Institutional discrimination against psychiatric patients in Poland

Abstract

Psychiatric treatment in Poland is based mainly in 51 large psychiatric hospitals, with only 16·9% of beds in general hospitals being available for psychiatric inpatient treatment.1Central Statistical Office. Health and health care in 2015. Warsaw, 2017.Google Scholar Although the number of places in day units has increased,2Supreme Audit Office (NIK)Official reports: Collapse of the Mental Health Protection Act and NIK about psychiatric hospitals.https://www.nik.gov.plGoogle Scholar the availability of psychiatric treatment to patients in crisis is still low, mainly because of the small number of intervention centres, poor organisation, and little funding. In Poland, about 3·5% of the National Health Fund is allocated for psychiatry,3National Council of DevelopmentInformation from the meeting of Health Care Section in National Council of Development on Feb 9, 2016.www.prezydent.plGoogle Scholar which is nearly half the corresponding ratio in other countries of the European Union. The Polish National Mental Health Protection Programme was announced in 2010 but was not implemented. It was impossible to establish any mental health centre that met the criteria of the Programme, and local authorities did not introduce the majority of tasks that the Programme had defined.2Supreme Audit Office (NIK)Official reports: Collapse of the Mental Health Protection Act and NIK about psychiatric hospitals.https://www.nik.gov.plGoogle Scholar An audit of 14 psychiatric hospitals showed that their technical and sanitary conditions were unsatisfactory.2Supreme Audit Office (NIK)Official reports: Collapse of the Mental Health Protection Act and NIK about psychiatric hospitals.https://www.nik.gov.plGoogle Scholar Problems in these hospitals concerned fire safety, sanitary issues, and availability of beds—patients who required admission to hospital were admitted, even if there were no places.2Supreme Audit Office (NIK)Official reports: Collapse of the Mental Health Protection Act and NIK about psychiatric hospitals.https://www.nik.gov.plGoogle Scholar The proportion of people who died by suicide and who had a diagnosis of a psychiatric condition increased from 9·3% in 2013 to 15·2% in 2016.4National Police HeadquartersOfficial data published on National Police Headquarters' website.http://statystyka.policja.pl/st/wybrane-statystyki/zamachy-samobojczeGoogle Scholar This increase might be an indication of a reduced availability of psychiatric treatment to diagnosed patients. Mental health centres, campaigned for by psychiatric associations and non-governmental organisations in accordance with the proposed regulation dated Feb 8, 2017, are structured as presented in the figure. In July, 2017, a series of regional meetings began, with the aim to establish 50 pilot mental health centres in Poland. These centres are to respond to the distribution of funds in their area, ensuring comprehensive care from hospital to home care. Until now, hospitals have also borne the costs of consultations and treatment of comorbidities of patients with a psychiatric disorder by doctors of other specialisations, which, combined with low levels of funding, dooms these centres to insolvency. Despite 30 years of fighting for reform in psychiatry, the present system of psychiatric care seems not only to breach the constitutional rights of individuals to equal access to health-care services, but to also be a manifestation of economic and institutional discrimination against patients with a psychiatric disorder. On May 8, 2017, during the first Mental Health Congress in Warsaw, a declaration was announced, the content of which refers mainly to basic human and constitutional rights (appendix). We hope this declaration will lead to improved care for patients with mental health problems in Poland. JG reports grants from Government of Poland and personal fees from Janssen Cilag. AM reports grants from the Government of Poland and personal fees from Janssen Cilag and Elly Lilly. TK and AS report grants from the Government of Poland and personal fees from Janssen Cilag. Download .pdf (.22 MB) Help with pdf files Supplementary appendix