Health Ministry blamed for Poland’s child psychiatry reform failures
A comprehensive report by Poland’s Supreme Audit Office has exposed severe shortcomings within the country’s psychiatric care system, with children waiting in hospital corridors and unacceptably long queues for treatment.
The report notes a shocking case of a teenager restrained for two months, just one of a list of alarming revelations from the investigation into Poland’s psychiatric facilities by the NIK (Supreme Audit Office).
“Direct coercion is a violation of personal rights and can only be applied by authorised individuals within the boundaries of the law,” Joanna Piasecka-Girguś, a state control specialist at NIK’s delegation, told Euractiv. “Yet, in every hospital audited, direct coercion was used against children and adolescents in violation of these regulations,” she added.
Reform of child psychiatry failed
The reform of child psychiatry, initiated by the Mental Health for Children and Adolescents Team established in February 2018, aimed to create a three-tiered support system. This system was designed to provide preventive healthcare, specialised care, and hospital-based treatment for the most severe cases.
The proposed model envisioned that highly specialised, 24-hour psychiatric care would be the last resort for patients rather than their first point of contact. However, despite the reform’s initial promise and the partial implementation of some changes, the results have fallen short of expectations.
The situation for young patients has worsened.
According to the NIK report, the Ministry of Health is largely blamed for the reform’s failure.
The report accuses the Ministry of failing to develop a comprehensive reform plan or to define necessary resources, expected outcomes, and a timeline. Consequently, despite four years of reform efforts, access to psychiatric care remains problematic in various regions of Poland.
The NIK also criticises the Ministry for its inadequate dissemination of information about available mental health services for children and adolescents. Awareness campaigns about mental health, which were only launched nearly three years into the reform, were deemed insufficient despite an expenditure of over €200,000.
Devastating audit results
A substantial NIK review was conducted examining the child psychiatry reforms implemented over the past four years and the provision of psychological and psychiatric care by schools and psychological-pedagogical centres.
The report reveals that from 2020 to 2023, minors did not receive the tailored, comprehensive psychological and psychotherapeutic support they needed. The child and adolescent psychiatric care system is deemed inadequate.
The reform’s goal of reducing the number of hospitalised children was not achieved. Instead, the number of hospitalisations has increased annually.
This has led to overcrowded hospitals, where young patients have been forced to stay in corridors or adult psychiatric wards. In extreme cases, admissions were denied due to insufficient beds.
By the end of March 2023, no single day-patient psychiatric unit for minors existed in three provinces.
“Between 2020 and 2023, the number of children and adolescents with mental health disorders increased by over 60%, with a growing link to modern societal conditions,” Karolina Wirszyc-Sitkowska, Director of the NIK Delegation in Poznań, revealed at a press conference.
“There has also been a dramatic rise in suicide attempts, from 843 in 2020 to over 2,102 in 2023, with 145 resulting in death,” she added.
63 days of restraint
The limited access to psychiatric specialists has led to significant breaches of regulations concerning the use of direct coercion measures.
Decisions to extend these measures were often made without mandatory patient examinations or by unqualified personnel, despite the requirement that only a psychiatrist can conduct such assessments for extensions beyond 16 hours.
All seven hospitals audited employed direct coercion measures, with NIK identifying improper practices in five of them.
In two cases, the use of coercion exceeded 300 hours, and in one particularly egregious instance, a 16-year-old patient was restrained continuously for 63 days. This meant the coercive measures were extended 235 times, with the patient being restrained for 98.6% of their hospitalisation time.
The audit also uncovered irregularities in the documentation and storage of monitoring records in isolation rooms at two hospitals.
NIK’s audit underscores Poland’s urgent need for improved resource allocation and better intersectoral cooperation to address its ongoing crisis in child and adolescent psychiatric care.
[Edited by Vasiliki Angouridi, Brian Maguire | Euractiv’s Advocacy Lab]
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