Abstract
"The involvement of patients and their families in healthcare policymaking has been a general trend in recent years. This tendency can be observed also in the process of the current reform of psychiatric care in the Czech Republic, which should gradually shift the focus of psychiatric care from large facilities to community care. Organizations representing patients and their families are among the key stakeholders in this reform. The present study analyses semi-structured in-depth interviews and documents with the objective to map and evaluate the process of patient involvement in the reform from its launch to its implementation in 2012-2019. The study identifies the major barriers to patient involvement – on the part of the patients and their organizations, professionals (healthcare professionals, care providers, administration, policymakers), as well as the whole society. It becomes clear that the reform encourages patient involvement, with a palpable shift from consultation to involvement. Still, there are many obstacles to patient involvement in the Czech Republic: the mental state, social and economic situation of the patients, paternalism on the part of care providers, tokenism or stigmatization of mentally ill people."
Highlights
Mental disorders have been major causes of sickness and disability all over the world
The four elite stakeholders represented the key institutions participating in the management of the mental health care reform (a top manager at the Ministry of Health (MoH) of the Czech Republic (CR), a member of the Executive Board for the Reform of Psychiatric Care, a member of the Advisory Board for the Reform of Psychiatric Care, a member of the Czech MoH’s Patients’ Council responsible for mental health)
We identified specific constraints to patient involvement, which could be divided into four categories: 1. on the part of patients and their families, 2. on the part of patients’ organizations, 3. on the part of the mental health care professionals and psychiatric care reform managers, and 4. on the part of the whole society
Summary
Mental disorders have been major causes of sickness and disability all over the world. Reforms of psychiatric care in CEE countries are hindered by several major constraints, including the persistent stigmatization and discrimination of people with mental disorders; relatively high cost of community care in countries with limited healthcare resources; and the lack of experts at all levels, from psychiatrists to social workers (Skuse, 2018). The EU has allocated financial resources within its structural funds for its member and candidate states to carry out reforms of mental health care. These resources are currently used, e.g., in the Czech Republic (CR), Poland and Turkey (Muijen and McCulloch, 2019)
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