Three and a half years ago, PERH announced a public procurement for the construction of a psychiatric hospital on the grounds of its Mustamäe medical campus in Tallinn, aiming to have it built by 2023. The procurement failed to attract any bids, and in October 2022, PERH announced a second procurement for the project. This procurement extended the deadline to 2026 – when the psychiatric hospital currently operating on the grounds of the former Seewald Manor on Paldiski maantee was slated to relocate to the new facility.

By now, three public procurements have been announced for the psychiatric hospital project, all of which have failed, acknowledged PERH Infrastructure Department director Taavi Aare.

"It all comes down to the fact that the bids haven't been acceptable in terms of price for the hospital," Aare explained. "For example, in the most recent procurement, our projected budget for the procurement was €65 million plus VAT, and the bids we received significantly exceeded our capacity, i.e. the projected budget."

In other words, as of 2024, the situation remains unchanged in that no builder has been found for the planned new psychiatric hospital. The only difference is that it's no longer possible to build a building like this for €65 million.

Maarjo Mändmaa, secretary general of the Ministry of Social Affairs, told ERR that there is currently no telling when the new psychiatric hospital may be built, because no state budget or external funds will be available for it in the coming years.

"Building modern healthcare infrastructure on this scale requires an investment in the range of €100 million," he said, but added that uncertainty over funding doesn't mean that plans to build a new facility at Mustamäe have been abandoned.

"On the contrary – the hospital is actively seeking various funding options, and we're working to secure funding," the ministry official confirmed. "Modernizing psychiatric infrastructure in Estonia is a priority healthcare infrastructure project for the Ministry of Social Affairs."

While PERH is state-owned, the City of Tallinn is interested in the situation regarding the new hospital facility being resolved as well.

According to Tallinn Deputy Mayor Karl Sander Kase (Isamaa), the matter of building the new facility has been discussed with PERH board chair Agris Peedu.

"Everyone in the field considers the construction of the new hospital important," he acknowledged. "There's no sign of construction costs going down significantly, so if need be, we should consider involving the private sector to offset construction costs."

Asked whether Tallinn would be willing to financially support the construction of the new psychiatric hospital, the deputy mayor replied that discussions should also include the construction of Tallinn Central Hospital, the financing of which has been the subject of a long-running dispute between Estonia's capital city and the state.

"We hope that the ministry will take the long-term view and be prepared to financially support both the [psychiatric] hospital and the new Tallinn hospital complex," Kase said. "Tallinn is certainly willing to participate in discussions concerning healthcare investments and addressing the mental health crisis."

Conditions at Seewald deteriorating by the year

PERH had planned to sell the Seewald Manor property after relocating to the planned new facility. This plan has likewise been shelved for now.

The situation at the Seewald complex is dire, however, and only keeps getting worse. PERH has tried to improve conditions there on its own, but this hasn't been enough.

PERH infrastructure chief Taavi Aare said that a solution for building a new facility must be found in the coming years, because treatment, working and living conditions at Seewald are continuing to worsen by the year. And this solution, he emphasized, must be found in cooperation with the state.

At the Social Affairs Ministry, Mändmaa agreed, admitting that the conditions at Seewald don't meet modern standards – or what's more, the hospital should not be operating in such conditions at all.

"PERH staff are doing excellent work in helping people, but the conditions at Seewald are, in the worst sense, a real madhouse – they don't withstand any scrutiny whatsoever," Mändmaa stressed. The hospital has been improving its facilities as much as possible and will continue doing so until the financial capacity exists to build a new hospital."

Even so, he added, no matter how difficult the situation at Seewald is, there is currently no risk of disruption of care.

Tallinn's deputy mayor noted that mental health issues are growing concern by the year, and that it's clear that addressing it will require additional resources for both personnel as well as Tallinn's healthcare infrastructure.

"Better infrastructure is crucial not only for patients, but also for the staff," Kase said. "A modern work environment would be a significant step forward compared to the facilities at Seewald."

The Psychiatry Clinic at PERH is the largest psychiatric care provider in Estonia, accounting for nearly 40 percent of all psychiatric treatment in the country. The psychiatric hospital consists of inpatient facilities with eight departments as well as an outpatient psychiatric clinic. The hospital provides outpatient, day inpatient as well as inpatient psychiatric care for residents from across all regions of Estonia.

Should the new psychiatric hospital at Mustamäe ever ultimately end up being built, project plans call for it to consist of three main sections: a one-floor acute treatment section, a three-floor ambulatory care section and the main, six-floor section housing hospital wards.

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