More limited pilots included the following. Moscow Regional (country) Mental Hospital #10 implemented independent living skills training for long-term inpatient, and changed the hospital environment to be more home-like and stimulating in preparation for discharge of residents to the community. Independent living skills training was also tested and utilized in Yekaterinburg. The pilot project in St. Petersburg involved acute mental patients in different types of group work to reduce the maladaptive influence of hospital stay, and developed transitional forms of housing. Tambov focused on developing a functional rehabilitation unit in the regional mental health hospital to prepare long-term inpatients for discharge, and developed transitional forms of housing (sheltered living and a group home model). Tver's project was focusing on developing rehabilitation for elderly people with psychiatric impairments. Vladimir, Tambov and others used visual and performing arts (e.g. painting, theater and puppetry, crafts studio) to promote social rehabilitation and to connect people with psychiatric impairments to the local community.

Information gathered through this experience was summarized and disseminated through public media (television, radio and newspapers), presentations at conferences and publications in professional journals. Upon completion of the local pilot projects, it was clear that most had become sustainable and will continue to function.

Training in Community Mental Health Rehabilitation

The training program involved a Community of Learners (COL) of 35 participants from 24 cities and regions. Participants had a diverse background in psychiatry, psychology and social work. The program introduced the concepts and practices of community mental health rehabilitation. Some of the trainees were simultaneously involved in implementing those practices by taking an active part in developing community mental health pilot projects in their home facilities.

Strengthening Civil Society

Pilot projects, training and support from the Project Team fostered development of parent and self-help groups for persons with mental health problems. During the course of the project the number of local consumer organizations grew from 1 to 47. A significant outcome was to formally register the public organization "New Choices" for people with mental disabilities and their families as an All-Russia society. Collaboration between mental health consumers and professionals characterized its development, with most local groups supported by graduates of our program.

Benefits

Benefits to the two countries include the following. In Russia: 1) Learning through the model and pilot programs created the potential for guiding future changes in the mental health system. 2) Professionals trained through this project will become the trainers of future personnel capable of continuing to develop the needed resources and supports for people with chronic mental disorders (positions for such personnel are already established, though mostly vacant). 3) People with mental disorders and their families benefited from newly created service models, and will continue to benefit directly in the longer term. Canada obtained a useful comparison into a mental health system in transition at the same time as Canada's mental health services are being reformed. It is conceivable that reforms introduced to the mental health system through this project may have impacts much beyond the immediate services. Concepts of collaborative decision making, the role of self-advocates and families, and civil rights of the service user, as well as the introduction of new forms of community-based services, are likely to have a sizeable ripple effect impacting local communities as well as other health and social services.