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The National Mental Health Program continues to develop

Thanks to the implementation of the program, we want to provide people with mental disorders the best care that will be appropriate to their needs. We also want to prevent stigmatization and discrimination against such people. This year, the network of Mental Health Centers (CZP), currently consisting of 33 centers, is to expand by at least six centers. By the end of 2027, around 300 places of this type are to be operational across the country. "Mental health protection, also during a pandemic, is one of the priorities of the European Union, so financing should be provided," says Katarzyna Szczerbowska, spokeswoman for the Bureau for the Pilot of the National Mental Health Program (NPOZP).

The NPOZP pilot is implemented on the basis of the Ordinance of the Minister of Health of April 27, 2018 on mental health centers and will continue until the end of this year. The basic task of the so-called the contractor, i.e. the entity responsible for the functioning of the Mental Health Centers, is to provide adults residing at the center with comprehensive psychiatric care (emergency, outpatient, community, day and round-the-clock care). The Ministry of Health announces more Mental Health Centers. Provincial branches of the National Health Fund (NFZ) were instructed to ensure that by the end of November this year. prepare maps of the division of voivodeships into areas of CZP operation.

- The main premise of the mental health reform is to base care on the environment. Mental Health Centers is this form of primary care for patients with mental disorders - Dorota Olczyk, deputy director of the Public Health Department at the Ministry of Health, emphasizes in an interview with the Newseria Biznes agency.

The centers are to fight to eliminate the profession of "patient", the social role of which is 100 percent of the problem related to disease and treatment. the patient's attention and the considerable energy enjoyment of his family. Traditional psychiatry and psychology, as Prof. Halina Sienkiewicz-Jarosz, a neurologist, director of the Institute of Psychiatry and Neurology, boiled down to treating symptoms and crisis interventions.

“Mental Health Centers' help also includes medical sciences other than psychiatry, as well as community support, or even help in finding a job. Family support is sometimes of key importance in the recovery process. Therefore, the relatives of the patient can and should use the services offered by CZP ”- emphasizes prof. Sienkiewicz - Jarosz.

“A psychiatric hospital should only be considered in the most severe cases and for a short time. It is even necessary to de-institutionalize the mental health care system in Poland, ”said Dr. Anna Depukat.

The pilot program of the Mental Health Centers was launched three years ago as part of the "National Mental Health Program 2017-2022". This is part of a thorough reform in psychiatry that the Ministry of Health has been working on for a long time. Currently, there are 33 such centers throughout Poland, which cover 12 percent. the adult population of the country, i.e. 3.8 million Poles. Each of them is obliged to provide patients with hospital, outpatient, community and day care in the area for which they are responsible (e.g. in the district or poviat).

- Such a center is a place of comprehensive mental health care, with an application and coordination point where anyone in a crisis can come and require psychological support or information advice, for example, regarding a loved one. Anyone can come forward and get advice, help and treatment when needed - says Dr. Anna Depukat, a psychiatrist and psychotherapist, head of the pilot office of the National Mental Health Program.

Anyone who needs help can come to CZP without registration or referral. Psychiatric assistance is also provided to uninsured persons. If the receiving psychiatrist, psychologist or psychiatric nurse at the reporting and co-ordination point decides that the case is urgent, assistance is provided within 72 hours. In CZP, the patient is initially diagnosed and the treatment plan is prepared individually. The assumption of this type of facility is to move away from institutionalized in favor of community-based psychiatric care.

- This community support is crucial for the patient to receive care quickly and comprehensively, and for the whole family to be supported. CZP also offers outpatient and stationary assistance when it is necessary. In such an arrangement, when we focus on community care, the assumption is that hospitalizations will be less frequent, only in necessary cases, and definitely shorter, because doctors will be able to refer the patient to specialists who will help him recover in his own environment - says Dorota Olczyk.

According to the data of the Human Rights Defender, the very beginning of the piloting of the Mental Health Centers proved the sense of their functioning. In these centers, which are located at multidisciplinary hospitals and psychiatric departments, already in 2019 the effects were visible in the form of an increase in outpatient care services by 25.6%. and environmental aid by 26.9 percent. compared to 2018. At the same time, there was a decrease in psychiatric hospitalizations by 7.4%.

Mental Health Centers also proved their worth especially during the COVID-19 pandemic, as evidenced by the fact that the number of services in such centers has not decreased. However, the launch of new ones is too slow.

- This reform needs to be accelerated. The plan is to at least double the number of Mental Health Centers next year. That is why we have intensified the process of qualifying other service providers for such comprehensive care within the centers - says Dr. Anna Depukat.

As he informs, the provincial branches of the National Health Fund received an order from the minister of health to prepare maps of the division of individual provinces into areas of CZP activity by the end of November 2021.

- In December - when we get maps from the regions - we will be able to continue the process of qualifying the centers and the investment support process, because some of them are still unprepared, some have no buildings, others will probably require renovation - says the head of the pilot office for the National Mental Health Program. - We want all of Poland to be covered by CZP by the end of 2027. There should be over 300 such centers to fit in each poviat. In some of the smaller ones, up to 50 thousand. residents, CZP will provide services for two poviats.

- The work is still in progress. When we finally define what tasks the CZP will have, then we will also be able to think about what measures to prepare. If we want to allow over 300 entities to operate by the end of 2027, investments in buildings and infrastructure are necessary. Therefore, we must first conduct an inventory of resources and consider what investments are necessary. Today it is difficult to say what an order of magnitude it will be - adds Dorota Olczyk.

The CZP pilot is scheduled to end in March 2022. Four months ago, the minister of health appointed a special team, which by then is to develop a strategy for further psychiatry reform and measures for the years 2022–2027. The conclusions from the previous CZP pilot program are to be used in the preparation of this strategy.

- Availability, comprehensiveness and continuity of treatment are the basic assumptions of this reform. First, treatment will cease to be interventional, based on hospitalization - says Anna Depukat, MD, PhD. - Previously, in the case of a serious mental crisis, often the only place to obtain help 24 hours a day was a psychiatric hospital or HED. Such patients, after discharge from the hospital, had to report to a mental health clinic, where the deadlines were distant. At the moment when they needed treatment and support the most, when they had to return to work and family responsibilities after a mental crisis, they were left alone. On the other hand, CZP will provide psychological and psychotherapeutic help, as well as support of a recovery assistant or community therapist, who will help the patient find himself again in his local community after a crisis.

Experts indicate that the reform of psychiatry - which has been neglected and neglected for years - is becoming a necessity today, especially after the COVID-19 pandemic and months of social isolation, which have deepened the mental health problems of Poles. According to the information of the Human Rights Defender, only 3.4 percent go to psychiatric care (along with addiction treatment). funds from the National Health Fund, and the minimum level of expenditure is PLN 1.5 billion. In Europe, only Bulgaria has a lower level of spending for this purpose. Moreover, there is no balanced distribution of these funds - 1/3 should go to hospital care, and 2/3 - to other forms. Meanwhile, in Poland the proportions are exactly the opposite and as much as 70 percent. funds are allocated to inpatient care in hospitals.

Another problem is the fact that the Mental Health Act guarantees access to the basic four forms of assistance in psychiatric care (outpatient, community - home, day and emergency - hospital). However, 72 percent. service providers have only one form of this assistance contracted by the National Health Fund, which results in the lack of continuous and comprehensive psychiatric care.

The Commissioner for Human Rights also noted the unequal access to daily environmental aid. Only 34 percent. poviats have a community-home treatment team in their area, and 31 percent counties - day departments. Thus, 27 years after the entry into force of the Mental Health Act, 2/3 of the country's territory still has no access to environmental assistance. The Commissioner for Human Rights says that this means that only 5 percent. patients diagnosed with schizophrenia have the option of community care. As he notes, as a result, mental disorders generate the largest expenses, consuming as much as 16.2 percent. for the ZUS benefit related to incapacity for work.


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