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Mental Health Reform Moves Forward in Poland

HEALTH & MEDICINEMental Health Reform Moves Forward in Poland

As part of the pilot program, 100 mental health centers are already operating. More facilities will be launched in the first quarter of this year. Soon there are expected to be 129, which will allow care to be provided for 52.45 percent of the population over the age of 18, or almost 16.4 million people. The Pilot Mental Health Centre (CZP) is an important element of psychiatric reform in Poland. In parallel, the reform of child and adolescent psychiatry continues, which aims to introduce for them a brand new model of care. In this area, the pre-set goals have been surpassed – there are already more community psychological and psychotherapeutic assistance centers operating than planned. These are positive changes, the effects of which will be visible over the next couple of years, but the reform can still be improved.

“What is certainly lacking at the moment – and what we strongly notice when we want to tighten things happening in healthcare – is the lack of inter-ministerial cooperation. We have many ideas, programs that should be implemented in schools, for example, but this requires cross-sectoral cooperation between education, social assistance and the health care system. This is a matter that should be focused on in the near future,” says Dr. Daria Biechowska, an expert from the Office for the Prevention of Suicidal Behavior and the Institute of Psychiatry and Neurology in Warsaw. “Due to the lack of this cooperation, programs are being developed in parallel in various departments and by various sectors. Secondly, there is no continuity of care.”

The reform of adult psychiatry has been ongoing since 2018. One of its elements is the program of mental health centers – a pilot that started in 2018 as part of the National Mental Health Protection Program for 2017-2022. Its goal is to reform psychiatry so that it is not based on hospitalization but on community treatment, close to home, based on the resources and ties of the patient. According to the September amendment to the Minister of Health’s regulation, the pilot has been extended again until December 31, 2024. So far, 100 mental health centers have been established: 81 of type A, i.e. with an inpatient psychiatric ward, and 19 of type B, without a ward. In the following years, the pilot will be expanded to ultimately become part of the health care system and by 2027 provide support to the needy in 300 entities.

“Mental health centers provide coordinated care for people with problems, with mental disorders – both outpatient care, i.e. mental health clinic care, community care, but also care within day wards, and if necessary within 24-hour wards,” says Dr. Daria Biechowska.

In mental health centers, one can receive free, 24-hour support – without a referral and the need to make an appointment. Assistance is tailored to needs and may include visits to a clinic, stay in a day or full-time ward or support from a community treatment team, which visits the patient at home to help him and his family. Specialists – based on contact with a person experiencing a mental crisis – develop an individual treatment plan, and in urgent, urgent cases, help is provided within 72 hours.

The September Ministry of Health regulation stressed that “the implementation of the pilot program has primarily contributed to shortening the length of hospitalization and increasing the number of outpatient consultations”. The Ministry indicated that the accessibility to psychiatric health care has significantly increased.

“A parallel reform is underway, which concerns children and adolescents, and this is actually a completely new system, divided into three referral levels,” says an expert from the Office for the Prevention of Suicidal Behaviors. “The first referral level is community psychological and psychotherapeutic assistance centers. Here, the plan was ahead of schedule, as it assumed that in two years we would have about 400 such centers, while at the moment there are over 440 across Poland. The plus of the first referral level is that you can enter these centers without any referral, and there are psychologists, psychotherapists, who help the youngest people up to the age of 21, that is, until they participate in the education system.”

The Ministry of Health wants one such first-level center to function in every county or group of counties, where adolescents and parents with children with mental problems will be able to report. Young patients can use their help without a doctor’s referral. The facilities provide them, among others, individual and group psychotherapy, family therapy or work with a peer group.

The ministerial reform of child and adolescent psychiatry assumes that – besides community centers – second-level centers will also operate (community mental health centers), where a psychiatrist will work. Patients requiring more intensive care will be able to use services as part of a day ward. One such center would provide support for several neighboring counties. On the third level of referral, highly specialized full-time psychiatric care centers will function, i.e. hospitals and psychiatric wards. Patients requiring the most specialized help will find help there, including in particular people at risk of life and health, accepted on an urgent basis. At least one such center is to operate in each province.

“The complement of this reform – both for adults, which is carried out as a pilot, and for children and adolescents, which is a completely new treatment model – are also preventive activities carried out as part of the National Health Program, the entire third operational goal of which concerns mental health. Here, one of the most important things that has been introduced are preventive programs aimed at people at risk of suicide,” says Dr. Daria Biechowska. “In addition, it was also possible to introduce information about suicidal behaviors into public statistics. This information will be collected and monitored in the health care system.”

Statistics collected by the Police show that last year in Poland more than 5108 people committed suicide (compared to 5201 a year earlier) – about 2.7 times more than died in road accidents during this time.

“The effects of all these actions are not measurable at the moment, because the effects of any actions taken in public health are only visible in the long run. In order to be able to say that mental health has improved and, for example, the suicide rate has decreased, it is probably a matter of several to several next years,” predicts the expert.

As she points out, an important issue in the context of the implemented reform is also the fight against the stigmatization of people with mental disorders. This type of phenomenon is still present in Poland, although more and more is said about mental problems.

“From the research carried out by the Institute of Psychiatry and Neurology in 2017-2020, EZOP Condition of Polish Society, it turned out that practically none of us would like our child’s teacher or caretaker to be a person with mental disorders, so it is clear that stigmatization is still a huge problem. The fight against it is systemic. The introduction of a new profession to mental health centers, such as health assistants, i.e. people who have themselves gone through a mental crisis and help others, is one of such ways to fight stigmatization,” explains Dr. Daria Biechowska.

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