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System of care for the mentally ill in the Czech Republic 23 November 2009 CMHCD

System of care for the mentally ill in the Czech Republic 23 November 2009 CMHCD. O.Pěč. Introduction. Traditional and rather paternalistic approach, institutionally based care Vast majority of the care is still concentrated in mental hospitals

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System of care for the mentally ill in the Czech Republic 23 November 2009 CMHCD

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  1. System of care for the mentally ill in the Czech Republic23 November 2009CMHCD O.Pěč

  2. Introduction • Traditional and rather paternalistic approach, institutionally based care • Vast majority of the care is still concentrated in mental hospitals • Community care has been evolving very slowly in the last 20 years • Biological treatment (novel atypical antipsychotics) is as available as in other EU countries

  3. Introduction • There has been an uninterrupted tradition of psychotherapy, mainly group psychotherapy. • A great portion of psychiatrists and psychologists are trained in group psychotherapy. • Tradition of psychotherapy in day clinics and in therapeutic communities even from communist times

  4. Providers of MH care • State institutions • Majority of mental hospitals • University clinics with psychiatric departments • Municipality (region, city) • General hospitals with psychiatric departments • Some mental hospitals • Social institutions (pensions´ houses) • Private • Outpatient departments of psychiatry, clinical psychology • Some day clinics • Non-governmental organizations • Psychiatric rehabilitation services • Users and relatives associations • Initiative and „roof“ associations

  5. Payers of MH care • General health insurance • Vast majority of people are insured • compulsory for employees • people insured from the state – children, pensioners • Small portion of people are uninsured • Homeless, long-term unemployment • General Health Insurance Company (approx.70%) • Other health insurance companies (incl.some private) • State or municipality financial grants • For social services • Care allowances • For people with disabilities • MH problems underestimated in evaluation of disabilities • For caregivers /incl.family/, residential social services • „Out of pocket“ payments • Minimal in comparison with other EU countries, regulatory fees

  6. Who pays for whom

  7. A portion of costs in health care system used for MH care

  8. Mental hospitals uneven geographic distribution long distances for patients from their homes (more 100 km) mixed care for acute and long-term patients 19 MH, approx. 400 – 1200 beds, 9,3 beds per 10 thous.inhab., average stay – 82 days traditional approach Beds per 100 000 inhab. MH for adults MH for children

  9. Psychiatric departments of general hospitals 32 departments, only 1,4 beds per 10 000 inhab. for acute patients average stay 20,4 days Beds per 100 000 inhab.

  10. The comparison to other EU countries The proportion of beds in mental hospitals and community inpatient units per 100 000 inhab. Source: WHO Europe, 2008

  11. Psychiatric out-patient care 697 ambulant psychiatrists in 2007 6,72 amb.psychiatrist per 100 000 inhab. 467 thousands of treated patients in 2007, i.e. approx. 670 patients per 1 psychiatrist per 1 year small time space for individual patients „10 minutes“ visits with drug prescription Amb.psychiatrists per 100 000 inhab.

  12. Facilities providing day and crisis care Day clinics Com. psychiatric nurses Association of Day Clinics and Crisis Centers Crisis centers Stuchlík 2004, Pěč 2009 21 day clinics, 3 crisis centers, 3 facilities providing community psychiatric nursing

  13. Availability of day psychiatric care in EU Source: Maone, 2002; Kallert, 2001; Briscoe, 2004; Balicki, 2000; ÚZIS 2007

  14. Community rehabilitation services AKS (Association of Mental Health Care Community Services) 1991 – Fokus 1995 – MATRA I 1999 – MATRA II 2000 – new NGO´s after 2000 before 2000 Stuchlík 2004, Pěč 2009 30 NGO´s with 430 professionals (mainly social workers) cared about 4600 patients in 2007 (source: AKS, Fokus)

  15. The comparison to other EU countries The number of visits in out-patient and community facilities per 100000 inhab. Zdroj: WHO Europe, 2008

  16. The use of day clinics, crisis and rehabilitation services in patients of outpatients services Zdroj: ÚZIS, AKS, Fokus

  17. The changes in a structure of the care for mentally ill people in the last 20 years Source: UZIS CR

  18. Structure of costs for psychiatric care altogether • Year 2001

  19. Projects in the development of community care • The most important factors: • an activity of the newly established providers (NGO ´s) after the political changes in 1989 • New extramural mental health facilities • New NGO´s providing psychiatric rehabilitation • organizations promoting and encouraging changes in mental health care (NGO´s) • e.g. Center for Mental Heath Care Development, Czech Association for Mental Health • counseling and financial assistance from abroad (e.g. Netherlands)

  20. Development in rehabilitation community services • established in 1990 • providing community psychiatric rehabilitation services • from 1990 gradually emerging organizations up to 10

  21. Regional models of extramural care Centre for Mental Health Care Development & GGZ Netherlands & Min.of Foreign Aff.Netherlands 1995-1997 3 new regional community teams in Prague 11, Pardubice, Mladá Boleslav 3 new NGO ´s were created „MATRA I“ Mladá Boleslav (RKTMB – Fokus MB) Pardubice (PDZ–Pard.) Praha 11 (ESET-HELP)

  22. „Socialization Psychiatric Hospitals “ Centre for Mental Health Care Development & GGZ Netherlands & Min.of Foreign Aff.Netherlands & Trimbos • 1999-2001 linking up of newly established extramural NGO ´s or sofar existing NGO ´s with the services of 4 psychiatric hospitals • community care for discharged patients, slight reduction in the length of hospitalization, slight downsizing in the numbers of beds in PH „MATRA II“ PH Bílá Voda + EGO SUM, ESTER, Zahrada 2000, Diakonie PH Brno Černovice + PRÁH PH Jihlava + VOR PH Lnáře + POLIDON)

  23. Involvement of users and relatives KOLUMBUS– users´ organization Advocacy in mental hospitals, self organized exhibitions, lectures for public or lectures in schools, VIDA Users provide consulting services for users or for other people in 8 advocacy centers in CR. Centers are placed in public areas. Lectures for public or for schools. SYMPATHEA Association of relatives of people with MH problems AND MANY OTHER ORGANIZATIONS….

  24. Model of care Mental hospitals After-care Psychiatric departments of gen.hosp. General practitioners crisis services community residential services psychiatric ambulances Day clinics psychoth.prg Institutional residential services Case management general services in communiuty Rehabilitation consulting

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