Is private investment the answer to the crisis in psychiatric care in Poland?

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The health service in Poland has been struggling with underfunding for years, and one of the most affected areas is psychiatric care. Although mental disorders can be treated effectively, patients often do not receive help in a timely or appropriate manner. In order to avoid a worsening mental health crisis, it would be necessary to improve funding and availability of specialists, and to eliminate territorial restrictions and inequalities in access to services. In Poland, expenditure on psychiatry accounts for only 3.04% of the National Health Fund’s expenditure, so private investment could contribute to alleviating the crisis.

Poor mental health is not only a problem in Poland, and other countries face similar challenges. It is estimated that the total cost of mental ill-health in all EU countries is 4% of GDP, or over EUR 600bn. According to Joanna Szyman, Vice President of Upper Finance, spending on psychiatry from the NHF budget amounts to around PLN 3bn, which is 3.04% of the NHF spending on healthcare services. In Western European countries this percentage varies between 6% and 8%. As Joanna Szyman points out, 5%, i.e. around PLN 4.5bn, is the minimum required to meet the needs of the psychiatry sector, but this level of financing will only be achieved in a few years, taking into account private expenditure.

Psychiatry in Poland

It is estimated that before the Covid-19 pandemic, 8 million people suffered from mental disorders in Poland. The number of outpatient consultations amounted to about 9 million per year, and one had to wait more than 3 months for an appointment within the National Health Fund (NFZ). In total, there were around 280,000 hospitalisations, meaning 25,000 man-hours. In Poland, the ratio of psychiatrists per 200,000 inhabitants is 9.2, a result which places Poland in the last position among the European Union countries. According to the NIK (Supreme Audit Office), there is a great shortage of child psychologists, who are needed in 44% of Polish schools, and according to data provided at the end of February 2021 by the Supreme Medical Chamber, there are 4,347 specialists in psychiatry and 482 developmental psychiatrists in Poland.

The state of mental health of Poles

The EZOP study, carried out in accordance with the methodology of the World Health Organization (WHO) in collaboration with the World Mental Health (WMH) Consortium, showed the scale of mental disorders in Poland. In the case of 23.4% of respondents, at least one of 18 disorders defined in classifications (ICD-10 and DSM-IV) was diagnosed. More than one disorder was experienced by every fourth person in this group, and every fifth person – at least three.

The most frequently occurring disorders were those related to psychoactive substance use and occurred in 12.8 % of respondents. Among them, as many as 11.9% were related to alcohol abuse and dependence. It is worth noting that before the Covid-19 pandemic more than 3 million Poles were struggling with the problem of addiction to psychoactive substances.

Other disorders included neurotic disorders (affecting 10% of respondents), depression (3%), and impulsive behaviour disorders, including oppositional defiant disorder and explosive behaviour, which may be associated with other clinical conditions. These problems appeared in 3.5% of respondents, and extrapolation of the results to the Polish population can be used to estimate the number of people struggling with these disorders at around 1 million.

According to the report of the National Institute of Public Health – National Institute of Hygiene “Health situation of the Polish population and its determinants – synthesis”, mental and behavioural disorders are one of the main causes of lost years of healthy life due to reduced fitness among Poles. Among men, they account for 17% of years lost, and in the case of women, for 14.4%. The associated costs due to absenteeism and inability to work are estimated at PLN 30bn.

Has Covid-19 exacerbated psychiatry’s problems?

As Joanna Szyman points out, the Covid-19 pandemic is associated with increased levels of stress, which in turn affects the need for specialist mental health care. The ZUS report shows that in 2020, compared to 2019, the number of certificates for mental disorders increased by 25%, and the number of days of sickness absence increased by 37%. The average length of sickness certificates also increased from 17-18 days in 2019 to 19 days in 2020, and the most frequent users were those aged between 30 and 49. The main reasons for taking a leave included severe stress, adjustment disorders, depressive episodes, or anxiety disorders.

Will private investments improve psychiatric care?

The high demand for development in the psychiatric sector is encouraging private investment, and one of these investments is a network of clinics and a hospital in Warsaw, for which the Allenort Capital Fund is responsible. There are already 5 mental health clinics in the network and they are made up of more than 200 professionals. A team of 80 specialists, including psychiatrists, psychotherapists, psychologists, and nurses, work at the hospital where patients receive comprehensive care in the field of mental health. The Allenort Hospital has so far received more than 600 patients, with an average stay of between 10 and 14 days. The hospital’s paid care is used both by Polish patients, 40% of whom come from regions other than Mazowsze, and patients from abroad.

As Joanna Szyman points out, so far the average length of stay in hospital due to mental illness in Poland has been 35 days, while in Belgium it was only 9 days. Better results are also achieved by hospitals in Ireland and the Netherlands, where the length of stay of patients is 12 and 13 days. He adds that the largest group of patients at Allenort Hospital are aged between 31 and 49, and the hospital’s efficient care model is well appreciated, especially by people whose illness hinders their professional activity.

In addition to experienced teams of specialists, Allenort Hospital also has technological solutions to assist in diagnosis and treatment. New tools to improve psychiatric and psychological care may appear soon, and it is already estimated that the revenues of companies offering technological solutions in this area could increase by several hundred times. Currently, more solutions support the work of psychologists than psychiatrists, and these include CBT Thought Diary, or the Polish application Therapify, which allows people to book appointments with psychotherapists, monitor the progress of treatment, and complete prescribed tasks.