During the 3rd Mental Health Congress, which was initiated by psychiatrists and people with experience of mental crisis, the Warsaw Declaration, a vision of the most urgent needs that will complete the transformation of psychiatric care in Poland, was formulated.
The reform of psychiatric treatment was initiated in 2018 with a pilot, that is, the testing of new solutions in selected places in Poland. At the moment, there are 33 places where Mental Health Centres are in operation. What is this model based on?
The first principle is responsibility for the residents of a specific area: city, district, county. This is based on the fact that the Centre, when signing a contract with the National Health Service, declares that if a resident requires help, that help will be provided. If it is a so-called urgent case, a visit to a psychiatrist will be arranged within three days, and in emergencies immediately. The Centre must offer five basic forms of assistance: a 24-hour ward, a day ward, a community treatment team, a mental health clinic and an emergency service. Each Centre has a psychiatrist on duty - 24 hours and seven days a week. This makes it possible to provide immediate consultation and assistance to residents in the Centre area when needed. An important new feature is the notification and coordination pointwhich every Mental Health Centre must have. It is a place where you can get help or information without making an appointment, signing up or waiting in line. If you go to such a centre every weekday from 8 a.m. to 6 p.m., you will meet professionals, i.e. a psychologist, an experienced psychiatric nurse, a community therapist and sometimes a recovery assistant. An initial mental health assessment is carried out and an initial action plan is arranged, and if the matter is urgent, an appointment with a psychiatrist is made straight away.
Of course, all this is done with the patient's participation, in full respect of autonomy and dignity. In addition, other new functions are emerging at the Centre, such as. recovery assistants - that is, people who have experience of a mental health crisis, have received training and placements to be able to support people in crisis and their loved ones. They pour hope into recovery, help the patient bond with their doctor, co-lead support groups for people in crisis and their families. There are also care coordinators for people with chronic mental health problems who require more active support. The task of the coordinators is, among other things, to provide support and coordinate the implementation of the treatment and recovery plan, in the spirit of the recovery paradigm.
The existing model of mental health care is archaic, non-modern, described as 'asylum-like', which means relying on large psychiatric hospitals. It is a hospital and counselling system without intermediate forms and all that the community model brings. This old model, based on the biomedical paradigm, is characterised by a reductionist approach, i.e. a focus on the elimination of the symptoms of the disorder itself, rather than the understand the healing process functionally, in which the aim is to achieve full participation in society, work and education, despite the various limitations associated with mental health problems. We call this recovery or recov-ery. A move towards a community-based model is necessary if psychiatric care is to help, to provide support on the way to fulfilling social roles, to the best possible quality of life. Stigmatisation is linked to the asylum model, so if we break this model, we open the door to destigmatisation. It is also important to gradually convince the hitherto unconvinced. After all, the environmental model opens the door to better working conditions and greater satisfaction.
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The current pilot has been extended until the end of 2022. This gives time to prepare the legal foundations for the model to be disseminated in a systemic way after 1 January 2023. The solutions from the pilot regulation, which apply only to the Centres participating in the testing of the new model, need to be introduced into the law. And also add new elements that result from the pilot experience. These include, for example ensuring the autonomy of the Centres, autonomy in the disposal of budgets and a number of other organisational issues, as well as for better guarantees of respect for the rights and dignity of people with mental health problems. Discrimination against psychiatric patients in the realisation of the right to health care is still evident. If an acute patient goes to a psychiatric ward at a multispecialty hospital, he is also cared for in other areas of medicine - internal medicine, surgery and so on. If, however, he goes to a psychiatric hospital, he is deprived of this.
And this discrimination, this unequal treatment sometimes entails dramatic consequences for the patient's health. In the admission room of a psychiatric hospital, it is not possible 24 hours a day, all week long, to receive on-site laboratory diagnostics, X-rays, ultrasounds or CT scans. From the perspective of the right to health care - this is nothing more than a systemic deprivation of psychiatric hospital patients of the full possibility of realising these rights. Therefore, the relevant guarantees must be enshrined in the law, along with the changes introducing the reform.
The biggest success is that the pilot has taken off and at the same time provided more funding for psychiatric care. In Poland, approximately 3.4% of total NHF expenditure is spent on psychiatry, while in Europe it is 6 7%. We postulate at least 5% and this has been achieved in the pilot.
We are moving away from paying for individual visits, points and person-days to giving the Centre a lump sum, the amount of which depends solely on the number of inhabitants. If the Centre has, for example, 100,000 inhabitants in its area of operation, it will receive PLN 8.8 million this year, divided into monthly instalments. In return, the Centre takes on the obligation to provide psychiatric care to its residents. This funding means that if a patient is discharged from the ward more quickly, the Centre does not lose money because it has already received a lump sum payment. It can be said that the 24-hour ward is no longer penalised for a patient moving more quickly to the day ward or the Community Treatment Team.
The future psychiatric care system needs to be complemented by two segments
First are specialised programmes financed outside the lump sum, a second is the so-called highly specialised level, i.e. university clinics, which must also have their own separate funding. Only such three-tier system, with a strong basis in Mental Health Centres, will be complete.
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It is important to Ministry of Health announced a roadmap and completion date for adult psychiatry reform. That this year would be a draft law has been prepared to regulate the new model of psychiatric care. In the next year, the organisational standard of care in Mental Health Centres should be adopted, and scientific societies should start to develop recommendations and guidelines for treatment. It would be good for the other two elements of the new system to begin to be introduced next year, viz. health programmes and highly specialised centres. It is also important to have cross-sectoral cooperation for re-establishing social participation, returning to life roles - so that in the next two to three years, the principles for cooperation with NGOs, social assistance, support and employment activation centres etc. are established. Only then will there be a complete model of community psychiatry creating the conditions so that, after a mental health crisis, everyone can have a fulfilling life, full of hope and social participation, like any other citizen of our country.
The 3rd Mental Health Congress will see HERE
Source: medexpress.co.uk