Humanisation of Psychiatric Care: the contribution of CZK billions in investment subsidies will be difficult to assess, and an ineffective control system may pose problems
Press release on Audit No. 21/17 of 20 June 2022
The Supreme Audit Office (SAO) examined the use of European and national subsidies for the humanisation of psychiatric care in the Czech Republic between 2016 and 2020. The auditors examined the Ministry of Health (MoH) and the Ministry of Regional Development (MoRD) as the entities that distributed the subsidies, and selected beneficiaries of the aid — the University Hospital Brno (UH Brno) and the University Hospital Ostrava (UH Ostrava). In the audited years, the ministries distributed a total of approximately CZK 2.8 billion. The SAO has found that the MoH provided billions of CZK without a functioning control and management system. In breach of these rules, the MoH reimbursed the UH Brno for ineligible expenses exceeding CZK 50 million, thereby unjustifiably favouring this hospital at the expense of others. The SAO also draws attention to the possible risk of non-payment of European money. In addition, the evaluation of the impact of distributed money by the MoRD will be a problem.
The MoH paid more than CZK 50 million to finance ineligible expenditure related to the increase in the price of construction works. In doing so, it violated the mandatory rule that such expenditure is borne by the beneficiary of the subsidy itself. In another case, however, the MoH followed the rules, so that CZK 141 million ineligible expenditure had to be paid by another beneficiary from its own resources. By doing so, the MoH unjustifiably favoured the UH Brno.
The SAO’s experts also draw attention to the potential risk of non-payment of European money. Since the MoRD has not set up an effective control system, the review of two of the most financially important projects — the UH Brno and the UH Ostrava — is to be carried out only after their completion. If problems arise during the work on projects, EU subsidies totalling CZK 913 million may not be reimbursed to the Czech Republic.
According to the auditors, it will also be difficult to assess the actual impact of subsidies on the deinstitutionalisation of psychiatric care in projects supported by the MoRD. The MoRD has set a single indicator that monitors only a narrow group of patients. It accounts for less than one-fifth of all patients affected by the problem.
The SAO found that among the beneficiaries there was little interest in support for mental health centres. This is one of the important tools to help prevent or shorten long-term hospitalisation and thus help to reintegrate people with mental illness into everyday life. Out of a total of 24 projects supported between 2016 and 2020, only five related to mental health centres. The low interest was linked, according to auditors, to the outstanding system of financing the health and social care provided in these centres.
Subsidies for the humanisation of psychiatric care are to be one of the pillars of the ongoing reform of mental health care. With its help, it is intended to improve the quality and efficiency of the psychiatric care provided, as well as the quality of life of people with mental illness. The specific task of subsidies for the humanisation of psychiatric care is, for example, to improve the environment in psychiatric hospitals, to establish or reconstruct hospitals providing acute inpatient psychiatric care or to support community care, including the construction of mental health centres.
Communication Department
Supreme Audit Office