Prof. Jiří Raboch, M.D.

Transcription

1 TAKING CARE OF THE MENTALLY ILL IN THE CZECH REPUBLIC Prof. Jiří Raboch, M.D. PSYCHIATRIC DEPARTMENT General University Hospital 1st. FACULTY OF MEDICINE CHARLES UNIVERSITY

2 CZECH PSYCHIATRY GERMAN (AUSTRIAN) INFLUENCES SOVIET BLOC

3 PARTICIPATION IN EUROPEAN PROJECTS

4 2000 European Congress of Psychiatrists 2002 European Congress of CBT 2007 World Congress for Social Psychiatry

5 CZECH PSYCHIATRY LESSONS LEARNED 1. Organizational capabilities and high professional and scientific level 2. Traditional and paternalistic approach, institutionally based care 3. Relatively good quality of mental health care 4. Insufficient communication with consumers and general public 5. Low ability to influence politicians and payers 6. Stigmatization, economic conditions

6 CZECH PSYCHIATRY LESSONS LEARNED 1. Organizational capabilities and high professional and scientific level 2. Traditional and paternalistic approach, institutionally based care 3. Relatively good quality of mental health care 4. Insufficient communication with consumers and general public 5. Low ability to influence politicians and payers 6. Stigmatization, economic conditions

7 For the first time in Central and Eastern Europe More than participants from 125 countries Almost scientific contributions

8 thank you for your thoughtfulness to make this event the largest psychiatric congress of this year in Europe Prof. Siegfried Kasper, president World Federation for Biological Psychiatry the program was excellent, the organization really one of the best I have experienced. Prof. Allan Tasman, past president American Psychiatric Association

9 CZECH PSYCHIATRY LESSONS LEARNED Organizational capabilities and high professional and scientific level Traditional and paternalistic approach, institutionally based care Relatively good quality of mental health care Insufficient communication with consumers and general public Low ability to influence politicians and payers Stigmatization, economic conditions

10 Psychiatric hospital beds per Belgium Czech Republic France Finland Greece United Kingdom Portugal Italy

11 NUMBER OF PSYCHIATRIC BEDS/ psych.hosp. gen.hosp. total

12 NUMBER OF HOSPITALIZED PATIENTS IN CZECH PSYCHIATRIC FACILITIES GH PH total GH + 18,6 %, PH + 6,7 %, TOTAL + 10,6 % ÚZIS 2008

13 PRAGUE PSYCHIATRIC HOSPITAL BOHNICE

14 Psychiatric Department Hradec Králové Psychiatric Department GUH Praha

15 France Norway Belgium Greece Czech Republic Germany United Kingdom Italy Netherlands Number of psychiatrists per Finland

16 NEW PSYCHIATRISTS NUMBER YEARS

17 NUMBER OF PSYCHIATRISTS psych.hosp. gen.hosp. out-pat. total ÚZIS 2007

18 NUMBER OF FIRST OUT-PATIENT CONSULTATIONS/YEAR DIAGNOSIS CHANGES (%) ORGANIC BRAIN DISORDERS ,8 ALCOHOL/DRUG DEPENDENCIES ,4 SCHIZOPHRENIA ,2 AFFECTIVE DISORDERS ,0 NEUROTIC DISORDERS ,2 DEVELOPMENTAL DISORDERS ,9 CELKEM ,9 ÚZIS 2007

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20 HUMAN RESOURCES FOR MENTAL HEALTH ECONOMIC LEVEL low lower middle upper middle high INCOME/COUNTRY/ CZ psychologists nurses social workers WHO 2005, Vevera et al., 2008

21 COMMUNITY CARE (DAY CARE CENTRES, CRISIS INTERVENTION CENTRES, HELP LINES, ) NO CENTRAL STATISTICS AVAILABLE

22 DAY CARE CENTRES IN CR

23 DIAGNOSTIC STRUCTURE IN INDIVIDUAL DC CENTRES Dresden London Prague F2 F3 F4 Raboch et al., 2002

24 European Evaluation of Coercion in Psychiatry COERCIVE MEASURES IN INDIVIDUAL STUDY SITES Dr Sop Prg Th Nap Vil Wr Sp Lo Ör seclusion restraint medication Raboch et al., 2008

25 EUNOMIA FORCED MEDICATION IN INDIVIDUAL CENTRES typicals atypicals bzd 10 0 Dresden Praha Wroclav Michalovce Raboch el al., 2007

26 CONSUMPTION OF ANTIPSYCHOTICS DDD/1000 INHABITANTS/DAY IN CZ GER AUSTR. SLO POL 2005 Suchopár and Raboch, 2006

27 CZECH PSYCHIATRY LESSONS LEARNED Organizational capabilities and high professional level Relatively good quality of mental health care Traditional paternalistic approach and institutionally based care Low ability to influence politicians and payers Insufficient communication with consumers and general public Stigmatization, economic conditions

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31 CZECH PSYCHIATRY LESSONS LEARNED Organizational capabilities and high professional level Relatively good quality of mental health care Traditional paternalistic approach and institutionally based care Insufficient communication with consumers and general public Low ability to influence politicians and payers Stigmatization, economic conditions

32 STIGMA OF PSYCHIATRY ČR 1999, representative sample of 1248 respondents psychiatr. ophthalmolog. GP oncolog. social prestige cardiolog best, 5 - worst Raboch et al., 2000

33 Náklady na péči poskytnutou v oboru psychiatrie v letech VŠEOBECNÁ ZDRAVOTNÍ POJIŠŤOVNA ČESKÉ REPUBLIKY

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35 SATISFACTION WITH TREATMENT - EDEN (CAT 0 10) City Day care Hospitalisation Dresden London Wroclaw Michalovce Praha 7,4 7,7 7,8 8,2 8,2 7,5 6,5 8,2 8,5 8,3 Raboch et al., 2004

36 Seminar at the Senate of the Czech Parliament Under the auspices of its chairman MUDr. Přemysl Sobotka Czech Psychiatric Association 2007: National psychiatric program Czech Ministry of Health 2008: National action plan for mental health

37 Biennal Collaborative Agreement , WHO Community based MH care in selected pilot region Karlovy Vary region DEMo.Binc, EU Indicators of quality measurement for monitoring MH interventions

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39 THANK YOU FOR YOUR ATTENTION!

40 This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.