The Czech Republic has been suffering from a long-term shortage of psychologists and psychiatrists, while the number of patients is increasing. Overcrowded psychiatric hospitals are to be relieved by the planned reform, which is to introduce up to a hundred help centers. These offer comprehensive care and help prevent hospitalizations. However, experts fear that the ministry is undermining this effort.
Behind massive trees near Prague’s Vyšehrad and a few steps from the Vltava embankment stands an originally family villa built at the beginning of the 20th century. It was designed by the architect Otakar Novotný, just like the nearby Mánes Exhibition Hall. Today, a team of professionals works in Sequens’ simple gray brick villa, which cares for people with psychological problems.
One of thirty facilities in the Czech Republic operates here, which shows what the treatment of mental illnesses could look like in the future. Clients at the Podskalí Mental Health Center are cared for by specialists from several fields. In addition to psychologists and psychiatrists, there are social workers or consultants who have dealt with mental illness themselves.
The different approach is immediately apparent upon entering the center. Instead of the impersonal large spaces of psychiatry with the characteristic hospital smell soaked in disinfection, one finds oneself in the cozy entrance hall of a typical First Republic Prague apartment. Here, people sit in comfortable chairs with magazines in hand and wait for a consultation.
“We work with clients in consultation rooms, but we don’t have that many of them. Our work also consists in being in the field a lot,” explains social worker and team leader Darina Deáková. They drive directly home for clients, for example in cases where they do not feel like visiting the center.
If someone seeks help at the local center, they will spend more time than in a conventional hospital or at a psychiatrist. Signs of a more personal approach can also be observed in the equipment of the entire center. Consultations also take place on the spacious terrace with a view of the Prague embankment.
On it, local psychiatrist Jan Audrlický describes that working in the center places more general demands on him. But according to him, you can tell from the result. “The fact that the psychiatrist listens to people more and asks more questions and not just prescribes pills at the first opportunity is a new experience for many clients,” he explains.
Podskalí Mental Health Center in Prague. | Photo: Barbora Doubravová
In order to get to the psychiatrist Audrlické and the other twenty-one specialists in Podskálí, the applicant does not need a request form from a doctor. They don’t even have to have a diagnosed mental illness. “We meet a lot of people during hospitalization, or shortly after it ends. But we also meet people who, for example, just want to find their way around their experience or initial psychological difficulties,” adds Deáková. Often, the client’s family or loved ones also arrange for the client to enter the center.
Mental health care should be available at a hundred centers
Mental health centers are one of the pillars of the ongoing reform of psychiatry, they should gradually replace large psychiatric hospitals. However, according to experts, their future is uncertain.
Minister of Health Vlastimil Válek (TOP 09) said last week that it is “completely irrelevant” how many mental health centers there will be in the Czech Republic in the coming years. At the same time, the National Action Plan for Mental Health expects that there will be a hundred of them by the end of 2030. There are a third of them so far.
What is mental health reform about?
The transformation of Czech psychiatry began in 2017, when they managed to get money for it from the European Union. The latter sent a total of 2.5 billion crowns to the reform to pay for plans to reduce the number of beds in hospitals as well as the eighteen-month operation of mental health centers. The centers should largely replace psychiatric institutions in the future. However, European money is only for piloting and maintaining established services. After the end of funding from the EU, the support of the centers is now up to the state. The reform aims to increase the quality of care and reduce the stigmatization of people with mental illness.
Ministry spokesman Ondřej Jakob later stated that Válek meant his statement to mean that there will be as many centers as needed. He expects it to be around a hundred.
Last year’s report by the ministry also states that care in the centers pays off and can relieve overcrowded psychiatry. Thanks to it, it is possible to shorten the length of stay of patients in hospitals, or to completely prevent hospitalizations.
The ministry is taking a step back, experts criticize
Nevertheless, last week at the press conference on mental health, Minister Válek mainly talked about increasing acute beds in hospitals and supporting the education of doctors. The ministry promised to focus more on psychiatry.
Such an approach is criticized by Marie Salomonová, a member of the National Council for Mental Health, which advises the Ministry of Health. “It seems that he only chose psychiatry as a field. But he does not talk about the emphasis on prevention or community care. We do need beds, but it is not the right thing to strengthen acute beds in large hospitals. If we favor them by paying the people who will work there, we will have a problem finding workers for mental health centers,” he explains.
Even the director of Podskalí, Magdalena Mahu Opletalová, does not like the ministry’s approach. “They lack a bit of concern to do what is right. The idea of the reform was that we would veer off the beaten track, increasing the number of beds is actually a step backwards,” he thinks.
Concerns about whether the ministry is slacking off in the reform of care for the mentally ill have also been raised by information about the cancellation of positions for people who work on the reform. From the original department of forty members, there are now only three people in the ministry.
