Provision of mental services in Poland has long suffered from under-sourcing, with low financing and workforce shortages, and has been concentrated in institutional settings. Mental Health Centres, piloted since 2018, have offered an opportunity to shift provision of mental health services to the community, providing adult populations living in their catchment areas with tailored and comprehensive psychiatric assistance close to their place of residence.
In terms of their organizational structure, the centres should comprise at least the following units: an outpatient unit or clinic providing medical and psychological advice, individual and group psychotherapeutic assistance, nursing services, and social interventions; a mobile community unit providing home visits, individual and group (incl. family) therapy, skills training, rehabilitation services, and general assistance to patients in building a social support network; a day unit providing day psychiatric hospitalisation to support provision of diagnostic, therapeutic or rehabilitation interventions; and a hospital unit, ideally located within a local general hospital rather than a specialist psychiatric hospital, providing round-the-clock hospital care for patients suffering from or at risk of severe disorders. Each centre should also have a registration and coordination point and be accessible for at least 10 hours a day, Monday to Friday, that ensures quick (referral-free) access to a wide range of services and support from trained staff.
A new healthcare profession – recovery assistant – has been introduced through the pilot. Recovery assistants are people who have experienced a mental problem themselves, and after appropriate training, provide peer support to people who are currently experiencing such problems. A new role – mental care coordinator (case manager) – has also been introduced. They ensure that a treatment and recovery plan is in place and is implemented for each patient and support patients and their relatives not only in the treatment process, but also in other areas, for example, pertaining to their social life.
At the end of 2021, there were 41 mental health centres across the 16 regions of Poland, out of which 33 were in operation, covering 3.8 million people or 12% of the adult (18+) population. This reflects slow progress given that the reform assumed that 250–300 centres would be created by the end of 2027 and can be partly explained by the rigid inclusion criteria, precluding some of the interested entities from participation. However, available evidence so far suggests that the new model leads to an improved access to non-stationary care and a slight fall in hospitalisations, especially in Centres operating from psychiatric wards of general hospitals compared to those operating from psychiatric hospitals.
In August 2022, it was decided that the pilot should be extended until the end of 2023 to test the piloted solutions in larger cities that are not divided into individual districts and to allow inclusion of service providers that do not comprise stationary mental health ward within their organisational structures and have so far been excluded from the pilot.