Czechs open up about mental-health problems

Abstract

Mental health is coming out from under the shadows in the Czech Republic, with more people now seeking professional help. But, despite this positive step, psychiatric care in the country is largely lagging in the past, with too much emphasis on hospitalisation. Katka Krosnar reports. More Czechs are seeking psychiatric help now than in the 1990s—a phenomenon which many observers have said means that the negative attitudes towards mental-health problems in communist times are being overcome. Recently released figures from the Czech Institute of Health Statistics show that about a third more Czechs sought psychiatric help in 2006 than in 2000. The figures indicate that in 2006, 17 500 Czechs were admitted to hospital due to mental-health problems, while 458 000 people sought psychiatric help. Experts say that mental health issues were either neglected or misused by the former communist regime, which was in power from 1948 to 1989. During that time society looked very negatively on anyone who admitted to having mental-health problems. But now attitudes in society are changing, said Rostislav Kotrc, executive director for the Czech Association for Mental Health—an umbrella organisation for groups who work in the field and support patients and their families. Psychiatrists and people working in mental health say the growth in numbers of people needing psychiatric help in recent years is partly because fewer Czechs are afraid of a perceived stigma linked to seeking such help. “Under the communist regime anyone admitting to have a mental illness was automatically excluded from society. There is still a stigma about seeking help but that has been changing”, said Kotrc. According to the Czech Association for Mental Health, the number of people being treated with neurosis-related mental-health problems rose by over 50% from 118 per 10 000 people in 1997 to 175 per 10 000 people in 2004. Over the same period, the number of people with affective disorders rose from 50 per 10 000 people to 85 per 10 000 people, an increase of 70%. However, the end of communism might have also created added stress for Czechs, say experts. Martin Jarolimek, a psychiatric consultant, says the fall in the communist regime almost 20 years ago brought new freedoms but with that came new and greater forms of stress. Kotrc agrees. “Under the communist system people did not have much but they had security, a home, and a guaranteed job. Now people are having to deal with all kinds of problems such as unemployment, pressure at work, financial worries, homelessness, and trying to afford housing.” Although changing times have brought new problems, psychiatric care is largely lagging in the past, with too much emphasis on hospitalisation and too little community-based care, Jarolimek says. “There is a lack of political will to modernise the system of psychiatric care in the Czech Republic and turn it into a much more community-based care system as is the case in western Europe. Unfortunately, it is just not seen as a priority by most politicians.” The Czech Republic has just three community-care psychiatry complexes, he says. Jarolimek is leading a campaign for a change in law to shift the focus of psychiatric care to community care rather than keeping patients in hospitals. Jiri Svarc, consultant at Bohunice psychiatric hospital in Prague, says there is now less stigma surrounding mental-health problems, which has encouraged more people to consult doctors. But he says that psychiatric wards have too few beds which are constantly full, and that the country does not have a properly functioning social services system, including no community care. Ivan David, director of Bohunice psychiatric hospital in Prague, says Czech psychiatric hospitals desperately need a cash injection of around CZK 6 billion (US$373 million). Psychiatrists say the Czech government allocates far too little money to psychiatric care. Of the 27 European Union countries, the Czech Republic spends the least on psychiatric care, with about 4% of total health-care-sector spending allocated to psychiatric care. According to David, there is a desperate lack of social care facilities for seriously-ill mental health patients. He says that hospitals were caring for around 300 people whose psychiatric state was not acute but who simply needed long-term care.