Psychiatric care in Central and Eastern Europe, including the Czech Republic, is ineffective and heavily underfinanced, suggests an international study, which has just been published in the prestigious US journal The Lancet Psychiatry. In most of the post-Communist countries, mental health care still relies on large psychiatric hospitals and there is a huge stigma connected to mental health problems. I spoke to Doctor Petr Winkler from the National Institute of Mental Health, who headed the international team of experts, and I first asked him to outline the main focus of the study:
“We focused on 24 countries which used to be east of the Iron Curtain during communism in Europe. We covered the period sends the revolutions and profound social, economic and political changes, which took place in 1989 to 1991, up to now.
“Our main findings are that the systems of mental health care for people with severe mental illnesses in the region are outdated and ineffective. They are heavily underfinanced, they still rely on large psychiatric institutions, large psychiatric hospitals with many beds.
“Sometimes there are even 17 beds in one room with no space for intimacy whatsoever. There are people hospitalized for inadequately long, sometimes even for more than 20 years, and there is a huge stigma covering mental health problems in the region as well.”
Where does this stigma come from? Would you say that this is the heritage of the communist period?
“We see stigma around mental illness all over the world, but it seems that in this region it is particularly high and I would agree with you that it’s kind of a heritage from communism, as well as lack of cultivated and intelligent debate about mental health, which actually hasn’t changed much since the revolutions in 1989 and 1991.”
Were the results of this study surprising to you in any way or did it confirm what you have already expected?
“They were surprising in many ways and in many ways they also confirmed what we know from here, from the Czech Republic, although it focused on all the countries in the region.
“For example, it seems that the most developed communitive areas in the countries which had their psychiatric systems destroyed by war, such as Kosovo and Bosnia and Herzegovina, and where Unites Nations took over the governments of the countries in the aftermath of the war and basically used the air forms more effectively than in other countries.
“Surprisingly enough to us, there are examples of high quality community care all over the region in each of the countries regardless of their income status. The problem with this is usually that they are available only to a few inhabitants of that particular country.”
And speaking about the Czech Republic in particular, how would you describe psychiatric care in our country? How does it work in comparison to the rest of Europe?
“Well I would like to mention two points. First we have very good psychiatrist and the staff that really care about the patients. That’s one side of the problem.
“But the structure of the care, including financing, the legislative background, this is not in very good condition and the system these days is heavily underfinanced.
“The reforms and the efforts to reform the system stayed in the realm of aspiration or rhetoric for most of the last 25 years, although nowadays there are efforts to reform the system and we will see whether these efforts will be successful or not.”
So what are some of the positive trends that you have noticed that took place in recent times?
“The effort to reform mental health care, which is supported by the funding from the European Union, is definitely a very good sign that things might be changing nowadays and there has been a lot of initiative to bring this problem to the attention of the public and politicians and these are all very good signs, but we will see whether this will also translate to real world changes.”
Would you say that psychiatry patients in Central and Eastern Europe and in the Czech Republic in particular have some specific problems that are perhaps different from the rest of Europe?
“I think that the problems are specific in the sense that the structure of services which currently exists in the country doesn’t apply to their needs. There is also a huge stigma surrounding mental illness so people who might have severe mental health problems will be hesitant to seek treatment, because they are afraid that they might be hospitalized for excessively long in outdated psychiatry hospitals and also they might face severe stigma and discrimination from their surroundings, from external society.
“That’s right. I don’t know about other drugs but definitely we are one of the leading nations in the consumption of alcohol per capita and there is also quite excessive consumption of cannabis.
“On the other hand I don’t think that we are doing any bad in terms of hard drugs like cocaine, heroin and so on. I think that with respect to these kinds of drugs we are doing pretty well.”
What measures or steps should be taken to reform psychiatry care in the Czech Republic?
“They have to be manifold, in fact. First we should cultivate a debate about mental health and speak about mental health not just in terms of severe mental illnesses and in terms of some scandals, when people with mental health problems commit some crime.
We also have to cultivate the debate about mental health as an integral part of our health, saying that there is no health without mental health. it is also important to educate young people about their mental health because after all suicides, the living cost of mortality among Czech youth is even higher than accidents.
“We should also increase the financing of mental health, I would say scandalous that in terms of the impact of all diseases the mental health I count for 25 people but the location of budget from health to mental health is only around four people.
The study we have been talking about has recently been published in the lanced psychiatry magazine. How important is it for you to be published by such magazine? And would you says it is important to raise awareness for this problem?
“In terms of the problem itself it’s very important because it definitely attracts attention of people and it’s a high level scientific publication which we basically cannot ignore. For me personally obviously it’s one of the best achievements and it’s a dream of every scientist to be published by such a good journal.”