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NIK: Inaccessible help for young patients in crisis

MedExpress Team

Published Sept. 5, 2023 10:04

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Staff shortages, direct coercion in violation of the law, abysmal premises conditions, and failure to protect examination records from unauthorized access - these are just some of the findings of the NIK audit of the availability and scope of psychiatric and psychological care for children and adolescents in the Wielkopolska province.

In the first quarter of 2023. The NIK Delegation in Poznań completed an ad hoc inspection, during which it checked the availability and scope of psychiatric and psychological care for children and adolescents in the Wielkopolska Province. The audit was conducted at two psychological and pedagogical clinics, two schools - one primary and one secondary, four medical entities operating three centers for community psychological and psychotherapeutic assistance for children and adolescents, two mental health centers for children and adolescents, and two psychiatric wards of Poznań hospitals.

Key findings of the audit

  • Direct coercion in violation of the law - one of the findings of the audit concerned the failure to comply with the rules applicable to the use of direct coercion, i.e. actions used against the will of people with mental disorders. Direct coercion was applied to patients almost exclusively in the form of immobilization. At the K. Jonscher Clinical Hospital, the cases examined included cases of immobilization lasting continuously for at least 100 hours. Among them, direct coercion lasted from 160 to 1,413 hours (63 days) in half of the cases. These patients spent between 70% and 99% of their hospitalization time in immobilization, and immobilization was used repeatedly. When applying direct coercion in the hospital, illegal measures were acted upon, i.e. these measures were extended for successive periods without the doctor's personal examination of the patient, and the patient was immobilized in the corridor of the ward without being covered by a screen, which restricted the patient's right to respect for his dignity and intimacy. In both hospitals inspected, direct coercion was extended by doctors who were not psychiatrists, so they had no formal authority to do so. In connection with the irregularities found, the NIK Delegation in Poznan forwarded a notice to the Regional Ombudsman for Professional Responsibility on the professional misconduct of doctors using direct coercion in violation of the regulations, as well as a notice to the prosecutor's office on suspicion of committing a crime by five doctors providing medical services. The notice to the public prosecutor's office relates to an act under Article 160 § 2 of the Criminal Code, which involves exposing a patient to direct danger of loss of life or serious harm to health by prolonging immobilization of a patient eleven times without personally examining him.
  • the problem of unclaimed children - two of the hospitals audited had patients whose prolonged hospitalization was not due to medical indications, but to legal problems in determining where the patient was to go after discharge. Hospital staff had to make arrangements with social welfare centers and courts. In one of the hospitals audited, at least four patients were hospitalized after the indications for continued hospitalization had ceased. Because of this, one of the stays was extended by 3 months, meaning that the patient stayed in hospitals for a total of more than a year.
  • Lack of experienced psychologists and psychotherapists in schools - the NIK audit found problems with the availability of these specialists in both schools covered by the audit (elementary and high sc...

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NIK / psycholog

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