Concept of Psychiatry

Ministry of Health of the Slovak Republic, pursuant to article 45 para. 1, letter a /of Act no. 576/2004 Coll. on Healthcare, Healthcare-related Services as amended by Act no. 350/2005 Coll. issues the following concept.

1. Contents and Main Tasks of Care in this Field

1.1.  Contents and Main Tasks of Care in this Domain, Definition of Activities
Psychiatry is a separate specialized domain that deals with the prevention, diagnostics, treatment and follow-up treatment of mental and behavioural disorders in persons of all age groups. Health care provided within the domain of psychiatry is based on the principles of bio-social understanding of mental and behavioural disorders in accordance with the results of research in various specialties and other humanities.
The provision of healthcare within the domain of psychiatry also involves restoration of psychosocial functions in compliance with the bio-social model of understanding the disease pathology. In this respect, psychiatry emphasizes not only the biological, but also psychotherapeutic and socio-therapeutic methods in the approach to the patients. The specialized domain of psychiatry participates in the monitoring and implementation of preventive programs in the field of mental health.

1.2.  Characteristics of Care in this Field
Specialized psychiatric care is provided within the outpatient units and inpatient health care facilities. Network of these facilities is differentiated so as to ensure good-quality and accessible healthcare to the extent as determined by the health condition of the population, the epidemiological situation and the appropriate level of preventive protection. The starting point for the formation of a network of psychiatric facilities are the so-called regions of standard psychiatric care, which are created for geographic areas with a 100 to 150 thousand inhabitants. Ensuring the provision of a high-quality professional level psychiatric care requires development of specialized departments, vocational education and training specialized staff as well as development of scientific and research activities along with implementation of scientific knowledge into clinical practice.

1.2.1. Healthcare in the specialized field of psychiatry is provided at the following medical facilities:

•         specialized psychiatric outpatient units;
•         general hospitals (psychiatric wards), hospital clinics;
•         psychiatric ICUs,  JIS,  psychiatric follow-up treatment wards;
•         specialized hospitals (psychiatric hospitals, centres for drug addiction treatment, professional medical institute of psychiatry);
•         psychiatric day care centres;
•         mental health institutions;
•         home nursing agencies;
•         psychiatric units with specific purpose (protective psychiatric care, detention facilities, forensic expertise units, etc.);
•         community psychiatry centres (mental health community centres, early intervention centres, assertive community teams);
•         crisis centres with mobile teams;
•         other units (within the remit of other ministries – sheltered workshops, sheltered/assisted living, subsidized employment) with the expert guarantee of psychiatry.

1.2.1.1. Psychiatric Outpatient Units
Provide specialized  outpatient care to individuals with mental disorders not requiring inpatient health care. Personnel as well as material and technical equipment of specialized psychiatric outpatient units is regulated by a special regulation. Healthcare specialists working at these psychiatric outpatient facilities may be a clinical psychologist, remedial teacher, physiotherapist, social worker as well as other healthcare professionals (art therapist, ergotherapist, EEG technician).

1.2.1.2 Psychiatry Wards/ Hospital Clinics
Provide hospital psychiatric care to patients with mental disorders who cannot be cared for in outpatient care or whose health condition requires institutional care and treatment. In terms of internal specialization, the hospital can establish the following types of psychiatric wards.
•    psychiatric wards for adults;
•    psychiatric wards for children and adolescents;
•    gerontopsychiatric wards;
•    follow-up treatment wards;
•    wardsfor drug addiction treatments;
•    psychiatric rehabilitation wards.
The fundamental parts of the psychiatric ward/hospital clinic should always include: a psychiatric outpatient clinic, a ward with intensive psychiatric care unit for electro-convulsive therapy and magnetic stimulation with the appropriate equipment for the application of electroconvulsive therapy under general anaesthesia, psycho-diagnostic  facility or neurophysiology laboratory. The ward is usually divided into bed treatment units (15 to 30 beds), which can be specialized in the diagnosis and therapy of various types of psychotic disorders, acute psychiatric conditions, addictions, organic mental disorders, affective and anxiety disorders, personality disorders, eating disorders and so on. It is essential to have suitable premises for psychotherapy and occupational therapy at disposal because the spatial equipment is one of the elementary prerequisites for adequate treatment of psychiatric patients. A unit for intensive intervention is also a specific component. The psychiatric department is lead by a chief specialized in psychiatry or child psychiatry. The nursing care is in responsibility of the nurse/nurse with specialization in nursing care in psychiatry.  Units serving as teaching medical facilities are called departments. They conduct and develop psychiatric research.

1.2.1.3 Psychiatric Hospitals
These are specialized hospitals providing institutional healthcare primarily in the field of psychiatry and their role is similar to the roles of psychiatric wards/hospital clinics. The disadvantage is in their lower level of integration into general medicine, however, the advantage is higher possibility of complex psychiatric care as well as the possibility of more rational use of personnel and material and technical equipment of the hospital. If needed, the psychiatric hospital can establish specialized wards (units for drug addiction treatment, unit for treatment of neurotic disorders, psychiatric rehabilitation department, department for psychotherapy, follow-up treatment stay wards, socio-psychiatric unit, etc.).

1.2.1.4 Mental Health Institutions
They are health care facilities that provide specialized medical care, particularly focusing on chronic disorders in patients with chronic or recurrent mental health problems requiring long-term hospitalization (3-6 months), or even long-term detention if necessary. Mental health institutions are currently included in the process of transformation and they will be facilities providing social-healthcare services and/or psychiatric departments with special purpose (detention).

1.2.1.5 Psychiatric Day Care Centres
These are facilities for specialized outpatient psychiatric care where patients with mental diseases and disorders are during the day provided complex psychiatric care and treatment with specific emphasis on psychotherapy, psychiatric rehabilitation. The aim is to reach  such degree of recovery that allows the fullest possible employment and/or social reintegration of patients into society. The conditions for establishing and operation of psychiatric day care centres are stipulated by a separate regulation.

1.2.1.6 Psychiatric Units with Specific Purpose
a/ Psychiatric wards providing protective psychiatric treatment (a separate departments must be established for protective sexual therapy and protective treatment of drug addictions).
b/ Psychiatric units for institutional treatment of alcohol addiction (may be separate, which is less suitable; integrated as units within a psychiatric hospital or institution).
c/ Special security psychiatric wards for  long-term patients with aggressive behaviour.
d/ Departments for psychiatric forensic expertise.

1.2.1.7. Facilities within the Remit of other Ministries with an Expert Guarantee of a Psychiatrist
a/ Facilities of social-psychiatric care are ergotherapy workshops, sheltered workshops, sheltered homes, facilities providing care in other families. These are new forms of care, not implemented in our healthcare provision yet, for patients with mental disorders deteriorating the affected individual´s ability of labour and/or social inclusion as well as their ability to provide for the daily needs. Providing  for these forms of care goes beyond the scope of possibilities of the Ministry of Health, particular importance lies within the Ministry of Labour, Social Affairs and Family. These facilities are supervised by a psychiatrist who indicates, provides expert leadership and guidance of the other members of the therapeutic team.
b/ Psychiatric facilities (outpatient, hospital) within the range of medical facilities established by the Court Guards and Prison Wardens Corps of the Slovak Republic, which provide psychiatric care to individuals in custody or serving a prison sentence.
c/ Social services facilities with increased psychiatric care:
-  facility for patients with moderate to severe level of mental retardation;
-  facility for autistic patients (regardless of age).
d/ social care facility for severely socially impaired and drug addicted as well as post-processual patients.

1.2.2. Staff in the Specialized Field of Psychiatry
a/ physicians – psychiatrists, child psychiatrists, neuro-psychiatrists;
b/ nurses, registered nurses, nurses specialized in field of nursing care in psychiatry;
c/ other healthcare medical staff - physiotherapist, psychologist specialized in field of clinical psychology, remedial pedagogue, social worker;
d/ other healthcare staff
e/ volunteers in healthcare provision.

1.3. Relations of the Field with other Medical Department - Cooperation
Apart from using its own specific scientific knowledge and experience of working closely with many other specializations - neurology, clinical psychology, internal medicine and other - the field of psychiatry also uses and applies the expertise of other natural sciences and humanities.

1.4. Professional and Methodological Guidance in Care Provision in the Field
The department of psychiatry is managed and methodologically led by the Ministry of Health of the Slovak Republic in cooperation with the chief psychiatry expert of the Ministry of Health of the Slovak Republic. The chief expert cooperates with the Psychiatric Association of the Slovak Medical Association (hereinafter only referred to as SPA SkMA), with the Slovak Psychotherapeutic Association (hereinafter only referred to as SPTA), the Slovak Medical Chamber, Slovak Chamber of Nurses and Midwives, Slovak Chamber of other medical professionals, assistants, laboratory assistants and technicians as well as with other institutions and practitioners involved.

1.5. Mandatory Reporting and Processing of Statistical Data
Processing of statistical data and their mandatory reporting shall be performed in cooperation with the National Health Information Centre and the Statistical Office of the Slovak Republic.

1.6. Dispensarization
Dispensarization in psychiatry involves severe conditions requiring long-term medical care.  The severity of mental illnesses, also from the perspective of the society, underscores the need of dispensarization of certain patients with behavioural  mental disorders.

2. Care Development in the Domain

2.1. Care Development Trends in this Domain in the Next 5 to 10 Years
Care development in domain of psychiatry in the upcoming period of 5 to 10 years shall be based on the Reform of Psychiatric Care (1991), WHO Mental Health Declaration and Action Plan for Europe (Helsinki 2005) to  offset the differences in psychiatric care provision in the individual regions of Slovak Republic and to introduce new and advanced forms of psychiatric care. The Government of Slovak Republic approved a National Programme of Mental Health (2004) and an Action plan for the implementation of the National Programme of Mental Health for the period 2005 to 2015 /2005/, which aims to destigmatize the people with mental disorders, develop Agencies for home nursing care in psychiatry, establish services for crisis intervention and develop programs  for mental health protection. These proposals are also in line with the trends promoted in the EU countries and their future development is incorporated in the EC materials (Green Paper consultation on Metal Health, 2006).

2.2. Quality Control System for the Health Care Provision in this Domain
The quality of care focuses on retaining and/or improving the patient´s subjective assessment of quality of life, psycho-social behaviour, satisfaction with treatment and the overall well-being. These subjective indicators must be complemented by objective indicators of severity of symptoms, such as relapse frequency, length of hospitalization and the so-called cost/benefit analysis.
The most important quality indicator in terms of result-process-structure is the result of treatment - results summarize all that has been achieved:
•         from the aspect of patient (e.g. quality of life)
•         medical aspect (complications, relapse frequency)
•         aspect of institution/organization (length of stay/re-hospitalization).
In order to ensure the integrity of the control system , it is essential to ensure a continuous process of certification and accreditation of individual facilities, as well as ensuring a functional and flexible quality management with clearly defined goals and objectives.

2.3. Key Problems of Care Provision in the Field, Problem Solving
The specialized domain of psychiatry constantly struggles with problems related to absolutely unsuitable level of material and technical equipment of healthcare facilities providing psychiatric care. Providing good quality psychiatric care requires re-profiling and upgrading the network of psychiatric facilities while putting emphasis on their quality.

2.4. International Cooperation
The domain of psychiatry takes part in international cooperation via professional associations and organizations: PA SkMA, SPA and others, which are members of international organizations (WORLD) Psychiatric Association – WPA). Their representatives in UEMS (Section of Psychiatry) actively participate in creating and establishing common foundations and principles of further development of psychiatry in EU countries. Representatives of the department of psychiatry are actively participating in many international activities and projects, top international experts are being invited to accelerate the implementation of the latest findings in the field of psychiatry into routine practice.

3. Education and Training of Personnel in the Domain

3.1. Specialized Study, Certified Education
Further education in the specialized domain of psychiatry to perform specialized and certified jobs is conducted within accredited specialized study programmes and certified study curricula, under a special regulation.

3.2. Continuous Education
Continuous education is conducted under a special regulation.

4. Final Provision

The concept of psychiatry, no. SZS-792/1995/St from 1997, published in the Journal of Ministry of Health of the Slovak Republic 1997, issue 9, volume 45, is revoked.

5. Entry into Force

This concept shall enter into force as o July 1, 2006.