Following The Italian Model In A Polish Way

Agata Szulc is the head of the Department of Psychiatry at the Medical University of Warsaw, past President of the Polish Psychiatric Association, member of the Board of the European Psychiatric Association. The title of her presentation at Headway 2020 was about a reform of the mental health system now or never.

Is it still the same?

Nowadays pandemic has changed everything. Nevertheless, we have to think about the future and the contemporary system of mental health care in Poland is completely inadequate. It is based on the psychiatric hospitals while other facilities are still rendered secondary. Mental health care may be provided in the outpatient clinics, by home or community care teams, or in day-care psychiatric wards, but psychiatric hospitals still dominate in this area. During pandemic one can notice that patients need more outpatient care, for example telepsychiatry, and psychiatric hospitals unfortunately are not safe for the epidemiologic reasons. In 2018 the pilot program of community mental health centers, which should cover the needs of psychiatric patients in Poland, was introduced. The program’s results are still insufficient. 

What does the desired reform consist of? 

The Pilot Program includes a total of 29 Centers for Mental Health and is going to last 36 months. The Centers are financed "per capita" providing the psychiatric service for a given population. 

After the three years, the effectiveness of the program will be measured with the help of specific indicators, such as length of stay, number of hospitalizations, waiting times, number of readmissions etc. The Ministry of Health together with psychiatrists are strongly supporting this program. We hope that it would be prolonged and in future the Center’s web will cover the whole country and gradually all big psychiatric hospitals will be transformed into the chronic care centers or forensic psychiatry centers and no longer will be the main source of psychiatric care. The small acute psychiatric wards should take over the role of psychiatric hospitals if needed. 

What is the reference model? 

I think that Italian model is the most influential in this case, however, we should be careful to avoid some mistakes, which were probably done during “acute” phase of Italian reform. In some cases, the acute psychiatric care is needed and essential, and during the transition period we have to develop other facilities before we close or eliminate the psychiatric hospitals. Perhaps they should have another role or remain in some shape or form, but certainly not as a main source of the mental health care system. 

What is the history of psychiatry in Poland? 

In 2020, the Polish Psychiatric Association is celebrating its centennial anniversary, which is quite a long history for the Polish citizens. After 123 years of not having our own country, Poland regained its independence in 1918, and shortly after the Polish Psychiatry began its modern history. Big psychiatric hospitals were established like everywhere in Europe and many talented psychiatrists were developing their experience and knowledge serving the patients. Some forms of the community care were established, and it was quite a new type of thinking during that time. Unfortunately, the World War II has stopped this development, which then began to rebuild itself in 1945. Around the same time, the era of Communist rule distorted our history again. Luckily, our psychiatric system was mostly unaffected by the regime. The idea of the community psychiatry was always alive among Polish psychiatrists, but for many reasons, our governments were not willing to change their attitude towards psychiatry or increase the level of mental health financing. Several years ago, things began to change, and while we hope for the further improvements, the finances are still insufficient. 

Why the need for psychiatric hospitalizations in Poland has increased since 2010? 

This is an interesting question; in my opinion the number of psychiatric beds has been decreasing too early and too quickly in early 2000s, before any other forms of community health system have been developed. This was the reason for an increase of the number of beds during the last several years, just to compensate the lack of other facilities. Now we are working on the development of the proper number of the community mental health centers to cover all of the needs of our patients and subsequently the number of beds should decrease in future.