The present state of Mental health care in Slovakia
Transcript of The present state of Mental health care in Slovakia
Depressionreducessurvivalinpa;entswithchronicsoma;cdisorder
Prospec(vecohortstudyenrolling376hospitalizedpa(entwithCOPD;medianfollow-up369days
OR1,93
Barrierstotreatment(mentaldisorders)inEU
RespondentstotheEUCompassforAc4ononMentalHealthandWell-being2016surveyindicatedthefollowingbarriers:
• insufficientfundingformentalhealthserviceswasreportedby19outof22memberstateshavingsome(27.3%),high(18.2%)orveryhighimpact(27.3%);
• insufficientavailabilityofmentalhealthprofessionalswasreportedby16outof22memberstates,havingsome(31,8%),high(27,3%)orveryhigh(13,6%)impact;
• aMtudinalbarriers(lackoftrust,willingnesstohandleproblemsbyone’sown,s4gma)wasreportedby17ofthe22memberstates,havingsome(40.9%)high(27.3%)orveryhigh(9.1%)impact.
Animportantpartofmentalhealthcarecouldbemanagedbyinformalorganiza;ons.Whereaddi4onalsupportandexper4searerequiredamoreformalnetworkisneeded.
Theintegra4onofmentalhealthcareinprimaryhealthservicesisacri;calcomponentofacomprehensivementalhealthsystem.Essen4alservicesatthislevelincludeearlyiden4fica4onofmentaldisorders,managementofstabilizedseverementaldisorders,referralofcomplexcasestospecializedservices.
WHOpyramidnetwork
Thespecializedservicesareatthetopofthepyramid:• aprocessofdeins;tu;onaliza;on,• limi;ngtheroleofmentalhospitals• buildinganetworkofcommunityservices(includingcommunitymentalhealthcenters,generalhospitalpsychiatricunits,daycentersandcommunityresiden4alfacili4es)Thatallincreasestheaccessibilityofservices.Actually,hospitaltreatmentisrequiredforaminorityofpeoplewithmentaldisorders,evenincasesofseveredisorders.
WorldHealthOrganiza1on,2010;2011;2014
Problemsofslovakhealthcaresysteminthemanagementofmentaldisorders
• Ins;tu;onaliza;onofhealthcare.Equipmentandarrangementofins4tu4onalhealthcareproviders(MTS,PS).
• AbsenceofPsychiatricfacili;eswithspecialdesigna;on.• Unmetneedsintheareaofpediatricpsychiatry(inpa4entandoutpa4entcare,humanresources...).
• Insufficientconnec;on/collabora;onbetweeninpa4entandoutpa4entpsychiatriccarewithsocialservices.
• Insufficientconnec;on/collabora;onbetweeninpa4entandoutpa4entpsychiatriccarewithprimaryhealthservices.
• Absenceofanetworkofcommunitypsychiatrichealthcareservices:communitymentalhealthcenters,daycentersandcommunityresiden4alfacili4es,early-interven4oncenters,crisiscentersandotherservicesincludingmobile(mul4disciplinary)teams,specializedpsychiatriccommunitynursesetc.
• Publichealthinsurancepaymentsysteminoutpa4enthealthcare.
Activity I. r.
Number of visits
Patients at outpatient
clinics Domestic
visits
Domes-tic visits perfor-med by nurses
Age group a 1 2 3
0 - 18 01 86 499 4 0
19 + 02 1 702 055 1 019 0
Outpa;entpsychiatriccare(2016)
Ins;tu;onalpsychiatriccare(2016):Hospitalisa;ons
Mental and ehavioural disorders due to alcohol use
Organic, including symptomatic, mental disorders
Mood [affective] disorders
Disorders of adult personality and behaviour
Schizophrenia, schizotypal and delusional disorders
Mental and behavioural disorders due to other psychoactive substance use
Neurotic, stress-related and somatoform disorders Disordersofpsychological
development
43516(3,5%ofallhospitaladmissions)
Howmuchdowespendonmentalhealthdisorders?
ExpensesofHealthInsuranceCompaniesinMil€onGroupFandXdiagnoses(F*andX6*toX84*)
Year 2014 2015 2016
Outpa;enthealthcare 27,3 27 29,3Medica;ons 51,8 49,2 49Inpa;enthealthcare 62,5 64 71,5Together 141,6 140,2 149,8
OverallexpensesofHealthInsuranceCompanies 3853 3986 4113Propor;onofexpensesonpsychiatricdiseasescompardwithoverallexpensesonhealthcare 3,7% 3,5% 3,6%
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Thelackofphysiciansandnursesinslovakia–compúaredwithEU
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Physicians per 1000 inhabitants, 2015 or nearest year
EU: 3.6
EU: 8.4
Physicians Nr. low Nurses Nr. high
Physicians Nr. high Nurses Nr. high
Physicians Nr. high Nurses Nr. low
Physicians Nr. low Nurses Nr. low
Nurses per 1000 inhabitants, 2015 or nearest year
Thenumberofphysiciansandotherhealthcareprofessionalswhoaremissingintheslovakhelathcaresystem
NursePhysicianScrubNurseHealthAssistentMidwivesPhysiotherapeu;stsTechniciansinRadiology
changeHealthcareprofession
NumberofmissingspecialistsinSlovakiaaccordingtoNCHIdata
Deficiencyofphysiciansspecializedinpsychaitry
willrise...
Numberandaverageageofphysiciansac;ngintheareaofpsychiatriccareaccordingtotheirloca;on
Disciplineofmedicine District Numberofphysicians Averageage
Psychiatry
Slovakrepublic 651 46,93 Bra;slavskýkraj 141 48,37 Trnavskýkraj 33 46,15 Trenčianskykraj 66 47,48 Nitrianskykraj 67 47,82 Žilinskýkraj 95 46,53 Banskobystrickýkraj 59 47,95 Prešovskýkraj 76 45,24 Košickýkraj 124 45,55
Disciplineofmedicine District Numberofphysicians Averageage
Pediatricpsychiatry
Slovakrepublic 45 50,93 Bra;slavskýkraj 20 46,10 Trnavskýkraj 0 - Trenčianskykraj 3 51,33 Nitrianskykraj 5 60,80 Žilinskýkraj 4 64,00 Banskobystrickýkraj 6 55,50 Prešovskýkraj 0 - Košickýkraj 7 46,14
Špecializačnýodbor Početabsolventov2006-2015 VydanéOsvedčenieoakreditáciikudňu17.10.2016
Anesteziologiaaintenzívnamedicína 485 JLFUK,UPJŠ,LFUK,SZU,Angiológia 34 SZUDermatovenerológia 106 JLFUK,UPJŠ,LFUK,SZU,Diabetológia,poruchylátkovejpremenyavýživy 84 JLFUK,SZU,Endokrinológia 56 UPJŠ,LFUK,SZU,Fyziatria,balneológiaaliečebnárehabilitácia 115 UPJŠ,SZU,Gastroenterológia 61 JLFUK,LFUK,SZU,Pediatrickágastroenterológia,hepatológiaavýživa 6 JLFUK,LFUK,Geriatria 72 UPJŠ,LFUK,SZU,Gynekológiaapôrodníctvo 284 JLFUK,UPJŠ,LFUK,SZU,Hematológiaatransfuziológia 49 JLFUK,SZU,Chirurgia 231 JLFUK,UPJŠ,LFUK,SZU,Detskáchirurgia 14 JLFUK,LFUK,Infektológia 34 JLFUK,UPJŠ,SZU,Tropickámedicína 5 SZU,Kardiológia 132 UPJŠ,SZU,Pediatrickákardiológia 11 LFUK,Klinickáimunológiaaalergológia 46 JLFUK,Klinickálogopédia 22 SZU,Klinickáonkológia 77 LFUK,Klinickápsychológia 179 FFUK,SZU,Klinicképracovnélekárstvoaklinickátoxikológia 2 Lekárskagene;ka 10 SZU,Nefrológia 64 SZU,pediatrickánefrológia 3 SZU,Neonatológia 23 JLFUK,SZU,Neurológia 240 JLFUK,UPJŠ,LFUK,SZU,Pediatrickáneurológia 8 LFUK,Ozalmológia 192 LFUK,SZU,Ortopédia 130 LFUK,Pediatrickáortopédia 0 Otorinolaryngológia 81 JLFUK,UPJŠ,LFUK,SZU,Pediatria 395 JLFUK,UPJŠ,LFUK,SZU,Pneumológiaazizeológia 66 JLFUK,UPJŠ,SZU,Pediatrickápneumológiaazizeológia 12 JLFUK,SZU,Psychiatria 198 LFUK,SZU,Detskápsychiatria 23 LFUK,Gerontopsychiatria 3 Medicínadrogovýchzávislos{ 6 Rádiológia 245 UPJŠ,LFUK,SZU,Reumatológia 20 SZU,Pediatrickáreumatológia 3 UPJŠ,Úrazováchirurgia 113 UPJŠ,SZU,Urológia 92 JLFUK,UPJŠ,SZU,Pediatrickáurológia 1 JLFUK,Vnútornélekárstvo 286 JLFUK,UPJŠ,LFUK,SZU,
Numberofphysicianswhocompletedtheirspecializa;onstudywithinaperiodbetween2006and2015
198psychiatrists,butonly23pediatric
psychiatristsoveraperiodoflast10years...
Currently,thereare205physiciansinpreparingforthepsychiatricspecializa;on,howeveronly23
physiciansarelistedforpedopsychiatry...
Ins;tu;onalpsychiatriccare(2007-2016).Physicianpostsandbeds–currentsitua;on.
3739beds(Addictologynotincluded)standsfor12%oftheen;reresources
Thenumberofbedsforpedopsychiatricins;tu;onalhealthcare–thepresentstate
Bra1slavaandWestofSlovakiaKlinikadetskejpsychiatrieDFNsPaLFUK,Bra4slava20Pedopsychiatrickéoddelenie,Psychiatrickáklinika,Nitra12Noazer-treatmentbeds!32(-60)MiddleofSlovakiaPedopsychiatrickéoddeleniePsychiatrickáklinikaUKJLFaMFN,Mar4n8PedopsychiatrickéoddeleniePsychiatrickánemocnicaProf.Matulayia,Kremnica30Ʃ38EastofSlovakiaPedopsychiatrickéoddeleniePsychiatrickánemocnica,Stráňany,Michalovce30Detskápsychiatrickáliečebňa,n.o.,Hráň80(95)Significantreduc;onofhospitalbedsinacutehealthacreseMong!Ʃ110Limita;onofaccessability!ƩƩ-180
Source:J.Šuba
Adverseconsequences:- Lackofpedopsychiatricbeds,theirstructureandoccupancy
arelimi;ngthetreatmentofmentaldisordersinthepediatricandadolescentagegroups.
- Thenumberofpa;entsdemandingins;tu;onalfollow-uptreatmentisincreasing.Par;curarly,itrefersmainlytoadolescentswithdisordersofpersonality,pa;entswithsuicideriskorself-mu;la;on,pa;entswithmentaldisordersduetopsychoac;vesubstanceuseorwithdisordersoffoodintake.
- AbsenceofAzer-tretamentbedsandPediatricdaycenters.
Thereareunmetneedsinthefieldofcommunitypsychiatriccareservices
• ThereisanurgentneedforeffortsaimingatthedevelopmentofStandardpreven;ve,diagnos;candtherapeu;cprocedures.Moreover,accordingtoholis4capproach,thecomplexpa;entmanagementhastobeapplied.Pa4entsarefrequentlyunabletotakecareofthemselvesandmanagetheircommoneverydayac4vi4es.Therefore:
• Itisnecessarytoimproveoutpa;entpsychiatriccareaswellastoprovidepsychoscialrehabilita;onandresocializa;ontobringpeopleintocommunityandfullyintegratethemsotheyareabletoworkandliveindependently.Thecurrentnetworkofdaycentersandcommunityresiden;alfacili;esisunappropriateowingthedemandsofthementalhealthcare.
• ItisdesirabletoimprovetheaccesstoLong-termdomiciliaryservicesinordertoavoidprolongedhospitalstays,suicidalbehaviour,nosocomialinfec4onsetc.
ReformoftheMentalHealthCareintheCzechrepublic–Inspira;onforus?
Maintarget:ImprovingtheQualityofLifeforallpa;entswithmentaldisorders
Developmentofstandardsandmethodology
ImprovementofPsychiatriccarenetwork
Humanisa;onofPsychaitric
care
De-s;gma;za;on
andcommunica;on
Researchandeduca;on.
Legisla;veac;vi;es
Sustainablefinancing
Interdepart-mentalco-opera;on
EuropeanCommi�eeforthePreven;onofTortureandInhumanorDegradingTreatmentandPunishment(CPT)
• PastCPTac;vi;esinSlovakia:• 2000–AuditandvisittoSlovakia–thecommimedetectedsevereviola4onsagainsthumanrightsamongresidentswithmentaldisorderslivinginnursing
• 2018–forthcomingvisittoSlovakia• Member:MUDr.D.Breznoščáková,PhD.
• Ongoingac;vi;es:• Crea;onofDeten;oncentersinSlovakia• Crea;onofPsychiatricfacili;eswithspecialdesigna;onwithintheframe
ofexis4ngconcurrentpsychiatricfacili4es
WhatistheaimofSPDTP?
• Defini;onofclearguidelinesforallhealthcareproviders.• Standardisa;onandharmonisa;onofproceduresaimingatprevence,diagnos;csandtreatmentinselectedareas.
• Specifica;onofthecompetencesforallstakeholders.• Consolida;onofthequalityappraisalduringhealthacareproviding.• Preserva;onofequalityduringhealthcareproviding.• Crea;onofqualifiedes;ma;onofresourcesdemendedforfinancingofhealthcare.
• Legisla;vechanges.
SPDTPandpsychiatry
• ProcessingofSPDTPfortheareaofmentaldisordersrepresentsthemodernEurope-wideapproachtopsychiatriccare.
• Itwilldefinetelycontributetothequalityofhealthcare.• Itisimportanttorespectandrealis;callyreviewcurrentdiagnos4candtherapeu4cresourcesandcondi4onsinSlovakia
• ExpertWorkingGroupforthe1stphaseofSPDTP:• Chairman:assoc.prof..IvanDóci• Vice-Chairman:prof.JánPečeňák• Secretary:Dr.Breznoščáková• Members:Dr.JánDúžek,Dr.ĽubicaFerenčáková,Dr.JanaGrešková,Dr.KatarínaKubašovská,Dr.LíviaVavrušová,Dr.MarekZelman
• Selec;onofdiagnosesforthe1stphase(ICD):F30-34,F20-25/F40-43/
Na;onalProgramforMentalHealth
• ThedevelopmentoftheNPMHwasini4atedaccordingtotheWHOrecommenda4onsanddecisionoftheSlovakgovernmentfromJune27th2001.
• NPMHactasana;onalprogrammedocumentanditrepresentsthemostcomplexprogramdedicatedtothementalhealthcare.Thankstothedocument,mentalhealthbecameoneofthepoli4cpriori4esintheSlovakrepublic.
• Thedocumenthasbeenpreparedwithrespecttotheholis;cmul;disciplinaryapproachtothementalhealth.Alleffortsshouldbedonetosecureanequalaccesstobothsoma4candmentalhealthservices.
• Thisstrategicalmaterialdescribestheframeworkofglobalac4onswithin10keyareas.Themainpurposeistheimprovementofmentalhealth.
• Coopera4onandcollabora;onofmul;pledepartmentsisnecessary–healthcare,socialaffairs,culture,jus4ce,educa4on,finance,internalaffairsetc.
• TheCouncilforMentalHealthattheMoHisresponsiblefortheprepara4onofthedocument;themembersfromthepsychiatriccommunityare:Ľ.Izáková,I.Dóci(Vice-chairman),D.Breznoščáková,J.ŠubaandĽ.Okruhlica
• Currently,legisla4veprocessisinprogress.
TheEU-CompassforAc;ononMentalHealth
Theresourcesarestructuredaroundthe5priorityareasoftheEuropeanPactinMentalHealthandWellbeing:•Preven4onofSuicideandDepression•Promo4onofMentalHealthandWell-beingofChildrenandAdolescents•Promo4ngMentalHealthandWell-BeinginWorkplaces•OlderPeople’sMentalHealthandWell-being•Promo4ngSocialInclusionandComba4ngS4gma
hGp://ec.europa.eu/health/mental_health/eu_compass/index_en.htm
ConclusionsfromtheEUCompassforAc;ononmentalHealthandWell-beingscien;ficpaper
• TheaccesstomentalhealthcareinEuropeanUnionisfarfrombeingsa4sfactory.• Coverageisbemerforseverementaldisorders,suchaspsychoses,andmuchworsefordepressionandcommonmentaldisorders.
• Structuralbarriersmaybemoreimportantincountrieswithlimitedhealthcoverageandlessdevelopedcommunitycare,aMtudinalbarriersareimportanteverywhere.However,trendsincontainmentofhealthcostscanraisetheroleoffinancialbarriersevenincountrieswithuniversalhealthcoverage.
• Lowpercep;onofneedisanimportantaxtudinalbarrier.• Thelackofcoverageisespeciallyrelevantforpsychologicalandpsychosocialtreatments,despiteindica4onfromguidelinesaboutevidence-basedcaremodels.