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Abstract Background The objective of this international comparative study is to describe and compare the mental health policies in seven countries of Eastern Europe that share their common communist history: Bulgaria, the Czech Republic, Hungary, Moldova, Poland, Romania, and Slovakia. Methods The health policy questionnaire was developed and the country-specific information was gathered by local experts. The questionnaire includes both qualitative and quantitative information on various aspects of mental health policy: (1) basic country information (demography, health, and economic indicators), (2) health care financing, (3) mental health services (capacities and utilisation, ownership), (4) health service purchasing (purchasing organisations, contracting, reimbursement of services), and (5) mental health policy (policy documents, legislation, civic society). Results The social and economic transition in the 1990s initiated the process of new mental health policy formulation, adoption of mental health legislation stressing human rights of patients, and a strong call for a pragmatic balance of community and hospital services. In contrast to the development in the Western Europe, the civic society was suppressed and NGOs and similar organizations were practically non-existent or under governmental control. Mental health services are financed from the public health insurance as any other health services. There is no separate budget for mental health. We can observe that the know-how about modern mental health care and about direction of needed reforms is available in documents, policies and programmes. However, this does not mean real implementation. Conclusions The burden of totalitarian history still influences many areas of social and economic life, which also has to be taken into account in mental health policy. We may observe that after twenty years of health reforms and reforms of health reforms, the transition of the mental health systems still continues. In spite of many reform efforts in the past, a balance of community and hospital mental health services has not been achieved in this part of the world yet.

Mental health has an economic impact on both individuals & societies. There is lack of information on total cost of mental illness in the Czech Republic, especially on social services financed by municipalities & private resources. In the health sector, the share of mental health expenditures is estimated to be 3-4 % of total health expenditures. In the social security system, mental illness is responsible for 3.3 % of total sick-days, 14.2 % of full disability pensions & 9.5 % of partial disability pensions. The estimated mental health expenditures amount 15 362 millions CZK in the health sector & from the social security in 2006, which makes 0.48 % of gross domestic product. If the level of expenditures on mental health is interpreted as an indicator of the society's commitment to mental health, then mental health has a relatively low priority in the Czech Republic. Adapted from the source document.