Every fourth adult faces mental disorders during their lifetime. The frequency of occurrence of the problem is highest among adolescents entering adulthood and in individuals in the second half of their seventh decade of life. Psychiatrists are calling for the introduction of a new model of psychiatry, based on community care, and such are the assumptions of the National Mental Health Protection Program for the years 2023–2030. However, the implementation of these assumptions does not happen as quickly as clinicians and their patients would expect. The main barrier is insufficient financial expenditure.
“The main goal of the National Mental Health Protection Program in the current edition for the years 2023–2030 is to introduce a modern community model of psychiatric care, and an additional goal is to counteract the stigmatization and discrimination of people with mental disorders. However, the most important goal is the community model, that is the psychiatric care reform;” says Dr. Marek Balicki, a member of the Mental Health Council at the Ministry of Health, in an interview with Newseria agency.
The program adopted on October 30, 2023 aims to implement a community model of mental health care, ensuring comprehensive and universally accessible health care close to their place of residence and other forms of care and assistance necessary for life in a family and social environment. Experts emphasize that implementing this new community care model encounters a number of problems and barriers. One of the fundamental ones is the financial barrier, related to the low funding of psychiatry compared to other European countries.
“Last year it was less than 5% of total health spending, while in Europe it is 6-7%, in Germany over 10%, and we know that health spending in Germany is much higher than ours. So, the first barrier to overcome is the gradual increase in spending on psychiatric care, and the second is a system change. Such a change from the traditional, hospital outpatient model to a model in which there is community care, day care, everything in the place of residence is very difficult; it encounters a number of human and institutional resistances, also in decision-making spheres, but we try to overcome these barriers,” says Dr. Marek Balicki.
This year the pilot program in mental health centers ends. It has been running since 2018 and its goal was to test the environmental model of psychiatric health care. According to experts, after the end of the pilot, implementation of system solutions should follow. The Mental Health Congress Working Group and the Consortium for the implementation of the NPOZP have developed 40 recommendations that should enable the optimal implementation of the new model.
“Basic elements of the new model must be by law, that is, the mental health center operates in a specific area, for example, a county, district of a large city, that all forms of assistance, from mental health clinics, through the day ward, community care, hospital ward, are located in the area where the center operates, that this area cannot be too big – from 50 to 150 thousand inhabitants, to properly organize care, that the reporting-coordinating point is open to everyone and to accept patients or families, relatives when they report, it must be open from 8:00 to 18:00, that the center must have financial autonomy, it must be financed by a lump sum for the population, not for points or procedures,” lists the member of the Mental Health Council at the Ministry of Health. “These are examples out of the 40 recommendations we have prepared, and let’s hope the Ministry of Health will take this help.”
Meanwhile, the problem of mental disorders is growing, both globally and regionally. An analysis conducted after the outbreak of the COVID-19 pandemic by Thai and Canadian scientists based on electronic databases and research from 32 different countries shows that approximately 28 percent of the population show symptoms of depression. A similar proportion struggle with anxiety states and insomnia. Every fourth reports symptoms typical of post-traumatic stress (PTSD). One-third of the respondents report chronic stress symptoms, with half facing psychological stress. These trends are reflected in Polish analyses. The EZOP II study showed that 26.5 percent of adults revealed mental disorders in the perspective of their entire life.
“Approximately every fourth person in the adult population experiences mental health problems at some point in their life. The percentage of those suffering from more severe forms of mental disorders is a few percent of the population. However, if we count all those who need information, support, this number already exceeds needs in the millions,” points out Prof. Dr. hab. n. med. Jacek Wciórka, a psychiatrist from the Institute of Psychiatry and Neurology.
The EZOP II study shows that over half a million children and adolescents suffer from mental disorders, of which over 200,000 are children aged 7–11 years and over 350,000 adolescents aged 12–17. More than 300,000 children and adolescents (about 8% of children and 7% of adolescents) experience internalizing disorders, which mainly include anxiety disorders. Mood disorders, including depressive disorders and episodes of mania, were confirmed by far fewer, only 70,000 young people, the majority of whom were teenagers. Various types of disorders were also observed in about 16% of children up to six years old, which translates into a number of over 420,000.
“Entering adulthood and seniority are particularly difficult times. These are the two moments where disorders arise more often or people mature enough to seek help,” highlights the psychiatrist from the Institute of Psychiatry and Neurology.
The prevalence of mental disorders increases with age – from 19.2% aged 18-29 to 34.2% aged over 65, with the highest prevalence among seniors aged 65-69 years.
“What needs to be done to improve the mental health of the Polish population is primarily education and the removal of negative attitude to the sick, the incomprehensible full of unjustified convictions about risk, behaviors of these people, often unjust and damaging. This is breaking down the emotional barriers that hinder sensible help,” says Prof. Jacek Wciórka.
The ongoing reform of psychiatry has so far focused mainly on securing child and adolescent psychiatry, especially on building from the ground up a system of community care – the first level of referral. Since 2020, approximately 500 facilities of this type have been created, as well as over approximately 200 places providing services at the second level. Each province also operates a third level of referral, the Center for Highly Specialized Round-the-Clock Psychiatric Care. The reform of adult psychiatry is progressing more slowly, but the main emphasis should be placed on community care.
“The current mental health care system cannot be efficient because psychiatry has always been a specialty that was subject to a kind of systemic stigmatization, exclusion, starting from allocating the smallest expenditure, inadequate to the needs, through not attaching adequate importance to the need for reform, responding to growing challenges. The lack of specialists, poor local conditions, lack of initiatives for mental health prevention – all this contributes to these shortcomings and challenges that we must face,” assesses Dr. Tomasz Szafrański from the Wola Mental Health Center.
As he adds, changes in the Polish mental health care system are necessary, which will introduce a modern, tailored to needs, accessible to all systems, which will operate on the principles of community psychiatry.
“A system that moves away from the archaic hospital model, which will give the possibility of getting help and developing modern forms of care,” emphasizes Dr. Tomasz Szafrański.
“In the current system, the waiting period for an outpatient consultation is extended to weeks or months, which makes it difficult in situations causign hospitalization. It usually occurs when the disorders are already very difficult and growing, usually delayed, hence the suffering is greater, and the effect of help is more difficult to achieve,” explains Prof. Jacek Wciórka. “The whole reform of psychiatric care in Poland is aimed at changing this situation, to make help available quickly and of good quality, coordinated, comprehensive, that is, not limited to prescribing drugs, but also psychological help and social support. We have good experience from the first pilot period and we know that this is possible, but it requires maintaining continuity of all this reformative change.”
