INTERNATIONAL MEDICINE 1568 Tidsskr Nor Legeforen nr. 16, 2011; 131: 1568–70 International medicine Collaboration in psychiatry between Archangelsk and Northern Norway 1568–70 Psychiatry in Russia is dominated by large psychiatric hospitals and specialized open services, while the primary health and social services are underdeveloped and offer little in terms of treatment to people with psychological problems. This contrasts with the structure in Norway and many other countries, where mental disorders are more widely treated in the primary health services, and where the role of psychiatric hospitals has been reduced in favour of decentralized provision. Here, we will share some experiences from the Norwegian-Russian collaboration in the field of psychiatry. Tore Sørlie tore.sorlie@unn.no Psychiatry Research Group Institute of Clinical Medicine Faculty of Health Sciences University of Tromsø and Clinic for General Psychiatry University Hospital of Northern Norway Grigory Rezvy Nordland Hospital and Psychiatry Research Group Institute of Clinical Medicine Faculty of Health Sciences University of Tromsø Tordis Sørensen Høifødt Clinic for General Psychiatry University Hospital of Northern Norway and Psychiatry Research Group Institute of Clinical Medicine Faculty of Health Sciences University of Tromsø Vera Yashkovich District Psychiatric Centre of Archangelsk Oblast Elena Proselkova Health Care Department of Archangelsk Oblast The historical roots of international cooper- ation in the Barents Region reach back to Viking times. From the 1740s, the Pomor trade between Northern Norway and North- Western Russia constituted a necessary as well as a natural exchange between neigh- bouring peoples in the North. A separate language, Russo-Norwegian, was developed to promote communication and cooperation. The Russian Revolution put a temporary stop to this interchange. Towards the end of World War II, however, The Red Army came as the liberators of Finnmark. Later, perestroika and the fall of the Iron Curtain spelled the end of Soviet isola- tionism. Since then, Norwegian-Russian collaboration has gained new momentum. The Kirkenes Declaration, which forma- lized Norwegian-Russian international cooperation in the Euro-Arctic Region, was signed in 1993 (1). Since 1999, project fun- ding has been available through the Barents Health Programme. Collaboration on health between Tromsø and North-Western Russia dates back to the early 1990s. Since then, the Northern Norway Regional Health Au- thority has signed general agreements on cooperation with Murmansk and Archan- gelsk oblasts, in which the parties commit themselves to collaboration in the fields of public health, health services and networ- king. The collapse of the Soviet Union brought with it increasing social insecurity, inequality and unemployment. Mental health problems have become widespread, including a high incidence of depressive disorders, suicides and high mortality from alcohol-related diseases (2). Psychiatry was regarded as a medical field in which the need for renewal was most prominent. Russian and Norwegian psychiatry Soviet psychiatry was largely isolated inter- nationally, and psychiatry was also exploited for non-medical purposes, such as internment of dissidents (3). Russian psy- chiatry today is characterized by high pro- fessional standards and modern health legislation, as well as increasing contact and cooperation with other countries (3). Specialized open services While Western psychiatric hospitals have been all but dismantled during the last forty years in favour of the development of regio- nally decentralized service provision, Rus- sian psychiatry continues to rely mainly on large hospitals. In Norway, this structural change has been spurred by favourable economic conditions and an increased emphasis on active treatment methods and differentiation of the service provision, as well as on the principle that patients should as often as possible be provided with ser- vices in their home area (4). The anti-autho- ritarian movements originating in the late 1960s and the escalation plan for Nor- wegian psychiatry have also served as important factors (5). In Russia, the primary health and social services are not well developed. However, a specialized, open service is provided at centrally located district polyclinics, where psychiatrists work in cooperation with other medical specialists. Large psychiatric poly- clinics («dispensaries») are found in the lar- gest cities in each oblast, which may also include outpatient services. In Norway, most patients with mental disorders tend to receive treatment from the primary health services, and a separate model has been developed for cooperation between the regional psychiatric centres and the municipalities in the geo- graphical areas covered (6). The maintenance of this heavy emphasis on institutionalized psychiatry in Russia is caused by a lack of resources (7, 8). Further- more, health legislation has barred general practitioners who have no specific speciali- zation in psychiatry from diagnosing or treating mental disorders (9). However, recent legal amendments seek to enable gen- eral practitioners to treat depressive and psy- chosomatic disorders, diagnose serious mental disorders and follow up psychiatric patients after their treatment by the specia- list health services. These amendments still have the status of recommendations, and are subject to approval by the health authorities in each oblast before they can come into force. (V. Popov, Institute of Family Medi- Barentshavet Arkhangelsk Nord-Norge