by the state?

- If we assess the situation with psychiatry in one word, I would say so: badly. And if to unfold - different aspects of psychiatric care in Belarus are different.

Speaking about basic things: the possibility to get treatment for people with severe mental disorders, for example, schizophrenia or bipolar disorder - in general, help is available. I did an analysis: I compared the Belarusian lists of medicines with the WHO recommended list (basic minimum) and I can say that there is a correspondence.

But when we talk about mass disorders, which most of all "eat up" years of full life - depression and anxiety disorders - there the quality of assistance is poor in another sense: few people get help at all, and few people get it qualitatively. People have no support and no opportunity, for example, to buy the necessary drugs.

A separate issue is drug treatment. A huge disadvantage of all psychiatry and drug treatment in Belarus is the system of medical examination. By design, it was aimed at coverage and prevention: so that all those who fall into the risk group would receive basic examinations and treatment.

But because of the stigma of psychiatry and drug addiction, and, as a consequence, discrimination, including by the state, people get a big package of problems along with the opportunity to get free help.

That is why they try to go anywhere but to the state. Until it gets so bad that there is no choice.

- How is the state policy reflected in the goals that were declared? What has changed over the last decade?

- When setting goals, it is important to understand who sets them. It seems to be a "country", but programs are written by specific people - officials in the Ministry of Health and profile managers.

And the officials' logic is often the following: to set goals that can be achieved without doing anything. And even better - that they "achieve themselves". It is ideal to describe them in general words: "better", "more", "stronger", but without specific figures, so that you don't have to answer later.

- Is this a unique Belarusian practice?

- Belarus is not different from other countries in this sense. Officials are people everywhere. But in democratic countries there are additional levers: supranational structures and public opinion.

There are organizations that can insistently demand indicators - for example, the European Union through its documents and monitoring. There is the United Nations and its Sustainable Development Goals, where suicide mortality is a separate international indicator (SDG 3.4.2).

And there is WHO with its action plan on mental health until 2030, which also explicitly lists indicators and areas for reform.

- Tell us briefly about the "psychiatric" part of the program "People's Health". Why would it be of any interest to the average person?

- A more specific approach was in the program "People's Health and Demographic Security" for 2021-2025. It had three numerical indicators that directly addressed mental health and addictions.

Suicide mortality - the program had a goal of reducing it to 16.8 cases per 100,000 people.

Alcohol consumption per capita (15+) - the goal was to reduce it to 9.8 liters of absolute alcohol.

‍The coverage of rehabilitation of people with addiction to psychoactive substances - to bring it to 10%.

This is all directly spelled out in the state program as the expected results of the subprogram. We do not know whether they have been achieved: there is no public reporting, at least in a convenient and verifiable form.

- The year 2025 has come, it is time to set new goals. What has changed?

- Yes, there is a new program - "Health of the Nation" for 2026-2030. There are still a lot of beautiful things written in general words. But the most important thing is a table of criteria by which officials will actually report.

The program explicitly explains the logic: efficiency is calculated according to a formula, and if less than 50% - bad, 50-69% - average, above 70% - good, "the indicator has been achieved". In other words, it is not words that matter, but numbers and what exactly is chosen as indicators.

And in the new program, the key "psychiatric" goal in the indicators sounds like this: "to increase the coverage of persons suffering from substance dependence with rehabilitation measures". It even sets a scale of growth - up to 30% by the end of the period.

- Conditionally speaking, to "catch up" people in LTP - and everything is fine?

- Yes. And how effective these measures will be - no one is interested, because there are no such indicators.

No indicators about remission. There are no indicators about mortality reduction. No indicators about overdoses. The main thing is that somewhere there is a check mark "has been rehabilitated". Nobody cares what it looks like either.

- Why did the previous indicators disappear: suicides and alcohol?

- Because they are difficult to control and difficult to "fulfill" without doing anything.

Suicides are a difficult indicator. And without official statistics, we can't honestly assess what has happened in recent years. But it's logical to assume that mental health is affected by repression, forced emigration, and general societal pressures. That's not an "opinion", it's just a description of risk factors - but without transparent data, any assessment becomes guesswork.

Alcohol is also an awkward indicator. And the risk is huge: according to a major analysis in The Lancet, Belarus is the country with the highest alcohol mortality rate in the world. And in the documents of the European Commission, alcohol and tobacco are considered as key levers in the prevention of serious diseases.

- So before, the goals were clear, but now there is not a single "final" one?

- Previously, two of the three indicators could be called final: they reflect the real outcome for society (suicides, alcohol). Now there is essentially one operational indicator left in the measurable part, which can be solved mechanically.

- What about your neighbors? Are there any "best practices" nearby?

- I studied the documents and saw a picture that upset me: there are few good indicators with concrete figures in nearby Eastern Europe.

But EU countries look a bit better against the general background, because they have a common framework: European Mental Health Action Plan 2023-2030 and constant monitoring of indicators on a union scale.

In addition, the EU has separate substance policies (e.g., through agencies and specific programs) and goals such as "tobacco-free generation": to reduce the proportion of smokers to below 5% by 2040.

If we talk about specifics in national documents, Lithuania and Latvia have the best program. These countries have set good, interesting indicators for their mental health program goals, which can be important.

For example, in Latvia's public health strategy for 2021-2027, there is noticeably more attention to measurable indicators: the number of adolescents who use alcohol, the number of smokers and drug users among adults and adolescents. And also on care reform, including reducing reliance on hospitals.

Lithuania's 2030 health development documents have a broader focus on "preventable mortality" and population resilience, including psychological resilience. But since the use of psychoactive substances is, according to WHO and the UN, a preventable cause of death, it is impossible to reduce mortality from preventable causes without affecting mortality from alcohol, tobacco, drugs.

In Poland, indicators on suicides and suicide attempts are explicitly prescribed in the mental health program, as well as separate targets related to the effects of smoking in public health programs. And the country has also set intermediate indicators in the form of availability of psychiatric treatment, alcohol and substance use among young people.

In Russia, there is only one target - alcohol consumption per capita. But even it is more specific than in Belarus.

I deliberately do not make comparable conclusions about Ukraine: there is a war there, and it is methodologically unfair to compare "peaceful" indicators with a country in full-scale war.

It turns out that despite the declaration of the priority of mental health, in figures it is not a very high priority for all the countries of Eastern Europe. But! Even against this not very high background, the situation in Belarus looks like a complete failure.