Mental Health Care Reform in the Czech and Slovak Republics, 1989 to the Present

Mental Health Care Reform in the Czech and Slovak Republics: 1989 to the Present, edited by Richard Scheffler and Martin Potucek, is the product of collaboration between two great universities and scholars in the Czech and Slovak Republics. It is a masterful illustration ofthe importance ofcontext in understanding mental health policy and services. Read it and see how such collaboration can build a civil society.
HOWARD H. GOLDMAN, MD, PhD
PROFESSOR OF PSYCHIATRY, UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE
EDITOR, PSYCHIATRIC SERVICES

Scholarly examinations ofmental health systems in Central and Eastern Europe are rare, especially comprehensive research projects built upon well-based, long-term collaborations. This welcome volume from a team of experienced researchers in the Czech and Slovak Republics and the U.S. provides a bedrock of evidence for policy discussion and future research, relevant notjust to the Czech and Slovak Republics, but more widely.
MARTIN KNAPP, PhD
DlRECTOR OF THE PERSONAL SOCIAL SERVICES RESEARCH UNIT
AND PROFESSOR OF SOCIAL POLICY
LONDON SCHOOL OF ECONOMICS

Foreword

Chapter 1: The Forgotten Problem ofMental Illness: Lost Opportunities and Glimmers of Hope
Contextual implications of mental health care reform
Five-year collaboration
About this book
Looking ahead
Literature

Chapter 2: The History of Mental Health Care in Czechoslovakia
Care of the mentally ill before 1918
1918-1938: The First Republic
1938-1947: War and early post-war period
1948-1989: Socialism
Facilities and service use in Czechoslovakia
Trends at the end of communist era
Psychiatry in theory and practice
Conclusions
Literature

Chapter 3: Mental Health Status of the Czech and Slovak Populations
Measuring mental health status - main approaches and data sources
Main data sources in the Czech and Slovak Republics
Routine utilization statistics
Vital statistics
Health surveys
Mental Health in the European Context
Mental health in the Czech Republic: Prevalence of mental disorders
Lifetime prevalence
Types of psychiatric disorders during lifetime
12-month prevalence
Adjusted 12-monthprevalence
Co-morbidity
Age of onset
International comparison
Mental health in the Slovak Republic: Prevalence ofmental disorders
International comparison
Mental health in the Slovak and Czech Republic: Treated disorders
Outpatient mental health care
Impatient mental health care
Mental health in the Slovak and Czech Republic: Behavioral risk factors, substance abuse and suicidal behavior
Children and adolescents
Alcohol consumption
Tobacco consumption
Suicide as a cause of death
Suicidal ideation, plans, and attempts
Conclusions
Literature

Chapter 4: Mental Health Policies and Legislation
Main international regulations in the mental health care
Health and mental health policies in the Czech and Slovak Republics
Main political and economic transformation steps in the Czech Republic
Main political and economic transformation steps in the Slovak Republic
Health care reforms in the Czech and Slovak Republics
Czech Republic
Slovakia
Mental health developments
Box 4 National program for mental health of the Slovak Republic
Mental health legislation in the Czech Republic
Mental health legislation in the Slovak Republic
Legislation versus practice
Quality of care
Facilities and privacy
Informed consent and access to treatment information
Involuntary treatment and detention
Access to documentation
Use ofrestraints
Assistance ofpolice
Workofpatients
Incapacitation
Minorities and mental health
Monitoring and protection of human rights in mental health care
Complaints, appeals, and advocates
Courts
Public Defender ofRights of the Czech Republic
Public Defender ofRights of the Slovak Republic
Council for Human Rights of the Government of the Czech Republic
Governmental Board for People with Disabilities of the Czech Republic
Governmental Council for Issues ofPersons with Disabilities of the Slovak Republic
Committee on Human Rights of the National Council of the Slovak Republic
Association of Civic Advisory Centers
Slovak National Center for Human Rights
Health Care Surveillance Authority (HCSA)
Conclusions
Literature

Chapter 5: Organizational Structures
Main trends in mental health services
Administrative framework of mental health in the Czech and Slovak Republics
Organization of mental health services in the Czech and Slovak Republics
Intersectoral co-operation in mental health services
Cooperation with patient associations
Collaboration outside the health sector
Best practices
Centre for Mental Health Care Development
Otvorme dvere, otvorme srdcia (ODOS - Open the Doors, Open Your Hearths)
Michalovce
Integra and Tetralogue model
Plans for the future in the Czech Republic
Plans for the future in Slovakia
Conclusions
Literature

Chapter 6: Promotion, Prevention and Treatment
Model of the mental health care structure
Prevention and promotion in the Czech and Slovak Republics
Who is involved in prevention and promotion?
Ministry ofHealth
Ministry of Labor and Social Affairs
Ministry ofEducation, Youth, and Sports
Governmental agencies
Professional associations
Non-governmental organizations
Health insurance companies
Box 6A Examples ofrecent NGO activities
Treatment
Who treats psychiatric disorders?
Box 6B Nurses and their increasing role in mental health care
The changing role of primary care
Case identification, diagnosis, and classification
Phases of treatment
Early treatment
Standard treatment
Long-term psychiatric treatment
Treatment guidelines
Box 6C Psychosocial and psychotherapeutic approaches in the Czech and Slovak Republics
Box 6D Biological therapy available in the Czech and Slovak Republics
Conclusions
Literature

Chapter 7: Financing Mental Health Care
Financing ofhealth care
Existing systems to finance health expendirures
National economy and its impacts on health finance
Health financing in the Czech and Slovak Republics
Health care finance in the Czech Republic
Health care finance in Slovakia
Paying for mental health care
Payment arrangements in the Czech Republic
Payment arrangements in Slovakia
Expenditure for mental health care
Mental health spending in the Czech Republic
Mental health spending in Slovakia
International comparisons
Conclusions
Literature

Chapter 8: Advocacy, Stigma, and Self-Help
The problem of stigma
De-stigmatization
Efforts in the Czech and Slovak Republics
Advocacy and self-help
Barriers to advocacy
Goals of mental health advocacy movements
Box 8 Selected advocacy groups
Conclusions
Literature

Chapter 9: Human Resources and Training
International norms and principles
Optimal staffing
New European principles for medical staff and its education
Mental health personnel in the Czech and Slovak Republics
The Czech Republic
Long term psychiatric hospitals and general hospitals
Outpatient units
The Slovak Republic
Box 9A The impact of cheap labor on mental health care
Scope of practice of mental health care professionals
Education and training of professional mental health care personnel
Selected general aspects of academic mental health care education
Methods ofdelivery
Education and training of professional mental health care personnel in the Czech RepubUc
University education
Psychiatric doctors
General practitioners
Box 9B Only 2 % of depressive patients recive antidepresants
Secondary professional schools (nurses)
Postgraduate training
Education and training of professional personnel in Slovakia
University education
Psychologists
Social workers
PhD degrees
Nursing
Secondary professional schools (nurses)
Postgraduate training
Education and training of professional personnel in Slovakia
University education
Psychiatric doctors
General practitioners
Psychologists and psychology
Social workers
PhD degrees
Nursing
Secondary professional schools (nurses)
Postgraduate training
Specialized studies for medical doctors
Box 9C Specialized program in Psychiatry at the Slovak Medical University (www.szu.sk)
Certificates for medical doctors
Specialized studies for nurses
Other forms of training
Looking ahead in the Czech Republic
Looking ahead in the Slovak Republic
Box 9D Examples of innovations: Czech Republic medical curriculum reform
Conclusions
Literature

Chapter 10: Research and Evaluation
The importance of research
Basis terms and methodology
Issues addressed
Mental health research in the Czech Republic
National research system
Box 10A Most important strategic documents and legislation in the area of mental health research in the Czech Republic
Health research
Main institutions in the area of mental health research
Mental health research financed from public funds
Box 10B Selected research results
Mental health research in the Slovak Republic
National research system
Box 10C Most important strategic documents and legislation in the area of mental health resarch in the Slovak Republic
Research funding
Main institutions in the area ofmental health research
Mental health research financed from public funds
Box 10D Selected research results
International co-operation in mental health research in the Czech Republic and Slovakia
Main areas and selected projects
Conclusions
Literature

Editors
Acknowledgements