The political changes in 1989, with the introduction of a free market economy, caused the collapse of almost all sheltered employment institutions for the mentally ill. The social conditions of the mentally ill living in the community drastically worsened, with growing unemployment, poverty and homelessness. There was an increasing number of ‘‘new chronics,’’ requiring prolonged stay in the hospital or intensive community care. The lack of social support for them in the community was a serious problem.
Further reforms in Poland’s mental health system have been strictly connected with the reforms of the state. New legislation – the ‘‘Social Aid Act’’ and the ‘‘Mental Health Act’’ of 1994 – obliged municipalities to establish, in the framework of the local social welfare system and with partial financial support from the region, facilities aimed at ‘‘...rehabilitation and support for mentally ill or retarded persons with great difficulties in everyday functioning and social contact. The activity of private persons and nongovernmental organizations in that field is recommended’’.
The National Mental Health Program and General Health System Reform in Poland Poland’s National Mental Health Program was developed in 1995. According to that program, mental health policy was to be planned at the regional level by the regional health care administration, with the participation of a coordinator and an advisory committee (including representatives of local communities and patients’ associations). Each region (about 2 million inhabitants) was to be divided into smaller units (mental health centers), providing a complex array of psychiatric care (inpatient, outpatient and transitory forms of treatment ) for catchment areas of about 100,000-150,000 inhabitants, and financed through a capitation system. The program was approved by the Ministry of Health in 1995, but failed to be established as a governmental program. Thus, as of this writing Poland does not have a separate budget for mental health and the financing through capitation has not been established anywhere in the country. These delays are probably raising many obstacles for the further development of community-based psychiatry.
New legislation “The National Mental Health Program Act” of 2008 was passed in Parliament. In fact it was the same, old programme. However, a government order was postponed till 2011.So far the state hasn’t given money to local administration to ensure the implementation of The National Mental Health Program.
In Poland all services are divided into two separate systems: mental health (dependent on the Ministry of Health) and social welfare (dependent on the Ministry of Labor and Social Policy). These systems rely (at the regional level) on two independently financing separate bodies: the health funds and the social welfare budget.
It is worth noticing that since 1995, these new social welfare facilities were established:
Community centers of mutual help (CCOMH): day units with occupational therapy, basic living and social skills training and leisure time activities.
Specialized social help services (SSHS): services supporting everyday living skills at the client’s own home, as well as social activities outside their homes
Vocational rehabilitation centers (VRC). VRCs are day units that provide pre-vocational skills training, specific job training and liaison with employers to severely disabled persons in general, including those with disabling mental illnesses.
They (VRC, CCOMH and SSHS) should have undertaken many of the tasks of assertive community treatment that in other countries belong to the mental health care system. For example, in Poland services like ‘‘supporting daily living skills and medication,’’ ‘‘housing assistance,’’ ‘‘financial management,’’ and ‘‘help with social and family relationships’’ are currently provided by SSHS at clients’ homes; ‘‘occupational therapy,’’ ‘‘time structuring,’’ ‘‘enhancement of social contacts’’ and ‘‘leisure time activities’’ are delivered by CCOMH; and ‘‘prevocational training,’’ ‘‘providing liaison with and educating employers’’ and ‘‘finding vocational opportunities’’ are provided by VRC.
My comment (Dariusz Baran)
Unfortunately, it is not said in the paper that most participants of social service in Community centers of mutual help (CCOMH) and Vocational rehabilitation centers (VRC) are people with intellectual disability (learning difficulties). In statistics people with learning difficulties and people with mental health problems (schizophrenia, bi-polar and so on) are put in one category called “chronic mentally ill people”. There are few places in Poland where service is differentiated between two groups. In our region it is not differentiated. Sheltered accommodation in special apartments (each for a group of three to five patients under the care of SSHS services) for people with mental health problems, doesn’t exist here. Specialized social help services (SSHS) (services supporting everyday living skills at the client’s own home, as well as social activities outside their homes) are well developed for children with autism, instead of people with mental health problems in Rzeszow. It’s good for children with autism and their parents. Not enough for people with mental health problems.
Thanks to GRUNDTVIG projects (2003-2009) in partnership with Peter Kampman (INTERMINDS), Mary van Dievel (MENTAL HEALTH EUROPE), Roxana Braga (ESTUAR, and PENUMBRA behind), and Enric Arques (JOIA) and others , the Association of Families “Open Mind” was set up and developed in Rzeszów www.otwartyumysl.org . There is a group of users, parents, siblings, carers all together as a team. About a hundred people. Every year they manage to find about 25.000 – 30.000 EUROs for social activities, anti-stigma campaigns, conferences. They are promoters of community psychiatry and social services in our region. Some professionals co-operates with them as partners. They dream about developing social activation and integration centers with supported accommodation and employment for people with mental health problems in Rzeszow and Region. Regional government is very supportive.
For comparison there is the Association for People with Intelectual Disability (Learning Difficulties) in Jaroslaw (another city in region). They developed variety of services for people with learning difficulties, including supportive employment, supportive accommodation, vocational rehabilitation centres, day centres. People with mental health problems (schizophrenia and so on) are not offered such social service suitable for their needs in Podkarpacie Region.
There is no medical university, no psychology and psychotherapy institute in our region. There are pedagogic and social work schools mainly. That’s way there is a great army of human resources in social service, and very few in mental health service. Rzeszow is not far from Krakow (about 160 km, two hours by train). Krakow is a centre of excellence in community mental health service. They are very supportive indeed.