Psychiatry and public health: How to reduce social barriers to psychiatric care?

This applies to virtually all social groups, although, as Prof. Dominika Dudek, President of the Board of Directors of the Polish Psychiatric Association, said, special attention should be paid to children and adolescents on the one hand (which is talked about a lot) and seniors on the other (which is hardly talked about, or at any rate - rarely). - There are a lot of seniors facing mental crises, and there will be even more, she stressed. What is needed is a comprehensive senior policy, one of the goals of which should be to activate seniors and pull them - literally - out of loneliness, which is a risk factor for the onset of depression, among other things.

- Undoubtedly, we are diagnosing more and more psychiatric disorders, perhaps even a bit exaggeratedly," admitted Prof. Agata Szulc, head of the Psychiatric Clinic of the Faculty of Health Sciences at WUM, noting that there is a clear increase in the proportion of diagnoses of depression, which the WHO predicts could become the first cause of sickness absence in 2050.

The foundation for preventing such a scenario is primary prevention, i.e. - as part of a healthy lifestyle - taking care of mental well-being as well. It is necessary to remember, said Prof. Piotr Galecki, national consultant for psychiatry, to avoid overstimulation, to make a clear distinction between professional and private spheres. However, to what extent is this possible? Professor Mariusz Gujski, head of the Department of Public Health at WUM, who led the discussion, gave the example of students (specifically from the public health faculty, but this applies to the lion's share of students), at whose request classes were condensed into three days so that they could work in parallel. - Studying, which not so long ago was a time of strenuous study, but also gave time for fun, for free entry into adulthood, a kind of experimentation with adulthood, is a thing of the past, he pointed out, stressing that the percentage of students struggling with mental problems is now significantly higher.

Prof. Marcin Wojnar, head of the Department of Psychiatry at WUM, reminded that every person has a need for rest, needs time for physical activity, hobbies or doing something for pleasure. Of course, young people have ample opportunities to suppress these needs, but they still pay or will pay a price for it, he pointed out, adding that this price is - for example - addictions.

Although the discussion focused - in accordance with the spirit and letter of the NCP - on prevention and prevention, in the context of psychiatry there can also be no lack of systemic threads, if only because parallel to the Congress there was a protest in defense of mental health centers, which are an important element also in the prevention of mental disorders and care for the mental well-being of the population. The protest was triggered, according to Maciej Karaszewski, director of the Department of Treatment at the Ministry of Health, by ambiguous messages and information chaos, rather than by the real intentions of the Ministry of Health and the National Health Fund regarding the future of the centers or the reform of adult psychiatry. The goal of the solutions to be introduced after the pilot (which is scheduled for mid-2025) is to ensure comparable quality of care throughout the country. Thus, better qualitative and quantitative assessment components must be added to the current solutions when it comes to services, he explained. - There is no temptation to look for savings in the area of psychiatry, he assured.

Experts did not hide their hope that this assurance extends to the issue of funding drug therapies, and that the Health Ministry will issue a positive decision on the proposal to revise the drug program for drug-resistant depression. After a year of operation, it is known that patients are responding very well to the esketamine used in it - more than half have achieved remission. - The problem is the very strict criteria for inclusion in the program, which we would like to adjust somewhat, because at the moment the key is not the patient's clinical condition but the strict fulfillment of conditions, such as specifying that no more than five other drugs have been used in the patient before, the expert pointed out. Also in favor of relaxing the criteria are, as Prof. Dominika Dudek stressed, the results of observational studies conducted in Italy, which show that in some patients the drug brings excellent results after a longer period of use. - Patients and specialists are asking for minimal changes, she recalled. In August, a position paper was published by the Coalition to Combat Drug-Resistant Depression, which included a number of comments (and recommendations) on the B.147 Drug Program. Among other things, representatives of the community drew attention to the criteria that constitute the program's "bottlenecks," giving examples of the negative consequences of their adoption. One example, for example, is "allowing only patients with an episode of drug-resistant depression lasting more than 6 months to participate in the program, which can lead to unnecessary postponement of the inclusion of effective therapy and prolong the suffering of patients with untreatable depression."