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03 August 2022 | Policy Analysis
Extension of the Mental Health Centres pilot
5.11. Mental health care
According to the 1994 Act Mental Health Protection, provision of mental health care is the responsibility of the central and local self-governments and certain institutions established for this purpose, such as the Institute of Psychiatry and Neurology in Warsaw. Mental health care patients are mostly treated in institutionalized settings, the majority of them as outpatients (Table5.4). Although there is a general shift from institutionalized mental care towards community-based care, institutionalized care is still the dominant form of mental care provision in Poland.
Table5.4
In 2016, approximately 1.6 million people with mental disorders were registered in outpatient clinics or centres – about 75% in mental health clinics and 10% in alcohol dependence therapy outpatient centres (GUS, 2018h). The core of stationary mental care is provided in psychiatric hospitals and in psychiatric and addiction treatment wards within general hospitals (90% of all inpatients) (Table5.5).
Table5.5
An important amendment to the 1994 Act was made in 2008 to allow for the implementation of the National Mental Health Programme. The first edition of this Programme was in place for the 2011–2015 period and its key goal was to shift provision of mental care from hospitals to the community, with Mental Health Centres (to be piloted within the Programme) as the core of community mental care. These Centres were meant to improve the availability, continuity and effectiveness of psychiatric treatment, reduce the extent of hospitalizations, and thus reduce the cost of care and improve patient outcomes. However, for a variety of reasons, including lack of financial resources and poor coordination, the Centres had not been established and the Programme largely failed to achieve its objectives. These objectives are now pursued within the second edition of the Programme, which covers the 2017–2022 period.
The structure of the Mental Health Centres proposed by the Programme is depicted in Fig5.4. They are to cover populations of up to 200 000 and provide comprehensive psychiatric care through diverse types of services that are coordinated and adapted to the local needs. They are meant to provide short- and long-term outpatient care, counselling, and – to the extent necessary – hospital care. If possible, Mental Health Centres should provide immediate assistance in urgent cases and liaise with social welfare institutions. In July 2018 work has started on piloting 29 Mental Health Centres over a period of 36 months (Regulation of the Minister of Health of 27 April 2018 on the Pilot Programme in the Field of Mental Health Centre).
Fig5.4
In 2017 there were only 2469 psychiatrists in Poland – 8.5 per 100 000 population (GUS, 2019). This is much lower than the EU average of 17.16 per 100 000 (data for 2015; WHO, 2018b) and likely insufficient to meet the growing mental health care needs of the population (see section 1.4). In 2015, spending on mental health in the EU averaged 1.31% of GDP (or about 13% of health spending). In Poland, the respective figure was 1.19% of GDP, which is higher than in Slovakia, Lithuania and Czechia but lower compared with France, Germany and the United Kingdom where it was higher than 1.3% of GDP (OECD, 2018a).
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.
Authors
References
Sagan, A.; Kowalska-Bobko, I.; Biechowska, D.; Rogala, M.; Gałązka-Sobotka, M. Implementation of Mental Health Centres Pilots in Poland since 2018: A Chance to Move towards Community-Based Mental Health Services. Int. J. Environ. Res. Public Health 2022, 19, 5774. https://doi.org/10.3390/ijerph19095774
https://czp.org.pl