VERIFIED CONTENTConsultation: prof. dr hab. n. med. Agata Szulc, psychiatrist, head of the Psychiatric Clinic of the Medical University of Warsaw

The incidence of mental he alth disorders is increasing, and according to the World He alth Organization (WHO) - there will be more of them. Will a visit to a specialist under the NFZ not be possible in a moment? Among other things, we asked prof. dr hab. n. med. Agata Szulc, psychiatrist at the Myśliborska Therapy Center.

Mental he alth disorders in numbers

Forecasts of the World He alth Organization in the context of a further increase in the incidence of various types of mental disorders are worrying. Experts estimate that further growth in this respect can be expected.

The most common mental disorders include :

  • depression,
  • anxiety disorders,
  • addiction,
  • post-traumatic stress disorder
  • bipolar disorder,
  • insomnia,
  • obsessive-compulsive disorder.

Why are mental he alth changes so important? Just look at the numbers:

  • as a result of mental illnessesover 5,000 annually people take their own lives ,
  • I suffer from depression over 2 million Poles, and bipolar disorder about 800 thousand. people,
  • the number of suicides among children and adolescents is constantly growing, and Poland in this infamous count is at the forefront of European countries,
  • almost 60 percent entities providing services in the field of psychiatric care are private entities,
  • in Poland we have approx. 4 thousand psychiatrists - there are only 90 specialist doctors per 1 million population (similarly, in Western countries the number of psychiatrists is several thousand),
  • there are only about 400 doctors dealing with child psychiatrists in the whole country. World He alth Organization guidelines indicate that out of 10,000 children and adolescents should have 1 specialist. In Poland, it is half a doctor.

Neglects of Polish psychiatry

WHO assumptions are strictly defined as to the number of psychiatrists per a specific number of the youngest, but Poland differs significantly from them. The situation of adult struggling peoplestruggling with mental he alth is also not optimistic. The prognosis for the number of illnesses and mental disorders indicates that the increase will be even greater.

We asked prof. Agata Szulc about the problem of the shortage of specialists, who explains that doctors with this specialization are "definitely too little in relation to world standards". The psychiatrist also points to another important aspect.

- What worries even more is the dramatically small number of residents - in the Mazowieckie voivodship there were only a few last year, also due to the limited pool of qualified doctors who can educate apprentices - which means that in the future the problem will only get worse. Already, queues to psychiatrists are the norm, even in private clinics, including large centers such as Warsaw - he explains.

The problem is the lack of money, but people associated with this area of ​​medicine expose further neglect - lack of beds, staff, specialists. Although the number of about a few hundred missing psychiatrists may not impress at first glance, compared to other countries and WHO guidelines, our country fares very unfavorably.

There are still areas in Poland where there are no psychiatric wards for children and adolescents, e.g. in Podlasie. But the problems do not only concern the less prosperous provinces. In Warsaw, sometimes there is simply no room for hospitalization, even for young patients. As the expert emphasizes, "it should be remembered that a stay in a psychiatric ward should be a last resort, not a standard treatment, which is why it is so important to be able to use non-hospital treatment methods."

The Ministry of He alth takes measures to protect mental he alth. However, the National Mental He alth Protection Program created four years ago has recently expired. The representatives of the ministry announce that within 6 years at the latest, a mental he alth center will be established in each poviat, and schools will provide access to psychological care for children.

- The direction in which the reform of Polish psychiatry is heading, however, is not the liquidation of children's wards, but the removal of the burden of taking care of patients who can and should receive assistance in clinics and community centers - explains the psychiatrist.

As emphasized by prof. Agata Szulc “it should be remembered that the reform of psychiatric care in Poland is aimed at introducing a multi-stage approach. In her intention, contact with a psychiatrist is to be only the next stage of treatment after psychotherapy, psychoeducation,support in the family, school and community therapy. "

- Projects such as the Community Mental He alth Center for Children and Youth Warsaw-Wola, which was established under the Knowledge Education Development Operational Program (POWER) co-financed by the European Social Fund, show that it is possible to reduce psychiatric interventions even up to 40% if other forms of environmental therapy are available - he adds.

COVID-19 pandemic and mental disorders

Although the neglect of the area of ​​psychiatry in Poland has lasted for many years, the pandemic has definitely highlighted problems in the entire he althcare system. Doctors of various specializations predict that the number of cases of many different diseases will increase due to the difficulties caused by the restrictions due to COVID-19.

Empowering Children Foundation indicates as much as 44 percent. an increase in the number of interventions that employees of the organization had to undertake in the past year. The organization also conducted research on last year's spring lockdown among young people and children. As many as 1/3 of the youngest ones described their mental state as bad at that time. The most frequently mentioned factors were isolation and lack of contact, but also insecurity and fear.

The mental he alth of adults is also not looking good. According to a United Nations (UN) report last May, statistics before the outbreak of the pandemic revealed enormous mental he alth problems around the world. Experts indicate that in low and middle-income countries, about 76-85 percent. people suffering from mental disorders do not receive adequate support in the field of therapy and pharmacology.

The Social Insurance Institution (ZUS) draws attention to the record numbers of sick leaves issued last year. Doctors have issued over 500,000. million L4 due to adaptation disorders and severe stress reactions. For comparison, in 2022 there were 380 thousand. layoffs, and in 2022 - 340 thousand

5 million days of absenteeism - this is the number of absences of employees in the results of depressive episodes in 2022 according to ZUS data.

What will the future of Polish psychiatry look like?

If the situation in Polish psychiatry does not improve, and the challenges are not improved, i.e. the increasing number of patients, including minors with mental problems, who will increase from year to year, may even worsen the current condition. We asked prof. Szulc about whether we should prepare for the fact that in the next few years we will not be able to count on the help of specialists from the National He alth Fund.

-Undoubtedly, this is a black scenario, but not so impossible to fulfill. As you know, all reforms require money and time. Currently in Poland only 3.4 percent. the he alth budget is allocated to psychiatry, including an even smaller percentage for child psychiatry. The EU average is 6-7 percent, but for example in Germany it is 14 percent, but it should be remembered that the total funds allocated to he alth care in Germany are many times higher there than in Poland - he points out.

The expert emphasizes that it is the money allocated to the real situation that will play a key role in improving the current situation. He points out that "costs are constantly growing, there is also the problem of underinvestment in infrastructure, which has been neglected for years."

- At the same time, it is worth remembering that even the current reform aimed at transition to the environmental model also requires considerable expenditure, including the education of new specialists who will work in this new system. It is also necessary to create a system of incentives for residents and specialists, so that they would like to work also in smaller centers, to ensure equal access to services for everyone. In the context of this black scenario, I can say that there is already a growing concern among psychiatrists that in the future our field will experience the same situation as in dentistry. The dental offer under the National He alth Fund is very limited, most of the very expensive procedures are available only in private offices - adds prof. Szulc.

Can we protect ourselves against mental disorders?

Predictions concerning depression, first of all, show that its incidence will be even greater. What can "ordinary Kowalski" do to reduce the risk of depressive episodes or the disease itself in his life?

Prof. Szulc points out that "we can talk about prophylaxis here only in the context of what we have influence". - That is why it is so important to constantly take care of not only physical he alth, but also mental he alth. And we should start taking care of them at a very early stage of human life - he emphasizes.

The psychiatrist explains how "it is important to observe how a child, from an early age, develops not only physically, but also learns to build strong and he althy ties with family, loved ones and friends."

Additionally, it indicates the role played by adults in the aspect of mental he alth of the youngest. - Teachers and educators who are in contact with a young person on a daily basis should pay attention to the mental development of a child on a par with his intellectual development - he explains.

You should also remember that onmental he alth is influenced by many factors. - As in other he alth prophylaxis, in mental he alth prophylaxis it is important to lead a he althy lifestyle, exercise and proper diet - adds prof. Szulc.

- Factors such as obesity, in addition to a number of other serious he alth problems, can also lead to depression. It should also be remembered that in many mental disorders, excessive consumption of alcohol or abuse of psychoactive substances (including for the so-called "recreational" purposes) may also play a role, which is particularly dangerous in young people whose nervous system is still developing - he explains psychiatrist.

How can we help the youngest who struggle with mental he alth problems?

As a country, we are at the forefront of European countries with the highest number of suicides among children and adolescents. We asked prof. Szulc about what actions should be taken now to improve this state of affairs, so that we, as adults, could take care of the youngest. The expert has no doubts that "the most important are preventive actions."

- In our society, mental disorders are still a taboo subject. We can change this through educational activities. The first step should be to talk to the children about their feelings, not to ignore their problems, to show them not to be ashamed or afraid to talk about them - explains the specialist.

Prof. Szulc points to the role of educational institutions. - I believe that schools and kindergartens are a huge field for development in this case. Recently, in an interview with a patient, I heard about the fear that the suicide of a school friend's mother caused in her son. In this case, there was no conversation on this very difficult topic for a young person at school, with all children from a given class - he explains.

Another very important element is breaking the taboo, therefore, as the psychiatrist emphasizes, "you should not taboo the issue of suicide or mental disorders in the family, but explain, talk, answer questions in a way that also shows how to deal with difficult problems. situations and where you can seek help ".

- It is also important in the context of the pandemic and the long-term forced isolation of children and adolescents in their homes, which resulted in an increase in mental problems in this group. As Minister Niedzielski recently informed, over 300 community support centers have already been established all over Poland, where it is worth seeking help before going to a psychiatrist, especially if it involves the long waiting time for an appointment, concludes Prof. Agata Szulc.

prof. dr hab. n. med. Agata Szulc - psychiatrist, head of the Psychiatric Clinic of the Medical University of Warsaw From the beginning of her professional career, she has been associated with the Medical University of Bialystok, and since 2013 with the Medical University of Warsaw. Currently, he is the Head of the Psychiatric Clinic of the Faculty of He alth Sciences of the Medical University of Warsaw. She is the author of numerous scientific publications. The main area of ​​her research is neuroimaging in psychiatry, especially in schizophrenia, and more recently in bipolar disorder. The results of the research conducted so far indicate that the use of modern methods of neuroimaging may have real practical significance in the future in the diagnosis, prognosis of the results of antipsychotic treatment, as well as in the diagnosis of people prone to developing psychosis.

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Category:

Psychiatry