Mental health in Central and Eastern Europe: a comprehensive analysis.

Abstract

The post-communist WHO European region, often called Central and Eastern Europe (CEE), includes 28 countries with over 770 million people. Mental health systems remain shaped by the communist legacy of centralized institutions, a narrow biomedical focus, and neglect of social and psychological dimensions. Chronic underfunding persists, further strained by shrinking civic space in some countries and the war in Ukraine. Substantial progress has been made in the past decade, with modernization and rights-based approaches gaining ground. Yet reforms face entrenched barriers: underinvestment disproportionate to the burden; pervasive stigma, weak advocacy, and limited involvement of people with lived experience; dominance of institutional care over prevention, promotion, and community services; reliance on donor-driven projects that falter once funding ends; and human resource problems. Governance is often unstable, with low prioritization, clientelism, and personal biases undermining reforms. Research and data remain scarce, leaving systems unevaluated and vulnerable to reversal. Poor decision-making compounds these barriers: systemic missteps, driven by limited expertise, weak evidence, and personal biases, prevent resources from achieving the best possible outcomes. To move forward, CEE must integrate health, social, and education systems, secure sustainable crisis services, strengthen professional skills, involve people with lived experience, expand public mental health expertise, and, above all, commit greater and more transparent investment, closer to western European levels, if resilient and effective systems are to be built.