Estonia is a small country (45 000 km2) with a population of 1.3 million people. It has undergone rapid change since it gained independence from the Soviet Union in 1991. It has achieved some economic success, although there is a suggestion that this has been at the expense of the mental health and general emotional well-being of the people. In the Estonian Health Interview Survey, depressive symptoms were observed in 11.1% of respondents and their presence was strongly correlated with socioeconomic status (Aluoja et al, 2004).

Health system

The Estonian health system is funded via a national social insurance scheme. The Health Insurance Fund is provided from taxes on incomes of the working population, but it also covers those who have no income from employment. It is a universal scheme, under which medical institutions are reimbursed for treatments provided to all patients.

The first point of contact for the patient is the family doctor. Where necessary, the family doctor can refer the patient to a specialist for consultation or can transfer the patient to hospital. Emergency medical cover is provided to all persons staying in the territory of the Republic of Estonia, regardless of nationality, citizenship or possession of a health insurance card. Psychiatry belongs to the sphere of specialist medical care.

Mental health policy

There is no mental health policy in Estonia, although attempts have been made to draft one. The first of these was made as early as 2001, when the Ministry of Social Affairs ordered the compilation of a source document of mental health policy from the Praxis foundation. The project was ended in December 2002. The intention had been to gather together all the important organisations and different interest groups in the mental health area, and to draft a well-balanced mental health policy centred on the client's perspective. The policy document was to have included a hierarchical listing of the most important mental health problems in Estonia, together with their possible solutions. Options for the development of mental health services for Estonia were described, alongside the existing plans for their development. This document was never adopted. There is, though, a Mental Health Act that regulates the provision of mental health services, and this is described below.