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Who collaborating centre for research and training in mental health report on collaboration


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INSTITUTE OF PSYCHIATRY AND NEUROLOGY

WHO COLLABORATING CENTRE FOR RESEARCH

AND TRAINING IN MENTAL HEALTH

REPORT ON COLLABORATION

BETWEEN THE INSTITUTE OF PSYCHIATRY AND NEUROLOGY

AND THE WORLD HEALTH ORGANIZATION

2004-2007


9 Sobieskiego Str., 02-957 Warsaw, Poland

Tel: (48 22) 45 82 706, Fax: (48 22) 651 93 01

e-mail: hercz@ipin.edu.pl

home page: http://www.ipin.edu.pl/
Head of the Centre: Professor Danuta Ryglewicz M.D.
Warsaw, June 2008

CONTENTS
I. GENERAL REMARKS

II. IMPLEMENTATION OF THE WORK PLAN


II. A. Activities performed in relation to the terms of reference

II. B. Direct collaboration between the Centre and WHO


III. DIFFICULTIES ENCOUNTERED IN THE COLLABORATION WITH WHO
IV. SUGGESTIONS ON INCREASED AND IMPROVED COLLABORATION WITH

WHO


I. GENERAL REMARKS
In 1992 the Institute of Psychiatry and Neurology (IPN) was designated by the World Health Organization (WHO) as a Collaborating Centre for Research and Training in Mental Health (CC). This status was extended thrice, last in September 2004.
In 2004, conditions of cooperation were modified and since then the collaboration between IPN and WHO has been carried out under the following terms of reference:


  • assisting appropriate Polish as well as Central and Eastern European governmental agencies and NGOs in formulating and implementing of policies and programmes on mental health, substance abuse and neurology congruent with WHO policy;

  • carrying out research projects on mental health, substance abuse and neurology, with special emphasis on development of evidence-based policies and programmes in the field of mental health promotion and prevention of mental disorders;

  • training and education of primary health care professionals on mental health problems as well as on public health aspects of mental, neurological and substance abuse disorders;

  • consultations and exchange of information.

In the years 2004-2007, the IPN carried out more than one hundred forty research projects each year, many of them in international collaboration (about 20 each year). More than 1250 articles and monographs were published (170 in journals of the ISI Philadelphia citation report, 530 in journals indexed in the Polish database). In the years 2004-2006, 1750 citations were identified in the Science Citation Index Expanded, while in 2007 database Scopus recorded 909 citations of articles authored by the research staff of the Institute. Conferences and workshops were organised, staff of the Institute assisted in formulating and implementation national polices as well as participated in WHO consultation meetings on mental health and substance abuse around the world.

II. IMPLEMENTATION OF THE WORK PLAN
II. A. ACTIVITIES PERFORMED IN RELATION TO THE TERMS OF REFERENCE
TERMS OF REFERENCE AREA: assisting appropriate Polish as well as Central and Eastern European governmental agencies and NGOs in formulating and implementing policies and programmes on mental health, substance abuse and neurology congruent with WHO policy. (Activities 1-7)
Activity 1
Name of the activity:

Assisting in formulating and implementing the Mental Health Programme


Description of the activity:

  • updating the Mental Health Programme and taking successive steps to grant the Programme a governmental status,

  • monitoring implementation of the Programme.


Implementation of the activity
The Mental Health Programme, developed by the staff of the Institute of Psychiatry and Neurology in collaboration with WHO, was accepted by the Ministry of Health in February 1995. After evaluating the Programme’s progress in 1998, the Parliamentary Commission for Health recommended the inter-ministerial status for the Programme. Since then a number of changes were introduced to the Programme, the latest in December 2006, by the IPN staff: J. Wciórka, L. Boguszewska, W. A. Brodniak, Cz. Czabała, J. Jarema, W. Langiewicz M.A., K. Prot-Klinger, S. Pużyński, E. Słupczyńska-Kossobudzka. The newest version of the Programme for the years 2009-2013 was established as the national one and was accepted by the Ministry of Health in April 2007. To enable the Programme implementation and funding, the staff of the Institute drafted amendments to the Mental Health Act. The main proposed changes covered the following sections:
“1. Mental health protection encompasses its tasks involving in particular:

  1. promotion of mental health and prevention of mental disorders,

  2. providing persons with mental disorders with comprehensive and widely available health care and other forms of care and assistance which are essential for them to live in the family and the social community,

  3. reinforcing positive social attitudes towards persons with mental disorders, in particular understanding, tolerance and kindness, and counteracting their discrimination.

2. The tasks mentioned in section 1 are defined by the National Mental Health Programme, accepted by the Council of Ministers, by resolution, for five consecutive years.”

The interministerial consultations on amendments were closed in August 2007. In November 2007 the proposal on amendments of the Mental Health Act, including a draft of the executive act - the National Mental Health Programme for the years 2009-2013 - was sent by the government to the Parliament.
In May and June, the staff of IPN (M.Jarema, J.Wciórka, K. Prot-Klinger) presented the situation in psychiatric care and the Programme to the Commission of Health and the Commission of Social Welfare and Family of the Senate, the Upper House of the Parliament as well as to the Ministry of Labour.
The updated version of the Programme reflects its national status and recent trends in psychiatry. First, it was emphasised that the Programme should be implemented by the health sectors in partnership with other governmental departments: employment, housing, educational etc. Secondly, strong stress was put on the development of community base psychiatry, what requires organizing the Mental Health Centres. Thirdly, a necessity of coordination between mental health care and social help was underlined. The Programme focuses on guaranteeing social and occupational rehabilitation as well as employment for people with mental health problems.
Outcomes:
Publications:
PROT K., WCIÓRKA J. (2007) Mental Health Reform in Poland. Psychiatriki, 18 (Suppl.1), 114.
WCIÓRKA J. (2007) Narodowy Program Ochrony Zdrowia Psychicznego - projekt 2006 [National Mental Health Programme - draft 2006]. Psychiatria po Dyplomie. Czerwiec, special issue, 25-32.
WCIÓRKA J. (2007) Reformowanie opieki psychiatrycznej w Polsce [Mental health care reforms in Poland]. Psychiatria Polska, 41, 3 (Suppl.), 176-177.
Other outcomes:


  • mental health policy becomes more comprehensive

  • social awareness of mental health problems broadened



Difficulties:

Against expectations, the Mental Health Act has not been amended up to June 2008. The legislation process was interrupted by the parliamentary election and urgent reforms of the whole health system.



Activity 2
Name of the activity:

Monitoring implementation of the Mental Health Act


Description of the activity:

  • monitoring implementation of the Mental Health Act of August 19, 1994. Practical problems of implementation of the Act and irregularities of its observance were under review in the research project.


Implementation of the activity
Monitoring implementation of the Mental Health Act was carried out by S. Dąbrowski, W.A. Brodniak, S. Webel and W. Langiewicz. The findings showed that in the years 1996 -2005 the number of involuntary admissions to the hospitals increased by 27% and simultaneously the rate of such admissions decreased, probably due to the growth of the overall number of admissions. The number and the rate of involuntary admissions on the ground of the motion of relatives and legal representatives decreased, especially in psychiatric hospitals. Psychiatric hospitals more frequently than psychiatric wards in general hospitals admitted patients without the consent, with exception of admissions on the base of motion. Physical restraint to a person admitted without the consent was applied more frequently in psychiatric hospitals (16%) than in general hospitals (10%).
The evaluation of judicial decisions on involuntary admissions to psychiatric hospitals was carried out. It was found that the largest number of patients (63%) was involuntary admitted on the emergency base, because of imminent danger to their life or to life or health of others. However, in 18% of decisions, documents confirming personally conducted examination by a doctor were lacking, and information on behaviour, which would justify admission, was not given in 50% of cases. It was noted down that psychiatric hospitals did not declare to the court patients, involuntary admitted, but later accepted treatment in the hospital.
Outcomes:
Publications:
BRODNIAK W.A., LANGIEWICZ W., WELBEL S. (2007) Monitoring of the Polish Mental Health Act implementation in the years 1996-2005. BMC Psychiatry; 7 (Suppl 1), 100.
BRODNIAK W.A., LANGIEWICZ W., WELBEL S. (2007) Monitoring of the Polish Mental Health Act implementation in the years 1996-2005. WPA Thematic Conference Coercive Treatment in Psychiatry: A Comprehensive Review Abstract Booklet, Dresden, 92.
DĄBROWSKI S., BRODNIAK W.A., WELBEL S. (2005) Ocena przestrzegania przepisów o zgodzie na leczenie w szpitalu psychiatrycznym [Evaluation of observance of regulations on the consent for treatment in a psychiatric hospital]. Psychiatria Polska, 39 (1), 139-150.
DĄBROWSKI S., BRODNIAK W.A., WELBEL S. (2005) Przestrzeganie zaleceń lekarza przez pacjentów przyjętych za zgodą do szpitala psychiatrycznego [Compliance of patients admitted with consent to psychiatric hospitals]; Psychiatria Polska, 39 (1), 125-137.
WOŹNIAK A. (2007) Zmiany w art. 22 Ustawy o Ochronie Zdrowia Psychicznego - komentarz psychiatry. [Changes in art.22 of the Mental Health Act - comments of a psychiatrist] Wiad. Psych. 2007; 10 (2), 131-133.
Other outcomes:

  • In 2005, the Mental Health Act, was amended to establish a position of an ombudsmen of psychiatric hospital patients.



Activity 3
Name of the activity:

Monitoring the standards of psychiatric care in Poland


Description of the activity:

  • gathering information, preparing reports on current problems of psychiatric care and discussing results with prominent Polish professionals working in mental health (national consultant on psychiatry, regional consultants, heads of university clinics, directors of psychiatric hospitals) during annual meetings.


Implementation of the activity:

The annual meetings on the current situation in mental health care in Poland were held on 26 March 2004, 13 October 2005, 30 October 2006 and on 27 May 2008 in Warsaw. All conferences were organized by the staff of the Department of Health Care Organization.


The prominent Polish professionals working in mental health: the national consultant in psychiatry, the national consultant in mental health of children and adolescent, regional consultants, directors of psychiatric hospitals, persons responsible for mental health system on the local level participated in the conferences. Representatives of the Ministry of Health, other departments of the government, the National Health Fund (NHF) were also present.
The topics of the conferences covered a wide range of mental health areas: current problems of psychiatry and forensic psychiatry in Poland, financing mental health services, challenges of mental health care in Poland, draft of the National Mental Health Programme, and monitoring of the Mental Health Act in the years 1996-2005. Changes in financing mental health services, proposed by the NHF, were under consideration. The proposal concerned shifting a large amount of money from the most costly services (e.g. psychiatric hospitals) into outpatient, intermediate and complex care, provided by mental health centres.
Outcomes:
Publications:

LANGIEWICZ W., SŁUPCZYŃSKA-KOSSOBUDZKA E. (2004) Psychiatric services in the fifth year of health care reform in Poland. International Psychiatry, 6, Oct., 6-8.


PUŻYŃSKI S. (2005) Zasady stosowania leków przeciwdepresyjnych w terapii depresji [Guidelines for using antidepressant in therapy of depression]. Lekarz Rodzinny, 10, 462-469.
PUŻYŃSKI S., KALINOWSKI A., KOSZEWSKA I., PRAGŁOWSKA E., ŚWIĘCICKI Ł. (2004) Zasady leczenia nawracających zaburzeń afektywnych (2004) [Guidelines for treatment of affective disorders]. Farmakoterapia w Psychiatrii i Neurologii, 1, 5-46, Lęk i Depresja, 9, 227-256, Medycyna po Dyplomie, Special issue - lipiec, 15, 3-32.
PUŻYŃSKI S., LANGIEWICZ W. (2005) Aktualne problemy psychiatrycznej opieki zdrowotnej w Polsce (2004 r.) [Current problems in psychiatric health care in Poland (2004)]. Psychiatria Polska, 39 (4), 617-627.
PUŻYŃSKI S., LANGIEWICZ W., PIETRZYKOWSKA B. (2006) Aktualne problemy psychiatrycznej opieki zdrowotnej w Polsce (2005 r.) [Current problems in psychiatric health care in Poland (2005)], Psychiatria Polska, 40 (2), 177–189.
RYBAKOWSKI J., DUDEK D., JARACZ J., JAREMA M., KOSZEWSKA I., PARNOWSKI T., PUŻYŃSKI S., ŚWIĘCICKI Ł. (2007) Standardy leczenia chorób afektywnych [Standards of pharmacological treatment of affective disorders]. Farmakoterapia w Psychiatrii i Neurologii, 23, 7-61.
ZAŁUSKA M. (2006) Środowiskowy model leczenia psychiatrycznego, a zmiany w strukturze lecznictwa w ostatnich latach w Polsce [The community-based psychiatric care model and changes in the health system structure in recent years in Poland], Postępy Psychiatrii i Neurologii, 15 (4), 277–285.
Other outcomes:

  • higher standards of treatment of affective disorders established

  • information flow between interested parties improved



Activity 4
Name of the activity:

Assisting in formulating and implementation of the Mental Health Promotion Programme


Person responsible:

Prof. Czesław Czabała, Ph.D.


Description of the activity:

  • development of the Mental Health Promotion Programme, its implementation and monitoring,

  • conducting multi-dimensional research projects and surveys on the current status of mental health of the Polish population,

  • analysing infrastructure and strategies of local promotion programmes (e.g. school base prevention and promotion programmes).


Implementation of the activity:


  • Staff of IPN prepared the Mental Health Promotion Programme. It was included to the National Mental Health Programme as a priority no 1.




  • Research projects

Research projects were carried out on mental health of adolescents and young adults. Coping with stress in family and schools, use of psychoactive substance by adolescents, mental health of young adults and unemployment were investigated.

The findings showed that mental health of secondary school’s pupils was deteriorated in two years time. The number of pupils with problem behaviour syndrome risen, the percent of pupils getting drunk increased from 20% to 47%. Hypothesis on importance of sense of coherence, financial situation of family and support of peers, teachers and family for mental well-being of adolescents was confirmed.




  • Two National Conferences on Mental Health Promotion were held in 14-15 October 2005 and 27-29 September 2007

The conferences were organized by the staff of the Department of Psychology and Mental Health Promotion. There were over 100 participants representing various groups involved in mental health promotion: physicians, psychologists, sociologists, researchers from various universities and research institutes, practitioners working in health care or education sectors, counseling and social services, public health centers, governmental departments and even sanitary-epidemiological stations, as well as students. The WHO EURO was represented by E. Jane-Llopis. The second conference was co-organized by the WHO EURO, the State Agency for Prevention of Alcohol Related Problems, the National Bureau for Drug Prevention and the Centre of Psychological and Pedagogical Assistance.
During the conferences general recommendations on mental health promotion by WHO and EU were presented. The other lectures concerned: the current status of mental health in Poland (Cz. Czabała), implementation of mental health promotion programmes in Europe (E. Jané-Llopis, B. Mroziak), new needs, directions and risks to mental health promotion in schools (K. Ostaszewski) and in the workplace, home violence and substance dependence as risks to mental health and preventing stigmatization and reducing exclusion (K. Prot-Klinger).
A number of mental health promotion and mental disorders prevention programs planned or implemented all over the country were discussed. Among other ones – prevention of substance abuse among children and adolescents, preventing burnout of school teachers, doctors and nurses, programmes on stress management for policemen, on suicide prevention, on increasing social integration of the mentally ill, and on developing positive psychological resources in young people. The majority of presented projects and programmes were spontaneous initiatives undertaken in various, sometimes quite unknown centers, independently from each other.
During the second conference two additional problems were raised:

- the system of education of staff for health promotion in Poland and Europe;



- research on mental health promotion.
The role of drama/theatre in promotion of mental health was outlined in the special workshop.
Outcomes:
Publications:


BOBROWSKI K., CZABAŁA J.C., BRYKCZYŃSKA C. (2005) Zachowania ryzykowne jako wymiar oceny stanu zdrowia psychicznego młodzieży [Problem behaviors as a dimension of mental health assessment in adolescents]. Postępy Psychiatrii i Neurologii, 14 (4), 285-292.
CZABAŁA C.J., BRYKCZYŃSKA C., BOBROWSKI K., OSTASZEWSKI K. (2005) Problemy zdrowia psychicznego w populacji gimnazjalistów warszawskich [Mental health problems in the population of high school students in Warsaw]. Postępy Psychiatrii i Neurologii, 14 (1), 1-9.
CZABAŁA CZ., OSTASZEWSKI K., OKULICZ-KOZARYN K. (2005) Mental health promotion and mental disorder prevention across European Member States: a collection of country stories. Poland. DG Health & Consumer Protection, 125-129.
JELONKIEWICZ I., KOSIŃSKA-DEC K. (2004) Spostrzegane zasoby a doświadczanie stresu rodzinnego i szkolnego wśród młodzieży [Resources and family and school stress among youth]. in: Rozwój - Zdrowie - Choroba. Aktualne problemy psychosomatyki, KOSIŃSKA-DEC K., SZEWCZYK L. (eds.). Bel Studio, Warszawa, 71-90.
JELONKIEWICZ I., KOSIŃSKA-DEC K. (2006) Wsparcie rodziców i rówieśników a doświadczanie stresu u młodzieży [Parents and peers support and stress in youth]. in: BRYC S. (ed.) Promocja zdrowia w chorobie i niepełnosprawności, Annales Universitatis Mariae Curie-Skłodowska, Sectio D Medicina, Vol. LX (Suppl. XVI, 3), Lublin, 43–46.
JELONKIEWICZ I., KOSIŃSKA-DEC K. (2007) Poczucie koherencji zasobem szczególnie ważnym w promocji zdrowia młodzieży [Sens of coherence an important resource in health promotion of adolescents] in: Promocja zdrowia w różnych okresach życia. Annales Universitatis Mariae Curie-Skłodowska. Sectio D Medicina, Vol. LXII, Suppl. XVIII, N 3, Lublin, 83-86.
KOSIŃSKA-DEC K., JELONKIEWICZ I. (2004) Zasoby a radzenie sobie ze stresem rodzinnym i szkolnym oraz zdrowie młodzieży [Resources, coping with family and school stress and health of youth]. in: Rozwój - Zdrowie - Choroba. Aktualne problemy psychosomatyki, KOSIŃSKA-DEC K., SZEWCZYK L. (eds.). Bel Studio, Warszawa, 91-104.
KOSIŃSKA-DEC K., JELONKIEWICZ I. (2006) Poszukiwanie podstaw empirycznych programu profilaktycznego podnoszącego skuteczność radzenia sobie młodzieży ze stresem [Searching for empirical prevention programme, which increased effectiveness of coping with stress among youth], in: PASIKOWSKI T., SĘK H. (eds.) Psychologia zdrowia: teoria, metodologia i empiria, Bogucki Wydawnictwo Naukowe, Poznań, 141–152.
KOSIŃSKA-DEC K., JELONKIEWICZ I. (2006) Style radzenia sobie ze stresem jako czynnik chroniący zdrowie młodzieży [Styles of coping with stress as a factor protected health of youth], in: Promocja zdrowia w chorobie i niepełnosprawności, Annales Universitatis Mariae Curie-Skłodowska, Sectio D Medicina, Vol. LX (Suppl. XVI, 3), 445–448.
STĘPIEŃ E. (2004) Poczucie powodzenia życiowego od dorastania do wczesnej dorosłości: wzory zmian a zasoby społeczne i osobiste w dorastaniu [Sense of success from adolescence to early adulthood: patterns of changes and social and personal resources in adolescences]. in: Rozwój - Zdrowie - Choroba. Aktualne problemy psychosomatyki, KOSIŃSKA-DEC K., SZEWCZYK L. (eds.). Bel Studio, Warszawa, 105-116.
STĘPIEŃ E. (2006) Adolescents' health-related behaviors and their well-being between adolescence and adulthood, Psychol Health, Abstracts Book 20th Annual Conference of the European Health Psychology Society 30 Aug–2 Sept 2006, "Social change and new challenges for health psychology", Volume 21 (Suppl. 1), 144–145.
STĘPIEŃ E. (2006) Styl życia i zasoby osobiste młodzieży a zmiany jej samopoczucia w okresie dorastania – wczesna dorosłość [Style of life and personal resources of youth and changes of well-being in adolescence - early adulthood], in: BRYC S. (ed.) Promocja zdrowia w chorobie i niepełnosprawności, Annales Universitatis Mariae Curie-Skłodowska. Sectio D Medicina, Vol. LX (Suppl. XVI, 7), Lublin, 240–244.
STĘPIEŃ E. (2007) Osobowościowe źródła obniżonego samopoczucia u progu dorosłości [Personal sources of lowering well-being on the verge of adulthood]. in: LIBISZOWSKA-ŻÓŁTKOWSKA MARIA (ed.) Czego obawiają się ludzie? Wydawnictwa Uniwersytetu Warszawskiego, 144-158.
STĘPIEŃ E., MROZIAK B. (2007) Zdrowie psychiczne dorastających - związki z zachowaniami zdrowotnymi i zmiany w czasie [Mental health of adolescents - relations between health related behaviours and changes in time]. in: ŚLADKOWSKI (ed.) Promocja zdrowia w różnych okresach życia. Annales Universitatis Mariae Curie-Skłodowska, Vol. LXII, Suppl. XVIII, 8, 20-23.
Other outcomes:

  • translation into Polish by B.Mroziak and disseminate the book:

JANE-LOPIS E., ANDERSON P. (2005) Promocja zdrowia psychicznego i zapobieganie zaburzeniom psychicznym. Polityka dla Europy [Mental Health Promotion and mental disorders prevention. A policy for Europe]. Nijmegen.

  • Council for Mental Health Promotion, chaired by M. Jarema, resumed its activities in October 2006

  • mental health promotion and prevention programmes were catalogued.

  • anti-stress prevention programme aiming at decreasing experience of stress and enhancing skills of coping with stress for adolescents

  • awareness and better understanding of mental health problems among the public raised.



Difficulties:
The most important factors hampering promotion of mental health and prevention of mental disorders are the following:

  • lack of post-graduate education in the field of mental health promotion and prevention of mental disorders;

  • unsatisfactory funding research on mental health promotion (most research projects are sponsored by international organization);

  • lack of evaluation of mental health promotion strategies on the national level.

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