When it comes to psychiatric care, many agree that the Czech Republic is still one foot in the past: a time when mental hospitals were built on the periphery of towns to keep mental patients out of sight and out of mind. Since the 1990s, things have changed but, Health Ministry representatives are well aware that broader reforms are still needed.
The plan is to begin building a network of up to 100 centres that would help patients not far from their homes or within their districts. Not uprooting patients but providing them with treatment and support in familiar surroundings would likely be beneficial in many cases while ultimately costing the state less. The head of the National Institute of Mental Health, Cyril Höschl outlines how the new system would be different:
“This is something completely different than existing mental hospitals. We have those and they were the result of several decades of largely centralised healthcare. At the turn of the 19th and 20th century, the main aim was to bundle misbehaving and unruly patients away from towns.
“Changing the old model influenced by the Soviets began after 1989 and the World Health Organisation was one that recommended that care be set up in localities near patients… The fact is, there are a large number of patients who don’t deserve to be shut away.”
Building a network of some 100 facilities has been estimated as taking up to two decades and 15 centres will be tested in pilot projects. Once local mental health centres are operational, they could play a key role in helping patients suffering a first crisis or patients treated in the past, providing follow-up consultation and support. Cyril Höschl again:
“The first in the field are regular doctors, the second emergency psychiatric specialists, and the next level would be the mental health centre. A centre in operation 24 hours a day, 7 days a week, 365 days a year, where more serious cases could be assessed: a patient suffering a first schizophrenic or psychotic episode, from clinical depression or manic-depression and so on. It would be the first filter to get help to patients before institutional care, and also serve patients who had had treatment and would be there to help them stay on the right path and not need to be re-institutionalised.”
The de-stigmatisation of mental illness is part and parcel of reforming psychiatric care, experts say, so that all parties involved – from lawmakers to members of the public understand what is at stake and what works. The hope is also to prepare people not to be alarmed when learning a mental health care centre may be opened in their town or neighbourhood, but to have an understanding of the help such facilities will provide and, ultimately, that they do not represent a risk.