SAO audit: mental health centres are scarce, there is a lack of professional staff, funding is not ensured
PRESS RELEASE ON AUDIT NO 23/22 – 7 October 2024
People with serious mental illness should have the chance to be treated in their natural environment instead of long-term stays in psychiatric hospitals. This is one of the government's continuing priorities. Mental health centres should also contribute to shifting the focus of mental health care to the community. The SAO focused on the audit of European subsidies earmarked specifically for the establishment and pilot operation of such centres in the Czech Republic. The audit showed that, although the money was spent effectively, the objective of building a network of 100 mental health centres by 2023 has not been met, the number of mainly medical specialists and sustainable financing of social care in the centres is not ensured, and the legislation regulating the operation of these centres is not yet in force. The continuation of the shift of psychiatric care to the community is thus at risk.
Thanks to the CZK 407 million subsidy, 29 mental health centres were set up. This established their initial network and demonstrated the interest in their services. This is also confirmed by the growing number of clients. While in 2018, the first year of their existence, the mental health centres had 302 unique clients, in the fifth year they already had 6,257 clients. The number of long-term inpatient psychiatric patients dropped from nearly 30,300 in 2018 to 25,300 in 2022. However, services in natural environment continue to be available to only a portion of people with mental illnesses, which are increasing in the Czech Republic.
Neither the Ministry of Health (MoH) nor the Ministry of Labour and Social Affairs (MoLSA) have fulfilled a number of tasks imposed by the government and have not taken all the necessary steps to stably anchor and develop the network of these centres, whose mission is to provide health and directly related social services by a multidisciplinary team. And, as already mentioned, the lack of professional staff, the failure to ensure sustainable funding for social care in the centres and the shortcomings in the legislation threaten the operation of existing centres and act as a serious obstacle to the creation of new ones.
Less than a third of the planned 100 centres were operational at the end of 2023. According to the SAO, the creation of a network of 100 mental health centres covering the entire territory of the Czech Republic is not realistic even with the postponed deadline of 2030. The Czech Republic still lacks more than half of the necessary specialists, especially psychiatrists and psychiatric nurses, for the creation of new centres and for mental health care in general. According to the SAO, the MoH has not taken sufficient steps in this respect. For example, in 2021 and 2023, it did not support the specialisation training of doctors in psychiatry with subsidies for residency places.
Even six years after the first mental health centres were established, funding for the social part of the centres is not ensured. While health services are covered by public health insurance, the MoLSA has not set up sustainable funding for social services. Both Ministries have also failed to meet the January 2022 deadline for anchoring mental health centres in the relevant legislation and their legislation is not yet in force.
According to the SAO, many of these problems are caused by the low level of cooperation between the two Ministries, which slows down progress in shifting the focus of psychiatric care to the community and thus hinders the progress of the entire mental health care reform in the Czech Republic.
The identified systemic problems are also confirmed by the findings of a questionnaire survey in which the SAO contacted all 28 mental health centres still in operation that received EU support for their establishment. The majority of the 82% of centre operators who responded to the SAO questionnaire reported that they perceived the existence of obstacles and risks to the long-term sustainability of their activities. Respondents identified the lack of professional staff for health services, conceptual and legislative barriers and insufficient funding for services as the biggest risks. Details can be found here: https://www.nku.cz/scripts/detail.php?id=14056 (only czech).
Communication Department
Supreme Audit Office