INSTITUTE OF PSYCHIATRY AND NEUROLOGY

WHO COLLABORATING CENTRE FOR RESEARCH

AND TRAINING IN MENTAL HEALTH

REPORT ON COLLABORATION

BETWEEN THE INSTITUTE OF PSYCHIATRY AND NEUROLOGY

AND THE WORLD HEALTH ORGANIZATION

2004-2007

9 Sobieskiego Str., 02-957 Warsaw, Poland

Tel: (48 22) 45 82 706, Fax: (48 22) 651 93 01

e-mail: hercz@ipin.edu.pl

home page: http://www.ipin.edu.pl/

Head of the Centre: Professor Danuta Ryglewicz M.D.

Warsaw, June 2008

CONTENTS

I. GENERAL REMARKS

II. IMPLEMENTATION OF THE WORK PLAN

II. A. Activities performed in relation to the terms of referenceII. B. Direct collaboration between the Centre and WHO

III. DIFFICULTIES ENCOUNTERED IN THE COLLABORATION WITH WHO

IV. SUGGESTIONS ON INCREASED AND IMPROVED COLLABORATION WITH WHO

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I. GENERAL REMARKS

In 1992 the Institute of Psychiatry and Neurology (IPN) was designated by the World Health Organization (WHO) as a Collaborating Centre for Research and Training in Mental Health (CC). This status was extended thrice, last in September 2004.

In 2004, conditions of cooperation were modified and since then the collaboration between IPN and WHO has been carried out under the following terms of reference:

assisting appropriate Polish as well as Central and Eastern European

governmental agencies and NGOs in formulating and implementing of policies

and programmes on mental health, substance abuse and neurology congruent

with WHO policy;

carrying out research projects on mental health, substance abuse and neurology,

with special emphasis on development of evidence-based policies and

programmes in the field of mental health promotion and prevention of mental

disorders;

training and education of primary health care professionals on mental health

problems as well as on public health aspects of mental, neurological and

substance abuse disorders;

consultations and exchange of information.

In the years 2004-2007, the IPN carried out more than one hundred forty research projects each year, many of them in international collaboration (about 20 each year). More than 1250 articles and monographs were published (170 in journals of the ISI Philadelphia citation report, 530 in journals indexed in the Polish database). In the years 2004-2006, 1750 citations were identified in the Science Citation Index Expanded, while in 2007 database Scopus recorded 909 citations of articles authored by the research staff of the Institute. Conferences and workshops were organised, staff of the Institute assisted in formulating and implementation national polices as well as participated in WHO consultation meetings on mental health and substance abuse around the world.

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II. IMPLEMENTATION OF THE WORK PLAN

II. A. ACTIVITIES PERFORMED IN RELATION TO THE TERMS OF REFERENCE

TERMS OF REFERENCE AREA: assisting appropriate Polish as well as Central and Eastern European governmental agencies and NGOs in formulating and implementing policies and programmes on mental health, substance abuse and neurology congruent with WHO policy. (Activities 1-7)

Activity 1

Name of the activity: Assisting in formulating and implementing the Mental Health Programme

Description of the activity: updating the Mental Health Programme and taking successive steps to grant the Programme a governmental status, monitoring implementation of the Programme.

Implementation of the activity

The Mental Health Programme, developed by the staff of the Institute of Psychiatry and Neurology in collaboration with WHO, was accepted by the Ministry of Health in February 1995. After evaluating the Programme’s progress in 1998, the Parliamentary Commission for Health recommended the inter-ministerial status for the Programme. Since then a number of changes were introduced to the Programme, the latest in December 2006, by the IPN staff: J. Wciórka, L. Boguszewska, W. A. Brodniak, Cz. Czabała, J. Jarema, W. Langiewicz M.A., K. Prot-Klinger, S. Pużyński, E. Słupczyńska-Kossobudzka. The newest version of the Programme for the years 2009-2013 was established as the national one and was accepted by the Ministry of Health in April 2007. To enable the Programme implementation and funding, the staff of the Institute drafted amendments to the Mental Health Act. The main proposed changes covered the following sections:

“1. Mental health protection encompasses its tasks involving in particular:a) promotion of mental health and prevention of mental disorders,b) providing persons with mental disorders with comprehensive and widely available health care and other forms of care and assistance which are essential for them to live in the family and the social community,c) reinforcing positive social attitudes towards persons with mental disorders, in particular understanding, tolerance and kindness, and counteracting their discrimination.

2. The tasks mentioned in section 1 are defined by the National Mental Health Programme, accepted by the Council of Ministers, by resolution, for five consecutive years.”The interministerial consultations on amendments were closed in August 2007. In November 2007 the proposal on amendments of the Mental Health Act, including a draft of the executive act - the National Mental Health Programme for the years 2009-2013 - was sent by the government to the Parliament.

In May and June, the staff of IPN (M.Jarema, J.Wciórka, K. Prot-Klinger) presented the situation in psychiatric care and the Programme to the Commission of Health and the

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Commission of Social Welfare and Family of the Senate, the Upper House of the Parliament as well as to the Ministry of Labour.

The updated version of the Programme reflects its national status and recent trends in psychiatry. First, it was emphasised that the Programme should be implemented by the health sectors in partnership with other governmental departments: employment, housing, educational etc. Secondly, strong stress was put on the development of community base psychiatry, what requires organizing the Mental Health Centres. Thirdly, a necessity of coordination between mental health care and social help was underlined. The Programme focuses on guaranteeing social and occupational rehabilitation as well as employment for people with mental health problems.

Outcomes:

Publications:

PROT K., WCIÓRKA J. (2007) Mental Health Reform in Poland. Psychiatriki, 18 (Suppl.1), 114.

WCIÓRKA J. (2007) Narodowy Program Ochrony Zdrowia Psychicznego - projekt 2006 [National Mental Health Programme - draft 2006]. Psychiatria po Dyplomie. Czerwiec, special issue, 25-32.

WCIÓRKA J. (2007) Reformowanie opieki psychiatrycznej w Polsce [Mental health care reforms in Poland]. Psychiatria Polska, 41, 3 (Suppl.), 176-177.

Other outcomes: mental health policy becomes more comprehensive social awareness of mental health problems broadened

Difficulties:Against expectations, the Mental Health Act has not been amended up to June 2008. The legislation process was interrupted by the parliamentary election and urgent reforms of the whole health system.

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Activity 2

Name of the activity: Monitoring implementation of the Mental Health Act

Description of the activity: monitoring implementation of the Mental Health Act of August 19, 1994. Practical problems of implementation of the Act and irregularities of its observance were under review in the research project.

Implementation of the activity

Monitoring implementation of the Mental Health Act was carried out by S. Dąbrowski, W.A. Brodniak, S. Webel and W. Langiewicz. The findings showed that in the years 1996 -2005 the number of involuntary admissions to the hospitals increased by 27% and simultaneously the rate of such admissions decreased, probably due to the growth of the overall number of admissions. The number and the rate of involuntary admissions on the ground of the motion of relatives and legal representatives decreased, especially in psychiatric hospitals. Psychiatric hospitals more frequently than psychiatric wards in general hospitals admitted patients without the consent, with exception of admissions on the base of motion. Physical restraint to a person admitted without the consent was applied more frequently in psychiatric hospitals (16%) than in general hospitals (10%).

The evaluation of judicial decisions on involuntary admissions to psychiatric hospitals was carried out. It was found that the largest number of patients (63%) was involuntary admitted on the emergency base, because of imminent danger to their life or to life or health of others. However, in 18% of decisions, documents confirming personally conducted examination by a doctor were lacking, and information on behaviour, which would justify admission, was not given in 50% of cases. It was noted down that psychiatric hospitals did not declare to the court patients, involuntary admitted, but later accepted treatment in the hospital.

Outcomes:

Publications:

BRODNIAK W.A., LANGIEWICZ W., WELBEL S. (2007) Monitoring of the Polish Mental Health Act implementation in the years 1996-2005. BMC Psychiatry; 7 (Suppl 1), 100.

BRODNIAK W.A., LANGIEWICZ W., WELBEL S. (2007) Monitoring of the Polish Mental Health Act implementation in the years 1996-2005. WPA Thematic Conference Coercive Treatment in Psychiatry: A Comprehensive Review Abstract Booklet, Dresden, 92.

DĄBROWSKI S., BRODNIAK W.A., WELBEL S. (2005) Ocena przestrzegania przepisów o zgodzie na leczenie w szpitalu psychiatrycznym [Evaluation of observance of regulations on the consent for treatment in a psychiatric hospital]. Psychiatria Polska, 39 (1), 139-150.

DĄBROWSKI S., BRODNIAK W.A., WELBEL S. (2005) Przestrzeganie zaleceń lekarza przez pacjentów przyjętych za zgodą do szpitala psychiatrycznego [Compliance of patients admitted with consent to psychiatric hospitals]; Psychiatria Polska, 39 (1), 125-137.

WOŹNIAK A. (2007) Zmiany w art. 22 Ustawy o Ochronie Zdrowia Psychicznego - komentarz psychiatry. [Changes in art.22 of the Mental Health Act - comments of a psychiatrist] Wiad. Psych. 2007; 10 (2), 131-133.

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Other outcomes: In 2005, the Mental Health Act, was amended to establish a position of an ombudsmen of psychiatric hospital patients.

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Activity 3

Name of the activity: Monitoring the standards of psychiatric care in Poland

Description of the activity: gathering information, preparing reports on current problems of psychiatric care and discussing results with prominent Polish professionals working in mental health (national consultant on psychiatry, regional consultants, heads of university clinics, directors of psychiatric hospitals) during annual meetings.

Implementation of the activity:The annual meetings on the current situation in mental health care in Poland were held on 26 March 2004, 13 October 2005, 30 October 2006 and on 27 May 2008 in Warsaw. All conferences were organized by the staff of the Department of Health Care Organization.

The prominent Polish professionals working in mental health: the national consultant in psychiatry, the national consultant in mental health of children and adolescent, regional consultants, directors of psychiatric hospitals, persons responsible for mental health system on the local level participated in the conferences. Representatives of the Ministry of Health, other departments of the government, the National Health Fund (NHF) were also present.

The topics of the conferences covered a wide range of mental health areas: current problems of psychiatry and forensic psychiatry in Poland, financing mental health services, challenges of mental health care in Poland, draft of the National Mental Health Programme, and monitoring of the Mental Health Act in the years 1996-2005. Changes in financing mental health services, proposed by the NHF, were under consideration. The proposal concerned shifting a large amount of money from the most costly services (e.g. psychiatric hospitals) into outpatient, intermediate and complex care, provided by mental health centres.

Outcomes:

Publications:LANGIEWICZ W., SŁUPCZYŃSKA-KOSSOBUDZKA E. (2004) Psychiatric services in the fifth year of health care reform in Poland. International Psychiatry, 6, Oct., 6-8.

PUŻYŃSKI S. (2005) Zasady stosowania leków przeciwdepresyjnych w terapii depresji [Guidelines for using antidepressant in therapy of depression]. Lekarz Rodzinny, 10, 462-469.

PUŻYŃSKI S., KALINOWSKI A., KOSZEWSKA I., PRAGŁOWSKA E., ŚWIĘCICKI Ł. (2004) Zasady leczenia nawracających zaburzeń afektywnych (2004) [Guidelines for treatment of affective disorders]. Farmakoterapia w Psychiatrii i Neurologii, 1, 5-46, Lęk i Depresja, 9, 227-256, Medycyna po Dyplomie, Special issue - lipiec, 15, 3-32.

PUŻYŃSKI S., LANGIEWICZ W. (2005) Aktualne problemy psychiatrycznej opieki zdrowotnej w Polsce (2004 r.) [Current problems in psychiatric health care in Poland (2004)]. Psychiatria Polska, 39 (4), 617-627.

PUŻYŃSKI S., LANGIEWICZ W., PIETRZYKOWSKA B. (2006) Aktualne problemy psychiatrycznej opieki zdrowotnej w Polsce (2005 r.) [Current problems in psychiatric health care in Poland (2005)], Psychiatria Polska, 40 (2), 177–189.

RYBAKOWSKI J., DUDEK D., JARACZ J., JAREMA M., KOSZEWSKA I., PARNOWSKI T., PUŻYŃSKI

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S., ŚWIĘCICKI Ł. (2007) Standardy leczenia chorób afektywnych [Standards of pharmacological treatment of affective disorders]. Farmakoterapia w Psychiatrii i Neurologii, 23, 7-61.

ZAŁUSKA M. (2006) Środowiskowy model leczenia psychiatrycznego, a zmiany w strukturze lecznictwa w ostatnich latach w Polsce [The community-based psychiatric care model and changes in the health system structure in recent years in Poland], Postępy Psychiatrii i Neurologii, 15 (4), 277–285.

Other outcomes: higher standards of treatment of affective disorders established information flow between interested parties improved

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Activity 4

Name of the activity: Assisting in formulating and implementation of the Mental Health Promotion Programme

Person responsible: Prof. Czesław Czabała, Ph.D.

Description of the activity: development of the Mental Health Promotion Programme, its implementation and monitoring, conducting multi-dimensional research projects and surveys on the current status of mental health of the Polish population, analysing infrastructure and strategies of local promotion programmes (e.g. school base prevention and promotion programmes).

Implementation of the activity:

Staff of IPN prepared the Mental Health Promotion Programme. It was included to the National Mental Health Programme as a priority no 1.

Research projectsResearch projects were carried out on mental health of adolescents and young adults. Coping with stress in family and schools, use of psychoactive substance by adolescents, mental health of young adults and unemployment were investigated.The findings showed that mental health of secondary school’s pupils was deteriorated in two years time. The number of pupils with problem behaviour syndrome risen, the percent of pupils getting drunk increased from 20% to 47%. Hypothesis on importance of sense of coherence, financial situation of family and support of peers, teachers and family for mental well-being of adolescents was confirmed.

Two National Conferences on Mental Health Promotion were held in 14-15 October 2005 and 27-29 September 2007The conferences were organized by the staff of the Department of Psychology and Mental Health Promotion. There were over 100 participants representing various groups involved in mental health promotion: physicians, psychologists, sociologists, researchers from various universities and research institutes, practitioners working in health care or education sectors, counseling and social services, public health centers, governmental departments and even sanitary-epidemiological stations, as well as students. The WHO EURO was represented by E. Jane-Llopis. The second conference was co-organized by the WHO EURO, the State Agency for Prevention of Alcohol Related Problems, the National Bureau for Drug Prevention and the Centre of Psychological and Pedagogical Assistance.

During the conferences general recommendations on mental health promotion by WHO and EU were presented. The other lectures concerned: the current status of mental health in Poland (Cz. Czabała), implementation of mental health promotion programmes in Europe (E. Jané-Llopis, B. Mroziak), new needs, directions and risks to mental health promotion in schools (K. Ostaszewski) and in the workplace, home violence and substance dependence as risks to mental health and preventing stigmatization and reducing exclusion (K. Prot-

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Klinger).

A number of mental health promotion and mental disorders prevention programs planned or implemented all over the country were discussed. Among other ones – prevention of substance abuse among children and adolescents, preventing burnout of school teachers, doctors and nurses, programmes on stress management for policemen, on suicide prevention, on increasing social integration of the mentally ill, and on developing positive psychological resources in young people. The majority of presented projects and programmes were spontaneous initiatives undertaken in various, sometimes quite unknown centers, independently from each other.

During the second conference two additional problems were raised: - the system of education of staff for health promotion in Poland and Europe;- research on mental health promotion.

The role of drama/theatre in promotion of mental health was outlined in the special workshop.

Outcomes:

Publications:

BOBROWSKI K., CZABAŁA J.C., BRYKCZYŃSKA C. (2005) Zachowania ryzykowne jako wymiar oceny stanu zdrowia psychicznego młodzieży [Problem behaviors as a dimension of mental health assessment in adolescents]. Postępy Psychiatrii i Neurologii, 14 (4), 285-292.

CZABAŁA C.J., BRYKCZYŃSKA C., BOBROWSKI K., OSTASZEWSKI K. (2005) Problemy zdrowia psychicznego w populacji gimnazjalistów warszawskich [Mental health problems in the population of high school students in Warsaw]. Postępy Psychiatrii i Neurologii, 14 (1), 1-9.

CZABAŁA CZ., OSTASZEWSKI K., OKULICZ-KOZARYN K. (2005) Mental health promotion and mental disorder prevention across European Member States: a collection of country stories. Poland. DG Health & Consumer Protection, 125-129.

JELONKIEWICZ I., KOSIŃSKA-DEC K. (2004) Spostrzegane zasoby a doświadczanie stresu rodzinnego i szkolnego wśród młodzieży [Resources and family and school stress among youth]. in: Rozwój - Zdrowie - Choroba. Aktualne problemy psychosomatyki, KOSIŃSKA-DEC K., SZEWCZYK L. (eds.). Bel Studio, Warszawa, 71-90.

JELONKIEWICZ I., KOSIŃSKA-DEC K. (2006) Wsparcie rodziców i rówieśników a doświadczanie stresu u młodzieży [Parents and peers support and stress in youth]. in: BRYC S. (ed.) Promocja zdrowia w chorobie i niepełnosprawności, Annales Universitatis Mariae Curie-Skłodowska, Sectio D Medicina, Vol. LX (Suppl. XVI, 3), Lublin, 43–46.

JELONKIEWICZ I., KOSIŃSKA-DEC K. (2007) Poczucie koherencji zasobem szczególnie ważnym w promocji zdrowia młodzieży [Sens of coherence an important resource in health promotion of adolescents] in: Promocja zdrowia w różnych okresach życia. Annales Universitatis Mariae Curie-Skłodowska. Sectio D Medicina, Vol. LXII, Suppl. XVIII, N 3, Lublin, 83-86.

KOSIŃSKA-DEC K., JELONKIEWICZ I. (2004) Zasoby a radzenie sobie ze stresem rodzinnym i szkolnym oraz zdrowie młodzieży [Resources, coping with family and school stress and health of youth]. in: Rozwój - Zdrowie - Choroba. Aktualne problemy psychosomatyki, KOSIŃSKA-DEC K., SZEWCZYK L. (eds.). Bel Studio, Warszawa, 91-104.

KOSIŃSKA-DEC K., JELONKIEWICZ I. (2006) Poszukiwanie podstaw empirycznych programu profilaktycznego podnoszącego skuteczność radzenia sobie młodzieży ze stresem [Searching for empirical prevention programme, which increased effectiveness of coping with stress among youth], in: PASIKOWSKI T.,

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SĘK H. (eds.) Psychologia zdrowia: teoria, metodologia i empiria, Bogucki Wydawnictwo Naukowe, Poznań, 141–152.

KOSIŃSKA-DEC K., JELONKIEWICZ I. (2006) Style radzenia sobie ze stresem jako czynnik chroniący zdrowie młodzieży [Styles of coping with stress as a factor protected health of youth], in: Promocja zdrowia w chorobie i niepełnosprawności, Annales Universitatis Mariae Curie-Skłodowska, Sectio D Medicina, Vol. LX (Suppl. XVI, 3), 445–448.

STĘPIEŃ E. (2004) Poczucie powodzenia życiowego od dorastania do wczesnej dorosłości: wzory zmian a zasoby społeczne i osobiste w dorastaniu [Sense of success from adolescence to early adulthood: patterns of changes and social and personal resources in adolescences]. in: Rozwój - Zdrowie - Choroba. Aktualne problemy psychosomatyki, KOSIŃSKA-DEC K., SZEWCZYK L. (eds.). Bel Studio, Warszawa, 105-116.

STĘPIEŃ E. (2006) Adolescents' health-related behaviors and their well-being between adolescence and adulthood, Psychol Health, Abstracts Book 20th Annual Conference of the European Health Psychology Society 30 Aug–2 Sept 2006, "Social change and new challenges for health psychology", Volume 21 (Suppl. 1), 144–145.

STĘPIEŃ E. (2006) Styl życia i zasoby osobiste młodzieży a zmiany jej samopoczucia w okresie dorastania – wczesna dorosłość [Style of life and personal resources of youth and changes of well-being in adolescence - early adulthood], in: BRYC S. (ed.) Promocja zdrowia w chorobie i niepełnosprawności, Annales Universitatis Mariae Curie-Skłodowska. Sectio D Medicina, Vol. LX (Suppl. XVI, 7), Lublin, 240–244.

STĘPIEŃ E. (2007) Osobowościowe źródła obniżonego samopoczucia u progu dorosłości [Personal sources of lowering well-being on the verge of adulthood]. in: LIBISZOWSKA-ŻÓŁTKOWSKA MARIA (ed.) Czego obawiają się ludzie? Wydawnictwa Uniwersytetu Warszawskiego, 144-158.

STĘPIEŃ E., MROZIAK B. (2007) Zdrowie psychiczne dorastających - związki z zachowaniami zdrowotnymi i zmiany w czasie [Mental health of adolescents - relations between health related behaviours and changes in time]. in: ŚLADKOWSKI (ed.) Promocja zdrowia w różnych okresach życia. Annales Universitatis Mariae Curie-Skłodowska, Vol. LXII, Suppl. XVIII, 8, 20-23.

Other outcomes: translation into Polish by B.Mroziak and disseminate the book:

JANE-LOPIS E., ANDERSON P. (2005) Promocja zdrowia psychicznego i zapobieganie zaburzeniom psychicznym. Polityka dla Europy [Mental Health Promotion and mental disorders prevention. A policy for Europe]. Nijmegen.

Council for Mental Health Promotion, chaired by M. Jarema, resumed its activities in October 2006

mental health promotion and prevention programmes were catalogued. anti-stress prevention programme aiming at decreasing experience of stress and enhancing

skills of coping with stress for adolescents awareness and better understanding of mental health problems among the public raised.

Difficulties:

The most important factors hampering promotion of mental health and prevention of mental disorders are the following: lack of post-graduate education in the field of mental health promotion and prevention of

mental disorders; unsatisfactory funding research on mental health promotion (most research projects are

sponsored by international organization); lack of evaluation of mental health promotion strategies on the national level.

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Activity 5

Name of the activity:Assisting in implementation of the National Programme for Prevention and Treatment of Cardio-Vascular System Diseases [for the years 2003-2005 and 2006-2008]

Person responsible: Prof. Anna Członkowska, M.D.

Description of the activity: monitoring implementation of the neurological part of the above Programme entitled: the National Programme for Prevention and Treatment of Stroke, monitoring consequences of stroke, improving equipment standards of stroke centres, introducing new technologies in advanced treatment of stroke.

Implementation of the activity:

The main aim of the Programme is to maintain the rate of reducing cardiovascular mortality in Poland at least at the level of the years 1990–2004. In the years 2003-2012 cardiovascular mortality in persons aged below 65 should be reduced by over 30% (3% yearly). In the area of neurology, early stroke-related mortality rates should be brought below 20%. Also at least 70% of stroke victims, who survived the acute phase, should regain the ability to perform basic everyday life tasks on their own. These objectives are planned to achieve through introducing advanced neurological treatment and rehabilitation methods.The other objectives of the neurological part of the Programme are to monitor stroke care quality, create stroke units, educate physicians and patients, promote thrombolytic treatment and carotid angioplasty with stenting.

In the frame of the Programme two research projects were carried out.The first project was on evaluation of prevalence of stroke in the Polish population. The methodology of gathering data was prepared in order to set up a National Stroke Register. The data from 9 voivodiship (regions), which cover 60% of the Polish population was analysed. The haemorrhagic stroke was diagnosed at 10% of patients, ischaemic stroke at 78% of patients, and stroke of undefined etiology at 12%. Annual mean rate of hospitalization was 240 per 100 000 of the population.

The second project was on evaluation of frequency of occurrence of the late complication after stroke. The control examinations were conducted after 3 months since stroke occurred. Thirty percent of patients had symptoms of transient cerebral ischaemia, 26% - vision/speech disturbances, 40% - memory disturbances, 37% - depression, 45% persistent pain. The majority of patients were treated in accordance with secondary prevention standards of ischaemic stroke. Organizing the system of monitoring patients after stroke was recommended, especially the network of outpatient services for patients with cerebral vascular diseases. The network of stroke units, qualification, intervention, efficacy of rehabilitation, and use of different methods of diagnosis and therapy in Poland were monitored.

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In 1997 there were only 3 stroke units in Poland, in 2005 - 98 units (required 120), including 58 fulfilling all criteria of treatment and rehabilitation and providing thrombolysis. Not only a number of stroke units increased, but also they were made accessible in every region. Nevertheless, accessibility to stroke units and thrombolysis vary from region to region. Still too small number of stroke patients received thrombolysis. Only 14% of all neurological department and 10% of rehabilitation departments offered comprehensive early stroke rehabilitation. 15.8% of stroke patients in Poland were admitted to high quality rehabilitation centres. Improvement of rehabilitation accessibility was recommended.

Outcomes:

Publications:

CZŁONKOWSKA A. (2005) Udar mózgu - perspektywy leczenia w Polsce w świetle osiągnięć światowych. [Stroke - the outlook for treatment in Poland in the light of world’s achievements] Polski Przegląd Neurologiczny, 1, 1-7

CZŁONKOWSKA A., KOBAYASHI A., SKOWROŃSKA M., NIEWADA M., SARZYŃSKA-DŁUGOSZ I. (2006) Thrombolysis for stroke in Poland: first 2 years of experience, In J Stroke, 111–112.

CZŁONKOWSKA A., SARZYŃSKA-DŁUGOSZ I., KWOLEK A., KRAWCZYK M. (2006) Ocena potrzeb w dziedzinie wczesnej rehabilitacji poudarowej w Polsce [The evaluation of needs in early post stroke rehabilitation in Poland], Neurologia i Neurochirurgia Polska, 40, 471–477.

CZŁONKOWSKA A., SARZYŃSKA-DŁUGOSZ I., NIEWADA M., KOBAYASHI A., RYGLEWICZ D. (2004) Ocena zabezpieczenia chorych z udarem mózgu w zakresie dostępności pododdziałów udarowych w Polsce [Evaluation of the accessibility of stroke units in Poland]. Neurol. Neurochir. Pol., 38, 5, 353-360.

CZŁONKOWSKA A., SARZYŃSKA-DŁUGOSZ I., NIEWADA M., KOBAYASHI M. (2006) Eligibility of stroke units in Poland for administration of intravenous thrombolysis, Eur J Neurol, 13, 220–224.

CZŁONKOWSKA A., SKOWROŃSKA M., NIEWADA M. (2007) Stroke service in Central and Eastern Europe. International J Stroke, 2, 276-278.

KOBAYASHI A, SKOWROŃSKA M., LITWIN T., CZŁONKOWSKA A. (2007) Lack of experience of intravenous thrombolysis for acute ischaemic stroke does not influence the proportion of patients treated. Emerg Med. J. 24, 96-99.

KOBAYASHI A., BEMBENEK J., DOWŻENKO A., SKOWROŃSKA M., SARZYŃSKA-DŁUGOSZ I., CZŁONKOWSKA A. (2006) Angioplastyka i stentowanie tętnic szyjnych w profilaktyce udaru niedokrwiennego mózgu: wczesne wyniki rejestru Narodowego Programu Profilaktyki i Leczenia Chorób Układu Sercowo-Naczyniowego POLKARD [Angioplastic procedures and carotid artery stenting in ischaemic stroke prevention: initial results from the National Programme of Prevention and Treatment of Cardiovascular Diseases POLKARD], Postępy w Kardiologii Interwencyjnej, 2, 4 (6), 259–265.

KOBAYASHI A., BEMBENEK J., DOWŻENKO A., SKOWROŃSKA M., SARZYŃSKA-DŁUGOSZ I., CZŁONKOWSKA A., POLKARD Collaborators Warsaw. (2007) Carotid artery stenting in ischaemic stroke prevention: initial results from the National Programme of Prevention and Treatment of Cardiovascular Diseases POLKARD. Cerebrovasc. Dis. 23, Suppl 2,52.

KOBAYASHI A., BIAŁEK P., DOWŻENKO A., CZŁONKOWSKA A. (2007) Angioplasyka i stentowanie tętnic szyjnych w profilaktyce udaru niedokrwiennego mózgu [Angioplastic procedures and artery stenting in ischaemic stroke prevention]. Terapia (2) 189, 19-24.

KOBAYASHI A., CZŁONKOWSKA A. (2005) Leczenie trombolityczne w udarze niedokrwiennym mózgu [Thrombolysis in ischaemic stroke]. Farmakoterapia w Psychiatrii i Neurologii, 21, 5-18.

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KOBAYASHI A., CZŁONKOWSKA A., SKOWROŃSKA M. (2005) Organizacja pracy w oddziale udarowym na przykładzie II Kliniki Neurologi IPiN [Organization of a stroke unit: experience from the 2nd Department of Neurology of IPN). Neurologia i Neurochirurgia Polska, 39, 4, suppl. 2, 385-386.

KOBAYASHI A, SARZYŃSKA-DŁUGOSZ I., NIEWADA M., SKOWROŃSKA M., CZŁONKOWSKA A. (2005) Dostępność pododdziałów udarowych w kontekście wprowadzania leczenia trombolitycznego [Accessibility to stroke units in terms of implementation of thrombolysis ]. Neurologia i Neurochirurgia Polska, 39, 4, Suppl. 2, 384.

KOBAYASHI A., SKOWROŃSKA M., CZŁONKOWSKA A. (2007). Leczenie trombolityczne udaru niedokrwiennego mózgu [Thrombolysis of ischaemic stroke]. Terapia, (2) 189, 5-10.

MAZURKIEWICZ M., NIEWADA M., KOBAYASHI A., CZŁONKOWSKA A. (2005) Regional differences in stroke care delivery in Poland depend on size of the city. Cerebrovascular Diseases, 19, Suppl. 2, 137.

NIEWADA M., SKOWROŃSKA M., RYGLEWICZ D., KAMIŃSKI B., CZŁONKOWSKA A. (2006) Acute ischemic stroke care and outcome in centers participating in The Polish National Stroke Prevention and Treatment Registry, Stroke, 37, 1837–1843.

SARZYŃSKA-DŁUGOSZ I., CZŁONKOWSKA A., KRAWCZYK M. (2005) Accessibility of complex post-stroke rehabilitation in neurological department in Poland. European Journal of. Neurology, 12, Suppl.2, 152.

SARZYŃSKA-DŁUGOSZ I., KOBAYASHI A., NIEWADA M., SKOWROŃSKA M., RYGLEWICZ D., CZŁONKOWSKA A. (2005) Klasy pododdziałów udarowych w Polsce [Categories of stroke units in Poland]. Neurologia i Neurochirurgia Polska, 39, 4, Suppl. 2, 383-384.

SARZYŃSKA-DŁUGOSZ I., SKOWROŃSKA M., CZŁONKOWSKA A. (2007), Development of the stroke unit network in Poland – current status and future requirements. Neurol. Neurochir. Pol. 41, 107-112

SKOWROŃSKA M., CZŁONKOWSKA A., KOBAYASHI A., NIEWADA M. (2005). Regional gaps in stroke care delivery in Poland. Journal of Neurology, 252, Suppl. 2, 118.

SKOWROŃSKA M., KOBAYASHI A., CZŁONKOWSKA A. (2005) Czas od przyjęcia do leczenia w polskich ośrodkach biorących udział w badaniu Safe Implementation of Thrombolysis in Stroke (SITS) [Door to needle time in Polish centres participating in SITS]. Neurologia i Neurochirurgia Polska, 39, 4, Suppl. 2, 384-385.

Other outcomes: a stroke centres’ network was organised, the quality of rehabilitation was improved, thrombolytic treatment was introduced in many stroke centres, the hospital stroke register was set up.

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Activity 6

Name of the activity: Monitoring implementation of three targets of the National Health Programme

Persons responsible: Jacek Moskalewicz, Ph.D Janusz Sierosławski, M.A. Irena Jelonkiewicz, Ph.D.

Description of the activity: Monitoring implementation of the following targets of the National Health Programme (NHP) for the years 1996-2005:

target 4: reducing alcohol consumption and changing its structure as well as limiting harms associated with alcohol,

target 5: diminishing use of psychoactive substances and limiting harms associated with their use,

target 7: promotion of mental health and prevention of mental disorders.

Implementation of the activity:The Institute monitored achievement of basic indicators of three targets of NHP and produced annual reports including recommendations targeting national policy with regard to alcohol, drugs and mental health. All reports were sent to the Ministry of Health.

Summary of monitoring alcohol target

Prevalence of drinking and drunkenness among school children has recently tended to level-off after reaching relatively high level at the beginning of the 2000s. In contrast, average alcohol consumption in adult population has reached its after-war peak. Out-patient and in-patient admissions to alcohol treatment have doubled in less than 15 years. Despite serious treatment efforts mortality due to alcohol-related causes has been on the rise including liver diseases, mental disorders associated with drinking. Substantial reduction of excise tax on alcohol in 2002 reinforced these negative trends.

It was recommended to reinvigorate alcohol control policies at the national and local levels, including pricing policy and physical availability of alcohol.

Summary of monitoring drug target

Similarly to alcohol use, after more than a decade of continuous growth, recent school surveys suggest leveling off of drug use among teen-age population that may indicate declining demand. On the other hand, accessibility of drugs and their affordability are on the rise. Harm reduction seem to work as mortality due to drug overdose and HIV infections among injecting drug consumers have tended to stabilize at a relatively low level for the last 15 years.

Recommendations include intensification of demand reduction efforts, particularly at the local community level, their better inter-sectoral co-ordination, development of substitution treatment.

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Summary of monitoring mental health targetDespite continuous growth of a number of persons with mental health problems, which were treated in inpatient and outpatient care facilities, the financial resources for prevention of mental disorders and mental health promotion were low. In the years 2004-2007, the financial sources allocated to mental health were only 3.3%-3.5% of the overall health budget. Resources for developing new community psychiatry centres were inadequate. Mental health promotion activities were not coordinated and evaluated.

It was recommended to develop tools for monitoring programmes of mental health promotion and prevention of mental disorders as well as a system of evaluation of new methods in mental heath care.

The staff of IPN were involved in preparing the strategic objective and targets of NHP for the years 2007-2015:

strategic objective no 4. Prevention of mental disorders through preventive and promotive activities;

target no 2. Reducing alcohol consumption and changing its structure as well as limiting health harms associated with alcohol;

target no 5. Diminishing use of psychoactive substances and limiting health harms associated with them.

Outcomes:

Publications:

JELONKIEWICZ I. (2004) Promocja zdrowia psychicznego i zapobieganie występowaniu zaburzeń psychicznych. in: Monitoring oczekiwanych efektów realizacji Narodowego Programu Zdrowia, GORYŃSKI P., WOJTYNIAK B., KUSZEWSKI K. (eds.). PZH, Warszawa, 85-93.

MOSKALEWICZ J., ŻULEWSKA-SAK J. (2004) Zmniejszenie i zmiana struktury spożycia alkoholu oraz zmniejszenie szkód zdrowotnych spowodowanych alkoholem. in: ibidem, 59-66

SIEROSŁAWSKI J. (2004) Ograniczenie używania substancji i związanych z tym szkód zdrowotnych. in: ibidem, 67-76.

JELONKIEWICZ I. (2005) Cel operacyjny nr 7. Promocja zdrowia psychicznego i zapobieganie występowaniu zaburzeń psychicznych. in: Monitoring oczekiwanych efektów realizacji Narodowego Programu Zdrowia 1996-2005, GORYŃSKI P., WOJTYNIAK B., KUSZEWSKI K. (eds). MZ, PZH, Warszawa, 116-135.

MOSKALEWICZ J. (2005) Cel operacyjny nr 4. Zmniejszenie i zmiana struktury spożycia alkoholu oraz zmniejszenie szkód zdrowotnych spowodowanych alkoholem. in: ibidem, 77-89.

SIEROSŁAWSKI J. (2005) Cel operacyjny nr 5. Ograniczenie używania substancji i związanych z tym szkód zdrowotnych. in: ibidem, 90-104.

Other outcomes: a broad base for alcohol and drug policy formulation and implementation available, a system of monitoring alcohol and drug consumption and associated harm established, countermeasures to overcome the observed deficiencies in mental health promotion and prevention of mental disorders recommended.

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Activity 7

Name of the activity: Assisting in formulating and implementing programmes, strategies and policies undertaken by the governmental agencies on alcohol and drugs

Description of the activity: assisting in formulating preventive, promoting and educational programmes, strategies and policies undertaken by the State Agency for Prevention Alcohol and the National Bureau for Drug Prevention

Implementation of the activity:Staff of the IPiN participated in developing the National Programme for Prevention of Alcohol Related Problems for the years 2006-2010 and the National Programme for Counteracting Drug Addiction for the years 2006-2010. Its employees (e.g. J. Sierosławski, J. Moskalewicz, K.Okulicz, K.Ostaszewski, G. Światkiewicz) served as experts to parliamentary and governmental committees, gave opinions on draft legislations, provided information on implementation of alcohol and drug policies in close collaboration with the National Bureau for Drug Prevention and the State Agency for Prevention of Alcohol Related Problems. The Institute’s experts contributed to a training programme for local drug policy makers, covering 800 local out of 3000 communities, including drafting and testing a manual for local communities. The Institute carried out at least dozen or so studies commissioned by national or local authorities including the European School Project on Alcohol and Drugs -ESPAD (2003, 2007), evaluation of drug treatment system, drug problems in prison project and 15 regional and municipal studies on prevalence of alcohol and drug use as well as on treatment demand.

Outcomes:

Publications:

ANDERSON B., HIBBEL B., BECK F., CHOQUET, KOKKEWI A., FOTIOU A., MOLINARO S., NOCIAR A., SIEROSŁAWSKI J., TRAPENCIERIS M. (2007) Alcohol and Drug Use Among European 17-18 Years Old Students. Data from the ESPAD Project. Stockholm, The Swedish Council for Information on Alcohol and Other Drugs (CAN), Pompidou Group at the Council of Europe, Stockholm.

BUKOWSKA B., SIEROSŁAWSKI J. (2006) Gminne programy przeciwdziałania narkomanii [Communal drug prevention programmes], Serwis Informacyjny Narkomania, 33 (2), 4–6.

HEJDA A., OKULICZ-KOZARYN K. (eds.) Zapobieganie Narkomanii w Gminie. Zasady tworzenia gminnych programów przeciwdziałania narkomanii [Counteracting drug addiction in a commune. Guidelines for developing communal drug prevention programmes]. Krajowe Biuro ds. Przeciwdziałania Narkomanii, Warszawa 2007.

incl. articles of the IPN staff:

ECSTEIN G. K., SIEROSŁAWSKI J. (2007) Współpraca międzyinstytucjonalna w przeciwdziałaniu narkomanii na poziomie lokalnym (Collaboration between institutions in counteracting drug addiction in the local level], 195-199.

JABŁOŃSKI P., MOSKALEWICZ J. (2007) Narkomania a proces poszerzania Unii Europejskiej [Drug addiction and enlargement of the European Union], 9.

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MOSKALEWICZ J. (2007) Strategie (ograniczanie popytu, redukcja podaży, minimalizacja szkód) [Strategies (on demand, supply and harm reduction), 51.

OKULICZ-KOZARYN K., PISARSKA A. (2007) Profilaktyka i wczesna interwencja [Prevention and early intervention], 69-79.

SIEROSŁAWSKI J. (2007) Epidemiologia narkomanii [Epidemiology of drug addiction], 30-42.

SIEROSŁAWSKI J. (2007) Metody oceny epidemiologicznej [Methods of epidemiological assessment], 97-109.

ŚWIĄTKIEWICZ G. (2007) Problem narkotyków i narkomanii a inne problemy w percepcji społecznej [Drug and drug addiction problems and other problems in the social perspective], 43- 45.

ŚWIĄTKIEWICZ G. (2007) Reakcje społeczne (postawy, reakcje nieformalne, dylematy etyczne) [Social responses (attitudes, informal reactions, ethical dilemma)], 46-48.

ŚWIĄTKIEWICZ G. (2007) Zasady konstruowania programu [Guidelines for developing a programme], 113-114.

HIBELL B., ANDERSSON B., BJARNASON T., AHLSTRÖM S., BALAKIREVA O., KOKKEVI A., MORGAN M. with contribution from ALLASTE A., ANDERSEN T., BOHRN K., CHILEVA A., CHOQUET M., CSÈMY L., DAVIDAVICIÈNE A. G., ELEKES Z., FEIJÃO F., FLORESCU S., GMEL G., KOROLEVA I., KOSHKINA E., KRAUS L., KUZMAN M., LAMBRECHT P., MALLIA V., MARIANI F., MONSHOUWER K., MUSCAT R., NIAZ K., NOCIAR A., PLANT M., SABROE S., SIEROSŁAWSKI J., SKRETTING A., STERGAR E., STERIU A., UHL A., WEIHE P., VERESIES K. (2004) The ESPAD REPORT 2003. Alcohol and Other Drug Use Among Students in 35 European Countries. (2004) The Swedish Council for Information on Alcohol and Other Drugs (CAN), The Pompidou Group at the Council of Europe. Stockholm.

KLINGEMANN H., KLINGEMANN J. (2007) Hostile and favorable societal climates for self-change: some lessons for policy makers. in: H., SOBELL L. (ed.) Promoting Self-Change From Addictive Behaviors: Practical Implications for Policy, Prevention, and Treatment. Springer, New York, 187-212.

MOSKALEWICZ J., SIEROSŁAWSKI J., DĄBROWSKA K. (2006) Ocena systemu leczenia i rehabilitacji osób uzależnionych od substancji psychoaktywnych w Polsce [Assessment of a system of treatment and rehabilitation of drug dependence in Poland], Alkoholizm i Narkomania, 19 (4), 327–355.

SIEROSŁAWSKI J. (2005) Badania szkolne na temat używania substancji psychoaktywnych przez młodzież (ESPAD). Polska młodzież na tle Europy. in: Ewolucja wzorów używania alkoholu przez młodzież w Polsce w XX wieku. ZIELIŃSKI A. (ed.) Wydawnictwo Edukacyjne PARPA, Warszawa, 75-88.

SIEROSŁAWSKI J. (2005) Badania szkolne na temat używania substancji psychoaktywnych przez młodzież (ESPAD). Polska młodzież na tle Europy w 2003 r. Serwis Informacyjny Narkomania, 2 (29), 24-38.

SIEROSŁAWSKI J. (2005) Badania szkolne na temat używania substancji psychoaktywnych przez młodzież (ESPAD). Polska młodzież w latach 1995-1999-2003 na tle Europy. Serwis Informacyjny Narkomania, 3 (30), 31-38.

SIEROSŁAWSKI J. (2006) Jak budować gminne programy przeciwdziałania narkomanii (1-3) [How to develop communal drug prevention programmes], Gazeta Samorządu i Administracji, 218 (18), 4–17.09.2006, 28–30, 219 (19), 18.09–1.10.2006, 24–26, 220 (20), 2–15.10.2006, 32–34.

SIEROSŁAWSKI J., OKULICZ-KOZARYN K. (2005) Wstępna ocena Krajowego Programu Przeciwdziałania Narkomanii na lata 2002-2005 [Preliminary assessment of the National Programme of Counteracting Drug Addiction for the years 2002-2005]. Serwis Informacyjny Narkomania, 1 (28), 31-36.

ŚWIĄTKIEWICZ G. (2005) Program EDDRA – Ewidencjonowanie i ocena polskich programów ograniczających popyt na narkotyki [EDDRA programme - Recording and evaluation of the Polish programmes on drug demand reduction]. Biuletyn Informacyjny Problemy Narkomanii, 3, 43-50.

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Tworzenie gminnych programów przeciwdziałania narkomanii [Developing communal programmes on counteracting drug addiction], Fundacja Rozwoju Demokracji Lokalnej – Krajowe Biuro ds. Przeciwdziałania Narkomanii, Warszawa 2006.

incl. articles of the IPN staff:

HABRAT B. Leczenie i rehabilitacja [Treatment and rehabilitation], 70–73.

HABRAT B. (2006) Podstawowe pojęcia używane w odniesieniu do nielegalnych substancji psychoaktywnych i problemów związanych z ich używaniem [Basic terms regarding illegal psychoactive substances and problems related to their using], 11–14.

HABRAT B. (2006) Typy substancji psychoaktywnych i ich działanie farmakologiczne [Types of psychoactive substances and their pharmacological impact] , 15–19.

HABRAT B., MOSKALEWICZ J. (2006) Redukcja szkód [Harm reduction], 75–76.

Other outcomes: high standard preventive programmes on alcohol and drugs

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TERMS OF REFERENCE AREA: carrying out research projects on mental health, substance abuse and neurology, with special emphasis on development of evidence-based policies and programmes in the field of mental health promotion and prevention of mental disorders (Activities 8-15)

Activity 8

Name of the activity: Studying prevalence of mental disorders and resources of mental and neurological health care in Poland

Description of the activity: collecting and analysing detailed data concerning personal, material and organisational resources of the psychiatric and neurological care system in Poland. The following data sources are utilised: national reporting programme on psychiatric and neurological inpatient facilities, aggregated reports from outpatient facilities, inventories of organisational data.

Principal investigator: L. Boguszewska, MA

Implementation of the activity: Each year the data concerning personal, material and organisational resources of the psychiatric and neurological care system in Poland were collected and analysed. In 2006 inpatient care consisted of 54 psychiatric hospitals, 111 general hospitals with psychiatric and alcohol and drugs departments, 18 alcohol and drug centres, 31 rehabilitation centres and 38 institutions with care-treatment departments and care-nursing departments. The number of treated persons in this type of care had increased each year and in the last 5 years the rate per 100 000 of population rose by 7%. The outpatient care consisted of 1004 mental health clinics, including 162 for children and adolescents, 393 alcohol clinics as well as 87 drug clinics. Compared to the year 2005, in 2006 the number of day centres fall down, and the rate of treated persons reduced by 6%. Among intermediate forms of care, the best developed were day treatment units. 29 mobile community teams and 10 hostels were available.

The recent trend in mental health care did not correspond to recommendations of the National Mental Health Programme: the rate of patients in outpatient services and their number decreased while at the same time the rate of patients in inpatients care facilities increased. On the other hand, a number of beds in psychiatric departments of general hospitals has been on the rise at the expense of beds in psychiatric hospitals.

Outcomes:

Publications:

BOGUSZEWSKA L., SŁUPCZYŃSKA-KOSSOBUDZKA E., MILEWSKA D., SOWIŃSKA M., BARTNIK A., GŁAZOWSKI C., GOMUŁKA J., WELBEL M., SKIBA K. (eds.) (2007) Zakłady psychiatrycznej oraz neurologicznej opieki zdrowotnej. Rocznik Statystyczny 2006 [Mental health care and neurological care facilities. Statistical yearbook 2006]. IPiN, Warszawa.

BOGUSZEWSKA L., MOSKALEWICZ J., SŁUPCZYŃSKA-KOSSOBUDZKA E., KAROLAK H., SOWIŃSKA M., BARTNIK A., SZIRKOWIEC W., SKIBA K. (eds.) (2006) Zakłady psychiatrycznej oraz neurologicznej opieki zdrowotnej. Rocznik Statystyczny 2005 [Mental health care and neurological care facilities. Statistical yearbook 2005], IPiN, Warszawa.

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PIETRZYKOWSKA B., BOGUSZEWSKA L., KAROLAK H., SZIRKOWIEC W., SKIBA K. (eds.) (2005) Zakłady psychiatrycznej oraz neurologicznej opieki zdrowotnej. Rocznik Statystyczny 2004 [Mental health care and neurological care facilities. Statistical yearbook 2004]. IPiN, Warszawa.

PIETRZYKOWSKA B., BOGUSZEWSKA L., KAROLAK H., SZIRKOWIEC W., SKIBA K. (eds.) (2004) Zakłady psychiatrycznej oraz neurologicznej opieki zdrowotnej. Rocznik Statystyczny 2003 [Mental health care and neurological care facilities. Statistical yearbook 2003]. IPiN, Warszawa

SŁUPCZYŃSKA-KOSSOBUDZKA E., BOGUSZEWSKA L. (eds.) (2006) Mental health statistics. Poland, 1990-2005. IPiN, Warsaw

Other outcomes: information on mental health and neurological care facilities offered a base for policies health monitoring and recommendations for the National Mental Health Programme, national and local programmes on prevention of alcohol and drug related problems.

data on mental health and neurological care widespread.The statistical yearbooks were sent to libraries, psychiatric departments of medical universities, disseminated among professionals. The yearbook in English was also sent to all WHO collaborating centres for mental health and substance abuse world-wide.

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Activity 9

Name of the activity: Research on stigma and discrimination against people receiving psychiatric help and using psychiatric facilities

Description of the activity: gathering information and experiences of patients, who suffer discrimination, because of their mental health problems, finding connection between stigma and sort of mental disorders, forms of psychiatric care and the background of patients.

Principal investigator: Piotr Świtaj, MD

Implementation of the activity:Four hundred twenty patients with different diagnosis of mental disorders, treated in inpatient and outpatients facilities, were under study. The number of patients with schizophrenia was predominant. Majority of them (especially drug dependence patients ) experienced discrimination and social stigma. Discrimination in interpersonal relations constituted the most frequent form of discrimination. Discrimination in employment, education, or legislation was very rare. Stigmatization of persons with mental disorders seems to be an important social and clinical problem, which cause the social exclusion and impede the process of recovering.

Outcomes:

Publications:

ŚWITAJ P. (2005) Piętno choroby psychicznej. [Stigmatization of mental illness], Postępy Psychiatrii i Neurologii, 14 (2), 137-144.

ŚWITAJ P. (2008) Doświadczenie piętna społecznego i dyskryminacji u pacjentów z rozpoznaniem schizofrenii [Experience of social stigma and discrimination among patients with schizophrenia]. Monografie Psychiatryczne no 7. IPiN, Warszawa.

ŚWITAJ P., BEMBENEK A.M. (2004) Negatywne konsekwencje stereotypów i uprzedzeń w diagnostyce i leczeniu zaburzeń psychicznych - opis przypadku [Negative consequences of stereotypes and prejudice in the diagnostics and treatment of mental disorders – case report]. Post Psychiatr. Neurol., 13, 177-184.

ŚWITAJ P., WCIÓRKA J., SMOLARSKA-ŚWITAJ J. (2007) Subjective experience of sigma among patients with schizophrenia in comparison to patients with other medical conditions. XIXth World Congress of World Association for Social Psychiatry, Czech Republic, October 21-24, 2007. Book of Abstracts p. 156.

WCIÓRKA B, WCIÓRKA J. (2005) Sondaż opinii publicznej – czy Polacy niepokoją się o swoje zdrowie psychiczne? [An opinion poll – are Poles anxious about their mental health?] Postępy Psychiatrii i Neurologii, 14 (4): 305-317.

WCIÓRKA B., WCIÓRKA J. (2006) Sondaż opinii publicznej: społeczny obraz chorób psychicznych i osób chorych psychicznie w roku 2005 [Public opinion poll: social perception of mental illness and the mentally ill in the year 2005], Postępy Psychiatrii i Neurologii, 15 (4), 256–267.

WCIÓRKA J. (2007) Proces zdrowienia a radzenie sobie z poczuciem napiętnowania i samo-napiętnowania. [Process of recovering and coping with stigmatization and self stigmatization] Psychiatria Pol. 41; 3 (Suppl.), 178.

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Other outcomes: better understanding of therapeutic difficulties, rising awareness and knowledge of the factors, which caused discrimination of patients with mental disorders, reduced level of discrimination of patients using mental health care facilities.

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Activity 10

Name of the activity: Research on cost effectiveness of community psychiatric care

Description of the activity: finding out evidence of the effectiveness of community care, eg. the Mobile Teams operating in two districts in Warsaw. The family burden and the mental state of patients were assessed: at the patient’s entry to the programme and reassessed after one and two years.

Principle investigator: Katarzyna Prot-Klinger, MD

Implementation of the activity:In the frame of the activity two studies were carried out. In the first one the efficacy of new community model of treatment of patients with schizophrenia in Warsaw was estimated. Forty seven patients were assessed at the beginning of treatment in the community care and after one year of care. Improvement in mental state, contacts with family and life satisfaction were observed and destructive behaviours were reduced. Improvement was also noticed in undertaking social roles.

In the second study evaluation of the efficiency of a new community model of treatment for psychotic patients at the Centre of Mental Health in Warsaw was carried out. Social functioning and quality of life and psychopathological symptoms, family burden and treatment cost were assessed at the beginning of treatment in the Centre and after one year of care. The study showed that patients treated in the community model improved in some areas of quality of life. No difference in family burden was found but community care significantly reduced the destructive behaviors. There was also no improvement in social functioning, however, worsening in any other aspects of the patients’ state did not occur.

Both studies brought evidence that the community model of treatment seems to be cost effective mainly as a result of reduction of hospitalizations.

Outcomes:

Publications:

PROT – KLINGER K., PAWŁOWSKA M. (2007) The New Community Model of Treatment for Psychotic Patients in Poland – The Cost Effectiveness Study. The Journal of Mental Health Policy and Economics, 10 (Suppl. 1). s. 33.

PROT – KLINGER K., PAWŁOWSKA M. (2008) Costs savings as a result of major decrease in hospitalisations in a new form of community treatment of schizophrenia in Poland. The Journal of Mental Health Policy and Economics, [in print]

PROT K, PAŁYSKA M, ANCZEWSKA M, INDULSKA A, RADUJ J (2005). Badanie satysfakcji pacjenta w warunkach opieki środowiskowej [Patient satisfaction with community-based psychiatric care]. Postępy Psychiatrii i Neurologii, 14 (4), 299-304.

ZAŁUSKA M., PASZKO J., SUCHECKA D., TRACZEWSKA Z. (2005) The influence of the new social help facilities on the reduction of hospitalisations of chronically mentally ill patients . Archives of Psychiatry and Psychotherapy, 7, 3, 25-35.

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ZAŁUSKA M., SUCHECKA D., TRACZEWSKA Z., PASZKO J. (2005) Implementation of social services for the chronically mentally ill in a Polish mental health district: consequences for service use and costs, The Journal of Mental Health Policy and Economics, 8, (1), 37-44.

Other outcomes: evidence for cost-efficient community care available, work of Mobile Teams improved, provision of a community care model that can be applied in other settings.

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Activity 11

Name of the activity: Research on occupational stress with mental health clients in acute response

Description of the activity: comparing levels of occupational stress and burnout of mental health professionals in hospitals and community settings linked to the occurrence of the incidents of violence elicited by severely mentally ill clients in Poland.

Principal investigator of the Polish part of the project: Marta Anczewska M.D., Ph.D.

Implementation of the activity:The second stage of the project aimed to compare the demographic and situational variations in levels of occupational burnout among community and inpatient staff of mental health services, in six European towns: Aarhus and Storstrom in Denmark, Cambridge in the UK, Bodo in Norway, Tampere in Finland and Warsaw in Poland. A total of 414 staff members were assessed in the six settings: 205 in inpatient facilities and 209 in the community. In Poland, both community and inpatient teams reported medium levels of burnout, but in the former group it was higher. There were no statistically significant differences regarding emotional exhaustion. Depersonalisation (DP) was higher in inpatient settings than in community locations. Regarding personal accomplishment (PA) the statistically significant differences were observed. PA in Warsaw was high compared to other locations. Staff who had previously experienced training on occupational stress reduction scored significantly lower in emotional exhaustion than those with no prior exposure to relevant training. It was recommended that such training should not be limited to the singular module.

Outcomes:

Publications:

ANCZEWSKA M, ŚWITAJ P, ROSZCZYŃSKA J. (2005) Wypalenie zawodowe [Occupational burnout]. Postępy Psychiatrii i Neurologii, 14 (2), 67-77.

ANCZEWSKA M. (2006) Stres i wypalenie zawodowe u pracowników psychiatrycznej opieki zdrowotnej [Stress and burnout among staff of mental health services]. IPiN, Warszawa.

HILL R. G., RYAN P., HARDY P., ANCZEWSKA M., KUREK A., DAWSON I., LAIJARVI H., NIELSON K., NYBOURG K., ROKKU I., AND TURNER, C. (2006) Situational levels of burnout among staff in six European inpatient and community mental health teams. The Journal of Mental Health Workforce Development, 1(1), 12-21.

RYAN P., ANCZEWSKA M., LAIJARVI H., CZABALA C., HILL R., KUREK A. (2007) Demographic and situational variations in levels of burnout in European mental health services: a comparative study. Diversity in Health and Social Care, 4, 101-12.

RYAN P., HILL R., ANCZEWSKA M., HARDY P., KUREK A., NIELSON K., TURNER C., & THE OSCAR GROUP (2005) Team-based occupational stress reduction: A European overview from the perspective of the OSCAR Project. International Review of Psychiatry, 17(5): 401–408.

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Other outcomes: educational package on effective risk management and reduction of the occupational stress for those working with violent patients:

ANCZEWSKA M., ROSZCZYŃSKA J. (2004) Jak uniknąć objawów wypalenia w pracy z chorymi [How to avoid burnout in working with ill persons], IPiN, Warszawa.

SECHER S., SARIUSZ-SKĄPSKA M., ANCZEWSKA M., CZABAŁA J.C. (2007) Violence in Mental Health Services. in: RYAN P., DAWSON I., HILL R.(eds) Managing Stress and Violence at Work. A training manual and CD-rom for mental health services. Pavilion Publishing Ltd; Brighton; 32-54.

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Activity 12

Name of the activity: Studying suicidal behaviour among patients of alcohol treatment centres - psychosocial and medical risk factors and their prevalence

Description of the activity: defining psychosocial and medical risk factors for suicidal behaviour of alcohol dependent persons and prevalence of attempted suicides among patients in alcohol treatment centres in Poland.

Principal investigator: Włodzimierz Adam Brodniak Ph.D.

Implementation of the activity:In the frame of this activity two sorts of research were conducted. The first one was carried out among patients of alcohol treatment centres, who attempted suicides once or twice. They were compared to patients of alcohol treatment centres, without attempts of suicide and with no dependent persons without suicide behaviours. The first group was characterised by an younger age of initiating regular alcohol drinking, more often hospitalization episodes caused by alcohol problems, the lower skills to cope with stress, lower social support, weak sense of coherence and more intense symptoms of depression.

The aim of the second research was to estimate prevalence of suicide thoughts, plans and attempts among patients of alcohol treatment centres. The research shown that almost 14% of patients had at least one suicide attempt in their lifetime, while almost 6% attempted suicide at least twice, 8.3% reported a suicide attempt in the past three years. Occasional suicide thoughts associated with a feeling of being tired with life were reported by almost 12% of the patients, frequent suicidal thoughts by 13%, while suicidal plans by almost 7% of the respondents. The risk for suicidal behaviours was directly proportional to the intensity of suicidal thoughts and plans. As compared to patients free from suicidal thoughts and plans, the risk for attempting suicide was 7.2 times greater for those with frequent suicidal thoughts and 45 times greater for those planning suicide.

Outcomes:

Publications:

BRODNIAK W.A., MOSKALEWICZ J., MROZIAK B., ZWOLIŃSKI M. (2006) Suicidal behaviours among patients of alcohol treatment centres: prevalence and risk factors, Eleventh International Congress of the European Society for Health and Medical Sociology, 31 August–2 September 2006, Książka streszczeń – “EUROPEAN HEALTH: OLD AND NEW CHALLENGES Tackling health inequalities” Congresbook, Jagiellonian University Medical College, Krakow, Poland, 56.

BRODNIAK W.A., MOSKALEWICZ J., MROZIAK B., ZWOLIŃSKI M. (2007) Czynniki ryzyka zachowań samobójczych i ich rozpowszechnienie wśród pacjentów lecznictwa odwykowego [Risk factors of suicidal behaviours and their prevelance among patients of alcohol treatment centres] . Psychiatria Polska, 3, Suppl., 15.

BRODNIAK W.A., MOSKALEWICZ J., MROZIAK B., ZWOLIŃSKI M. (2006) Wybrane psychospołeczne i medyczne czynniki ryzyka zachowań samobójczych wśród pacjentów lecznictwa odwykowego [Chosen psycho-social and medical risk factors of suicidal behaviours among patients of alcohol treatment centres], in: BIŃCZYCKA-ANHOLCER M. (ed.) Agresja i przemoc a zdrowie psychiczne, VI Międzynarodowa

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Konferencja Naukowa, PTHP Oddział Wielkopolski, 7–8 grudnia 2006, Poznań. Streszczenia prac, 46–47.

BRODNIAK W.A. ZWOLIŃSKI M. (2006) Rozpowszechnienie myśli samobójczych wśród pacjentów lecznictwa odwykowego [Prevalence of suicidal ideation and behaviours among patients of alcohol treatment centres]. Alkoholizm i Narkomania, 19, 1, 25-34.

Other outcomes: empirical evidence for suicide prevention among alcohol dependent persons available, efficacy of diagnostic of suicidal behaviours among alcohol dependent persons increased.

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Activity 13

Name of the activity: Studying the Use of Stroke Register to Assess the Quality of Stroke Management Across Europe

Description of the activity: estimation of the quality and impact of stroke care in Poland, using innovative methods, identification of factors related to the quality of care – socio-demographic, organisational, clinical.

Principal investigators of the Polish part of the project: prof. Danuta Ryglewicz, M.D. and prof. Anna Członkowska M.D.

Implementation of the activity:The aim of the research was to select the optimal epidemiological methods, which allow evaluation of clinical state of patients with stroke. From 1 June 2004 to 31 December 2006 113 patients were included into the study. Cost of treatment was estimated, different models of care and organizational systems were under investigation.

The yearly death rate caused by stroke was estimated and compared with the results of the study carried out in 1991-1992. The preliminary finding showed that mortality of the first ever in life-time stroke in population under research significantly declined, probably due to better management of patients with the acute phase of stroke. Thirty day case fatality rates were decreased from 43% in 1991 to 17.4% in 2005 as well as one year after stroke from 59.7% to 31,7%, respectively. The death-rate also significantly declined from 90.6/100 000 in 1991/1992 to 37.57/100 000 in 2005. Diagnosis and treatment of hypertension and lipid metabolism disorders improved. The percent of patients brought to hospital in the first 3 hours after stroke and treated with thrombolysis was 5%.

Treatment cost of the first hospitalization of patients with acute phase of stroke in different regions of Poland and age groups was assessed. Calculation was base on data collected in the National Stroke Prevention and Treatment Registry. Data on 10141 patients in 26 centres was analyzed. The findings showed the significant differences in treatment cost in regions. The cost of hospitalization of patients above 40 years old decreased slightly with their age. Implementation of standards procedures to optimize cost and effects of treatment was recommended.

Outcomes:

Publications:

CZŁONKOWSKA A. NIEWADA M. (2007) Profilaktyka udaru mózgu [Stroke prevention], in: Udar mózgu. A. SZCZUDLIK, A.CZŁONKOWSKA, H. KWIECIŃSKI, A.SŁOWIK (eds). Wyd.UJ, Kraków, 286-296.

CZŁONKOWSKA A. SARZYŃSKA-DŁUGOSZ I. (2007) Oddział udarowy – organizacja leczenia udaru. Rehabilitacja chorych po udarze mózgu [Stroke unit - management of stroke treatment. Rehabilitation after stroke]. in: Udar mózgu. A. SZCZUDLIK, A.CZŁONKOWSKA, H. KWIECIŃSKI, A.SŁOWIK (eds.) Wyd.UJ, Kraków, 269-275.

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NIEWADA M., SKOWROŃSKA M., SARZYŃSKA-DŁUGOSZ I., CZŁONKOWSKA A. (2005) Koszty leczenia ostrej fazy udaru mózgu – Rejestr Narodowego Programu Profilaktyki i Leczenia Udaru Mózgu w Polsce [Treatment cost of acute stroke]. Neurologia i Neurochirurgia Polska, 39, 4, Suppl. 2, 129-130.

SIENKIEWICZ-JAROSZ H., GŁUSZKIEWICZ M., CHAHWAN M.J., PNIEWSKI J., PASZKIEWICZ D., WOLFE CH., CZLONKOWSKA A., RYGLEWICZ D. (2007) Decline of stroke mortality in Warsaw between 1991/1992 and 2005, comparison of two prospective population based studies. Cerebrovascular Diseases, 23, Suppl 2, 57

SIENKIEWICZ-JAROSZ H., GŁUSZKIEWICZ M., PNIEWSKI J., CHAHWAN M.J., PASZKIEWICZ D., CZŁONKOWSKA A., RYGLEWICZ D. (2007) Stroke risk factors and 1-year mortality of stroke: comparison of data from two population based studies conducted in 1991/1992 and 2005. Europ J Neurol. 14, Suppl. 1, 36.

SIENKIEWICZ-JAROSZ H., GŁUSZKIEWICZ M., PNIEWSKI J., CZŁONKOWSKA A., RYGLEWICZ D. (2006) Decline of 30 day case fatality for stroke between 1991/1992 and 2005, comparison of data from population based studies, J Neurol, 253 (Suppl. 2), 16–17.

WISZNIEWSKA M., KOBAYASHI A., MILEWSKA D., SZYCH Z., CZŁONKOWSKA A. (2005) Differences in distribution of risk factors in men and women with stroke in different age groups. Journal of The Neurological Sciences, 238, Suppl.1, 453.

WISZNIEWSKA M., KOBAYASHI A., MILEWSKA D., CZŁONKOWSKA A., SZYCH Z. (2005) Czy przebieg udaru niedokrwiennego mózgowego oraz jego następstwa są różne u kobiet i mężczyzn w zależności od wieku? [Are there age-base differences in the course of ischaemic stroke between women and men?] Neurologia i Neurochirurgia Polska, 39, 4, Suppl. 2, 216-217.

Other outcomes: guidelines for evaluation of stroke care, secondary prevention and rehabilitation after

stroke, methods to quantify consequences of different models of stroke care developed, comparative study on stroke management across Europe available.

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Activity 14

Name of the activityResearching major determinants of supply and demand for psychoactive substances

Description of the activity research project with focus on supply and demand side of psychoactive substances against a background of European integration. Methodology-wise, contextual constructionism approach is adopted, which implies that both public debate and epidemiology of substance use are analyzed in their mutual inter-play. A wide range of research methods is utilized including time series analyses, meta-analysis of existing studies, policy documents as well as media reports review.

Principal investigator: Jacek Moskalewicz, Ph.D.

Implementation of the activity:

Time series analyses confirmed strong relationship between physical availability of alcohol measured by a number of outlets per 10 000 inhabitants and its affordability on the one hand, and mortality due to liver diseases, particularly among men in their employment ages (20-64), as well as mortality due to mental and behavioural disorders associated with drinking. Strong relationship was also found between alcohol affordability and alcohol-related hospitalisations.

Similar relationship was identified between subjective accessibility to marihuana, proposals to get or purchase the drug and risk of drug taking.

Outcomes:

Publications:

COOKE E., HASTINGS G., WHEELER C., EADIE D., MOSKALEWICZ J., DĄBROWSKA K. (2004) Marketing of Alcohol to Young People: A Comparison of the UK and Poland. European Addiction Research, 10, 1-7.

DĄBROWSKA K., ŻULEWSKA J. (2005) Relacja pomiędzy dostępnością alkoholu a problemami zdrowotnymi i społecznymi - przegląd literatury [The link between alcohol availability and health/social problems - a literature review], Alkoholizm i Narkomania 18(4), 25-39.

KORF D.J., GAMELLA J.F., MOSKALEWICZ J., O’GORMAN A., OLSSON B., UHL A., WOUTERS M.. (2005) Social Drug Research In Europe: Current Themes and Futures Developments. in: KRAUS L., KORF D.J., (ed.) Research on Drugs Policy from an European Perspective. Past Science Publisher, Lengerich, 17-34.

MOSKALEWICZ J. (2004) Europerseringen av den europeiska alkoholpolitiken. Review of Trygve Ugland’s book Policy re-categorization and integration. Europeanization of Nordic alcohol control policies. Nordisk Alkohol-&Narkotokatidskrift, 21, 2, 167-168.

MOSKALEWICZ J. (2004) More Research on the Alcohol Industry’s Attempt to Influence Policy and Science is Needed. Comments on Monro G. An Addiction Agency Collaboration with the Drink Industry: Moo Juice as a case study. Addiction, 99, 1377-1378.

MOSKALEWICZ J. (2007) Reproductive health problems associated with alcohol consumption. in: NIEMIEC T. (ed.). Women’s reproductive health in Poland 2006. United Nations Development Programme (UNDP) and Ministry of Health, Warsaw, 70-72.

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MOSKALEWICZ J., ŚWIĄTKIEWICZ G., DĄBROWSKA K. (2004) Ecstasy use in Warsaw. Do cultural norms prevent harm? in: European Studies on Drugs and Drug Policy. Criminologische Studies. DECORTE, T., KORF, D. (eds.). VUBPress, Brussels,179-194.

MOSKALEWICZ J., BARRET D., BUJALSKI M., DĄBROWSKA K., KLINGEMANN H., KLINGEMANN J., MALCZEWSKI A., STRUZIK M. (2007) Harm reduction coming of age. International Journal of Drug Policy, 18 (6), 503-508.

MOSKALEWICZ J., SIEROSŁAWSKI J. (2005) Dostępność ekonomiczna napojów spirytusowych a szkody zdrowotne [Economic accessibility of alcohol and its harmful health consequences]. Alkoholizm i Narkomania, 18(4), 41-50.

MOSKALEWICZ J., SIEROSŁAWSKI J., DĄBROWSKA K. (2005) Dostępność fizyczna alkoholu a szkody zdrowotne [Physical availability of alcohol and harmful health consequences]. Alkoholizm i Narkomania, 18(4), 51-64.

MOSKALEWICZ J., ŚWIĄTKIEWICZ G., (2005): Nadużywanie substancji psychoaktywnych na tle innych problemów społecznych w Polsce [Psychoactive substance abuse in the context of other social problems in Poland]. in: PIĄTKOWSKI W., BRODNIAK W.A. (ed.) Zdrowie i choroba. Perspektywa socjologiczna. Wyższa Szkoła Społeczno-Gospodarcza, Tyczyn, 203-218.

Postawy i zachowania Polaków wobec alkoholu i problemów alkoholowych [Attitudes and behaviours of Poles to alcohol and alcohol problems] (2004). Państwowa Agencja Rozwiązywania Problemów Alkoholowych, Warszawa.

incl. articles by IPN staff:MOSKALEWICZ J. (2004) Pomiar i uwarunkowania spożycia napojów alkoholowych w Polsce [Measurement and determinants of alcohol consumption]. 78-89.

SIEROSŁAWSKI J., DĄBROWSKA K. (2004) W kierunku liberalnego podejścia do polityki kontroli podaży alkoholu. Wyniki badań ankietowych [Liberal attitude towards policy on alcohol supply control]. 117-123.

ŚWIĄTKIEWICZ G. (2004) Zmienna opinia publiczna na temat rangi alkoholizmu na tle innych problemów społecznych [Changes in public opinion on importance of alcohol abuse in the context of other social problems]. 95-106.

SIEROSŁAWSKI J. (2005) Dostępność przetworów z konopii a ich używanie [Cannabis availability and use]. Alkoholizm i Narkomania, 18(4), 65-72.

SIEROSŁAWSKI J. (2005) Problem narkotyków i narkomanii w Polsce i w Niemczech [Drug and drug abuse problems in Poland and Germany]. Remedium, Special issue, Listopad, 4-7.

ŚWIĄTKIEWICZ G. (2004) Krajowe programy przeciwdziałania problemom związanym z narkotykami w wybranych krajach europejskich [National Programmes on Counteracting Drug Problems in European countries]. in: Programy Narkotyków i Narkomanii w Ustawodawstwie Polskim. Krajewski, K. (ed.). United Nations Development Programme, Warszawa, 44-69.

ŚWIĄTKIEWICZ G. (2005) Problem nadużywania legalnych, psychoaktywnych farmaceutyków na tle społeczno - ekonomicznej transformacji w Polsce [The problem of psychoactive pharmaceutical abuse in the context of socio-economical transformation in Poland]. Alkoholizm i Narkomania, 18(4), 73-92.

WOJTYNIAK B., MOSKALEWICZ J., STOKWISZEWSKI J., RABCZENKO D. (2005) Gender-specific Mortality Associated with Alcohol Consumption in Poland in Transition. Addiction, 100,. 1779-1789.

ZIELIŃSKI A, SIEROSŁAWSKI J. (2005) Wahania popytu na napoje alkoholowe wśród dorastającej młodzieży w różnych okresach minionego wieku [Fluctuation of alcohol demand among adolescents]. Alkoholizm i Narkomania, 18(4), 93-117.

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ZIELIŃSKI A. (2005) Ewolucja wzorów używania alkoholu przez młodzież w Polsce w XX wieku [Evolution of patterns of alcohol use by youth in Poland in the 20th century]. Wydawnictwo Edukacyjne PARPA, Warszawa.

ŻULEWSKA J. (2005) Potencjał samouzdrawiający osób doświadczających problemów z alkoholem. Przegląd badań nad zjawiskiem samowyleczeń (1990-2004) [Self-healing potential of people experiencing alcohol-related problems. Literature review on self-change studies (1990-2004)], Alkoholizm i Narkomania 18(4), 9-24.

ŻULEWSKA-SAK J. (2005) Funkcjonowanie izb wytrzeźwień Polsce [Sobering-up station: Polish experiences], Alkoholizm i Narkomania, 18(1-2), 89-103.

ŻULEWSKA-SAK J., DĄBROWSKA K. (2005) Percepcja społeczna czynników udaremniających samodzielne przezwyciężenie uzależnienia - jakościowa analiza porównawcza [Social perception of factors impending chances for natural recovery from addiction - a cross-cultural qualitative perspective], Alkoholizm i Narkomania, 18 (3), 63-77.

Other outcomes: a set of policy recommendations addressing national and local community level available in the field of alcohol, and illicit and licit drugs

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Activity 15

Name of the activity: Assessing major risk and preventive factors in drug and alcohol use among children and adolescents

Description of the activity: monitoring drug and alcohol use among children and adolescents during economic and social transformation, development and evaluation of preventive methods.

Principal investigator: Krzysztof Ostaszewski, Ph.D.

Implementation of the activity:

Monitoring drug and alcohol use The study conducted every 4 years since 1984, was aimed at monitoring use of alcohol, tobacco, tranquilizers and illegal drug among 15-year olds from Warsaw. The self-report data were collected from a representative sample of students attending schools in Mokotów area - the district of Warsaw (sample size ranged from 1461 to 3918 in the different study editions). Between late 1980s and mid 1990s a significant increase in substance use by youth, including alcohol, cigarettes and illegal drugs, had been documented. The recent results (from 2000 to 2004) indicated stabilization in alcohol and illegal drug use and decrease in tobacco use. The trend of tranquilize/sleeping pills use was relatively stable over the past 20 years. Changes in adolescent substance use differ across gender. While boys as a group became more restrained in substance use, girls remained at the same level or continued growing trends (e.g. in getting drunk). These differences reflect changes in young female risky behaviours.

Preventive programmes School-based intervention for students using drugs

Despite a well developed primary prevention network and various treatment opportunities for drug addicts introduced in Poland, there was a lack of programmes for drug users with less serious problems. Attempts to develop brief intervention approaches, undertaken in the past decade, focused on the improvement of ability of educational institutions to help students and/or their parents in solving problems related to drug use. Evaluation of this intervention indicated that one of the barriers is related to the difficulties in accurate diagnose of a student’s drug problem. For the first time IPN and the National Bureau for Drug Prevention undertook the study aimed at development an effective screening test for adolescent drug problem use. The idea behind it was to enhance the effectiveness of intervention and treatment services by providing professionals with an easy-to use and very quick diagnostic tool. The psychometric properties of the problematic use of narcotics (PUN) screening test were examined and in result PUN test as a brief screening tool was confirmed.

The prognostic validity of the problematic use of marijuana (PUM) test was also examined in a large community sample. Satisfactory psychometric properties of the test allow to recommend it for use in different settings as in out-patient and primary care facilities, schools.

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Evaluation of preventive programmes

In the years 2004 and 2005 the second stage of a longitudinal outcome evaluation study was carried out. Its aim was to assess the stability over time of preventive intervention effects. The two year alcohol prevention programme for 10-12 year olds consisting of the Slick Tracy Home Team Programme and its continuation Amazing Alternatives was evaluated. The outcomes of evaluation showed changes in alcohol attitudes, increase of knowledge about consequences of drinking and assertiveness. Analyses also indicated that participation in this preventive programme was associated with lowering cases of drunkenness and drinking of alcohol among peers.

Evaluation of the cross-cultural adaptation of the American alcohol prevention programme Amazing Alternatives was carried out. The results showed that Polish version of the programme required substantial changes in contents of booklets and involvement of parents. The study proved the importance of collecting qualitative data during the cross-cultural adaptation of preventive programmes.

Outcomes:

Publications:

BOBROWSKI K. (2005) Używanie substancji psychoaktywnych i inne zachowania problemowe młodzieży gimnazjalnej. Zmiany pomiędzy 14. a 16. rokiem życia [Use of psychoactive substance and other problem behaviours among junior high school students. Changes between 14 and 16 year old]. Alkoholizm i Narkomania, 18, 1/2, 27-38.

BOBROWSKI K. (2007) Zmiany w rozpowszechnieniu używania substancji psychoaktywnych wśród gimnazjalistów w latach 2001-2005. Zagadkowe wyniki w Iławie [Changes in substance use among junior high school students, 2001-2005]. Alkoholizm i Narkomania, t. 20, 2, 133-150.

BOBROWSKI K., KOCOŃ K., PISARSKA A. (2005) Efekty dwuletniego programu profilaktyki alkoholowej [The results of the two-year alcohol prevention programme]. Alkoholizm i Narkomania, 18, 3, 25 - 41.

OKULICZ-KOZARYN K, BORUCKA A. (2008) Warsaw adolescent alcohol use in a period of social change in Poland: cluster analyses of five consecutive surveys, 1988-2004. Addictive Behaviors, 33, 439-450.

OKULICZ-KOZARYN K. (2007) Psychometric properties of the problematic marijuana use (PUM) test for adolescents, Postępy Psych. Neurlog. 16 (2): 105-111.

OKULICZ-KOZARYN K., SIEROSLAWSKI J. (2007) Validation of the “problematic use of narcotics (PUN) screening test for drug using adolescents, Addictive Behaviors. 32, 640-646.

OSTASZEWSKI K., PISARSKA A. (2008) Trends in adolescent substance use: the Mokotów Study 1988-2004. Drugs: Education, Prevention and Policy, in print

PISARSKA A., BOBROWSKI K., BORUCKA A., OKULICZ-KOZARYN K., OSTASZEWSKI K. (2005) Program Domowych Detektywów i program Fantastyczne Możliwości - dwuletni program profilaktyki alkoholowej dla szkół podstawowych [The Slick Tracy Home Team Programme and the Amazing Alternatives Home Programme -two year prevention programme for primary schools]. in: Diagnostyka - profilaktyka - socjoterapia w teorii i praktyce pedagogicznej. DEPTUŁA M. (ed.), Wydawnictwo Uniwersytetu Kazimierza Wielkiego, Bydgoszcz, 194-203.

PISARSKA A., OSTASZEWSKI K., BORUCKA A., BOBROWSKI K., OKULICZ-KOZARYN K. (2005) Adaptacja amerykańskiego programu profilaktyki alkoholowej Fantastyczne Możliwości – znaczenie ewaluacji procesu i badań jakościowych [Cross-cultural adaptation of the American alcohol prevention programme –

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Amazing Alternatives. The importance of the process of evaluation and qualitative methods] Alkoholizm i Narkomania, 18, 3, 43 - 62.

Other outcomes: evidence-based preventive programmes, training materials:

Fantastyczne możliwości. Poradnik dla rodziców. z.1-4. Adapted by: OKULICZ-KOZARYN K., OSTASZEWSKI K. Wyd. II, zmienione [Amazing Alternatives Home Programme. A Guide on Alcohol Related Issues for Parents. Booklets 1-4. Second edition, changed], IPiN, Warszawa 2005

Fantastyczne możliwości. Podręcznik dla lidera. Adapted by: PISARSKA A., BORUCKA A., BOBROWSKI K. [Amazing Alternatives. Peer Leader Manual. Second ed., updated], IPiN, Warszawa 2005

Fantastyczne możliwości. Podręcznik dla nauczyciela. Adapted by: PISARSKA A., BORUCKA A., BOBROWSKI K. OSTASZEWSKI K, OKULICZ-KOZARYN K. [Amazing Alternatives. Teacher’s Manual. Second ed., updated], IPiN, Warszawa 2005

Program domowych detektywów. Dla dzieci i dorosłych. Adapted by: BOBROWSKI K., BORUCKA A., OKULICZ-KOZARYN K., OSTASZEWSKI K., PISARSKA A., STARZYŃSKA J. [The Slick Tracy Home Team Programme. For children and parents. Second ed., updated], IPiN, Warszawa 2006

Program domowych detektywów. Podręcznik lidera. Adapted by: BOBROWSKI K., BORUCKA A., OKULICZ-KOZARYN K., OSTASZEWSKI K., PISARSKA A., STARZYŃSKA J. [The Slick Tracy Home Team Programme. Peer Leader Manual. Second ed., updated], IPiN, Warszawa 2006

Program domowych detektywów. Podręcznik nauczyciela. Adapted by: BOBROWSKI K., BORUCKA A., OKULICZ-KOZARYN K., OSTASZEWSKI K., PISARSKA A., STARZYŃSKA J. [The Slick Tracy Home Team Programme. Teacher’s Manual. Second ed., updated], IPiN, Warszawa 2006

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TERMS OF REFERENCE AREA: training and education of primary health care professionals on mental health problems as well as on public health aspects of mental, neurological and substance abuse disorders (Activity 16)

Activity 16

Name of the activity: Training and education of primary health care professionals on mental health problems as well as on public health aspects of mental, neurological and substance abuse disorders

Description of the activity: organising workshops and training on mental health, neurological and substance abuse problems for primary health care professionals, emergency staff and public health doctors. organising and contributing to conferences, meetings and workshops in which public aspect of mental, neurological and substance abuse disorders will be presented and discussed.

Implementation of the activity:

Lectures on mental health and neurological problems (such as Alzheimer disease, epilepsy, diagnosis and treatment of depression of aged, depression in neurological diseases, relation between depression and somatic diseases, pharmacotherapy in depression, patients with suicide’s thoughts, treatment of schizophrenia, psychoactive substance dependence, Mental Health Act - articles on treatment, care and rehabilitation) were provided by the IPN staff in a number of meetings, e.g.:

conference on anxiety and affective disorders in family doctors practice - June 2004

the cycle of workshops and training “Primary health professionals and psychiatric problems” - 2004 -2006 in different towns in Poland

the national conferences organized by the journal “Psychiatry in general practice” - 2004, 2006.

VI National Workshop of Family Doctors and Neurologists - November 2005

symposiums of the board of family doctors - February, April, May, June, September, November 2005, June, October, December 2006 in different towns of Poland

workshop on psychoactive substance dependence for primary health care physicians - Warszawa, June 2006

V Meeting of the Family Medicine Association - September 2006

training on psychological problems of children and adolescents patients for family doctors - 2006

international conference on treatment of depression in general practice - October 2006

conference on genetic problems in practice of primary health care physicians - December

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2006

training of family doctors, physicians working in emergency services, staff of police and fire-brigade in Maków district - 2006

the cycle of three lectures for primary health care physicians - Warsaw, Bydgoszcz, Gdańsk, February - March 2007

Handbooks and articles for primary health care physicians written by the IPN staff:

CZŁONKOWSKA A., NIEWADA M. (2006) Pacjent po udarze mózgu lub po przemijającym napadzie niedokrwiennym [Patient after stroke], in: OPOLSKI G., LUKAS W., STECIWKO A. (ed.) Choroby serca i naczyń; poradnik lekarza rodzinnego (Heart and vessels diseases. Handbook for family doctors), Via Medica, Gdańsk, 127–137.

JAREMA M. (ed.) (2007) Depresja w praktyce lekarza rodzinnego [Depression in the practice of primary health care physician], Termedia Wydawnictwa Medyczne, Poznań

PARNOWSKI. T. ŚWIĘCICKI Ł. (2007) Rozpoznawanie i leczenie depresji w praktyce lekarza rodzinnego [Diagnosis and treatment of depression in the practice of primary health care physician]. Medycyna Plus. Warszawa.

PUŻYŃSKI S. (ed.) (2006) Psychiatria w praktyce lekarza podstawowej opieki zdrowotnej [Psychiatry in the practice of primary health care physician], Medycyna po Dyplomie, no 1 (Suppl.).

RYGLEWICZ D., MILEWSKA D. (2004) Epidemiologia udaru mózgu. in: Udary mózgu w praktyce lekarskiej (Stroke in practice of physicians). MAZUR R., KSIĄŻKIEWICZ B., NYKA W.M. (ed.). Via Medica, Gdańsk, 5-14.

SIWIAK-KOBAYASHI M., BRYKCZYŃSKA C. (2004) Zaburzenia lękowe w praktyce lekarza rodzinnego (Anxiety disorders in the practice of primary health care doctors). Lekarz rodzinny, 9 (85), 962-975.

Outcomes: rising awareness and knowledge on psychiatric, neurological and substance use problems among primary care and public health professionals, skills in diagnosing and treatment of mental, neurological and alcohol and drug related disorders among primary care professionals improved.

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TERMS OF REFERENCE AREA: consultations and exchange of information (Activity 17)

Activity 17

Name of the activity: Consultation and exchange of information

Description of the activity: participating and contributing to the conferences, meetings and workshops on mental health and substance abuse organised by the WHO HQ in Geneva and WHO EURO in Copenhagen, participation in activities of the WHO Task Force on Mental Health Assessment, translation into Polish and dissemination of WHO documents and books, providing information and expertise upon the WHO request (including responding questionnaires, queries and alike).

Implementation of the activity:

Conferences

WHO Task Force on Mental Health Assessments Meeting, Bratislava, 18-20 March 2004The evaluation of the mental health system in Slovakia. Cz. Czabala participated in the meeting as a member of the task force.

8th Meeting of European National Counterparts for the WHO Mental Health Programme, Helsinki, 7-8 June 2004The conference was organized by WHO EURO. The situation on mental health in European countries, with special attention to experiences of Finland were discussed. Mental health problems in Poland were presented by Cz. Czabała on the plenary session.

2th International Meeting of WHO Collaborating Centres for Training and Research in Mental Health, Lille, 29-30 October 2004The conference focused on history and future tasks of the WHO Collaborating Centres (CC). Activities of the IPN as a WHO CC was presented by K. Prot-Klinger.

Pre-conferences of the WHO European Ministerial Conference on Mental Health: Facing the Challenges, Building SolutionsExperts on mental health, researchers, administrators and policy makers participated in the pre-conferences organized by the WHO EURO. During these meetings different aspects of mental health were discussed and conclusions for the final declaration were drafted. Experts from the IPN participated in almost all of these conferences, their suggestions were taken into account.

Suicide Prevention Strategies, Brussels, 11-12 March 2004 Suicide prevention programs were discussed, recommendation for prevention strategies were formulated. Suicide prevention programs for children and adolescents in different European countries were analyzed. Cz. Czabala contributed to the working

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groups.

Societal Stress and Mental Health, Moskva, 3-5 June 2004 The purpose of the meeting was to get an overview of the transition process with regard to societal, economic, cultural and personal factors; to analyze methods of coping with stress, types of intervention to prevent it. In the Central and Eastern European countries the main sources of stress are dramatic political transformation 90ties, in the “old” members states of EU are ethnic conflict and terrorist attacks. B. Mroziak participated in one of the working groups. Based on the Polish experiences, she proposed some methods to prevent and overcome the societal stress.

Comparing Mental Health and Risk Factors Across EU Countries, Paris, 30 June 2004

The conference explored the state of mental health of the population of the EU countries and the indicators for assessment and comparison. The findings of the research project on collecting statistical and epidemiological data were presented. Only representatives of Czech Republic and Poland from the “new” members of EU participated in the meeting.E. Slupczynska-Kossobudzka participated in the round-table and presented the state of art of mental health promotion, prevention of mental disorders and mental health resources in Poland.

Mental Health of Children and Adolescents, Luxemburg, 20-21 September 2004

The conference focus on the core areas of mental health of children and adolescents, including problems related to alcohol and illegal drugs. I. Namyslowska participated in plenary sessions, working groups and workshop on mental health promotion of children and adolescents. She presented outcomes of the research on prevention of eating disorders among girls in Warsaw.

Mental Health and Working Life, Tallin, 4-5 October 2004 The conference looked at the effects and impact of work on mental well-being of workers. Basic mechanism of work on mental health, stress factors, the effective methods of prevention of stress and burnout were explored. Also the role of persons with mental health problems in working life was discussed. M. Anczewska presented findings of the research on mechanism and factors of stress among mental health staff in Poland.

WHO European Ministerial Conference on Mental Health: Facing the Challenges, Building Solutions, Helsinki, 12-15 January 2005The conference organized by the WHO EURO and the government of Finland in collaboration with the European Commission and the Council of Europe, gathered ministries of health of European countries - WHO members as well as professionals, researchers, NGO representatives, patients and their carers. Poland was represented by dr P. Szwertnia, Undersecretary of State in the Ministry of Health and prof. I. Namyslowska and prof. Cz. Czabala, from IPN. During the conference the Declaration on mental health for Europe and Action Plan were signed by the ministers. These two documents defined the policy on mental health until the year 2015.

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Planning meeting „Cost of Alcohol Problems in Sweden”. Stockholm, 19 January 2005The aim of the project, carried out under the auspices of the WHO EURO, was to develop the methodology of cost evaluation of health and social alcohol consumption. J. Moskalewicz participated in the meeting as an adviser.

10th Meeting of National Counterparts for Alcohol Policy in the WHO European Region, Stockholm, 13-15 April 2005The aim of the conference, organized by the WHO EURO and Ministry of Health and Social Welfare of Sweden, was the evaluation of the European Alcohol Action Plan for the years 2000-2005 and development of recommendations for the similar plan for the next five years. J. Moskalewicz participated in the meeting as an adviser. He gave a lecture: “Alcohol policy -lessons to be learnt from the Eastern European perspective”.

WHO Consultative Meeting on Alcohol and Public Health, Geneva, 7-9 June 2005The meeting was organized by the WHO Headquarters in connection with the resolution on alcohol, adopted by the World Health Assemble. The aim of the conference was to discuss implementation of the resolution in the different regions of Europe. J. Moskalewicz presented the alcohol problems in developing countries.

9th Meeting of European National Counterparts for the WHO Mental Health Programme, Chania (Greece), 30 May-1 June 2006The conference organized by the WHO EURO as a follow-up to the Ministerial Conference in Helsinki. The priorities and future activities were discussed. As a result of evaluation of the mental health system in European countries, Poland was placed among countries, which developed mental health policy and strategies, but faced challenges of governance, human resources and financing. Cz. Czabała described the current mental health problems in Poland.

Conference on WHO Mental Health Declaration Baseline Project, Wien (Austria) 26-27 October 2006The conference was organized by the WHO EURO with aim to develop the questionnaire on monitoring the implementation of the Helsinki Declaration and Action Plan. Cz. Czabala took part in preparing questions of the questionnaire.

Building Capacity for Action. The 3rd European Alcohol Policy Conference, Barcelona, 3-5 April 2008

The conference, supported by the Ministry of Health of Spain and the Ministry of Health of Slovenia, was hosted by the Health Department of the Government of Catalonia, the Institute of Public Health of Slovenia and the Building Capacity Project. It was funded by the European Commission and co-sponsored by the WHO EURO. The conference’s aim was to exchange experience and good practices focused on preventing alcohol related harm. J. Moskalewicz and K. Dąbrowska participated in the conference. J. Moskalewicz chaired the session Standardization in diversified Europe, presented the project on standardizing

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measurement of alcohol related troubles (SMART) with focus on economic and physical availability of alcohol.

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Activities undertaken in the frame of the World Mental Health Day10 October 2004 The relationship between physical and mental health: co-occurring disorders10 October 2005 Mental and physical health across the life span. 10 October 2006 Building awareness - reducing risk: mental health illness and suicide10 October 2007 Mental health in changing world: the impact of culture and diversity IPN organised press conferences, on which experts presented problems related to the main theme of the Day. Usually 20 journalists from the specialist journals, reporters from radio, TV and newspapers of national and local circulation participated in such conferences. Staff of IPN outlined mental health problems in radio broadcast. IPN coordinated celebration in many towns and villages in Poland. Reports on celebrations were sent to the World Federation for Mental Health each year.

Dissemination of WHO documentsMental Health Declaration for Europe. Mental Health Action Plan for Europe. In 2005, both documents were translated into Polish and published in 1000 copies under the title: Podjąć wyzwania. Szukać rozwiązań. Deklaracja o ochronie zdrowia psychicznego dla Europy. Plan działań na rzecz ochrony zdrowia psychicznego dla Europy. Transl. G. Herczyńska, IPiN, Warszawa 2005.The book was disseminated among policy makers, professionals working in mental health area and librarians. The electronic version of the documents was placed on the home page of IPN. Both documents were used in updating the National Mental Health Programme as well as served as arguments in lobbing on improvement of mental health treatment and care with government of national and local levels (eg. during the conference organized in the President Office in 30 October 2007).

Main stream of discussions in the conference in Helsinki and the content of the Declaration and Action Plan were presented in the article: Herczyńska G., Czabała Cz., Namysłowska I. (2005) “Podjąć wyzwania, szukać rozwiązań” - zdrowie psychiczne w centrum uwagi rządów państw europejskich (Facing the challenges, building solution - European governments focus on mental health). Postępy Psychiatrii i Neurologii,14 (3), 259-266. This scientific journal published in 1000 copies has been subscribed by mental health professionals.

In the years 2004-2007 Publishing Unit of IPN sold 915 copies of the WHO books, published in the previous years: Lexicon of Alcohol and Drug TermsLexicon of Psychiatric and Mental Health TermsLexicon of Cross-Cultural Terms in Mental HealthThrough children’s eyes. A collection of drawings and stories from the WHO Global School Contest on Mental Health

Providing information

2004- Completing the questionnaire „Feasibility Study on Monitoring Mental Health System and Services”. The aim of the project conducted by the WHO EURO was to test a tool (questionnaire),

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which would allow getting information on a number of mental health indicators in WHO members countries. The questions concerned mental health in primary health care (in Poland - a separate collection of data is needed), availability of psychotropic medicines (in Poland - a special study is needed), mental health services in the community (in Poland - mainly some extra work is needed), public education (in Poland - special study is needed), involvement of communities, families (in Poland - special study is needed) and national policy and legislation (in Poland - data easily available).

- Comments to the “Mental Health Facilitator Questionnaire”. This initiative of the WHO Headquarters was relevant to the idea of training of mental health facilitators, which support and liaison to professionals.

- Updated information on suicide prevention programmes in Poland. The questionnaire prepared by the WHO Headquarters.

2005- II Neurological Department of IPN participated in the project of monitoring stroke. The aim of STEPwise system, initiated by the WHO Headquarter in Geneva, was to improve collecting and analyzing stroke data in all WHO members countries.

- An opinion on strategies on harm reduction of alcohol consumption in WHO members states in the West Pacific Region was prepared by J. Moskalewicz.

2006 - Completing the questionnaire “Atlas country resources on intellectual disabilities”. The project was conducted by the Department of Mental Health and Substance Abuse in Geneva and PAN-American Health Organization in Montreal. Information on intellectual disability - its definition, epidemiology, policy, legislation, finances, services, data collection and research in Poland was gathered.

2007- Completing the questionnaire in the frame of the Mental Health Declaration Baseline Project. Its aim was to assess the state of mental health activities undertaken by the WHO European Member States since the endorsement of the Helsinki Declaration in January 2005. Prepared by the WHO EURO in collaboration with the National Counterparts for Mental Health Programme, the questionnaire contained 91 questions concerning almost all mental health problems. Information for answering questions was collected by G. Herczyńska in consultation with Cz. Czabała.

Outcomes: improvement of competence, increasing collaboration between researchers and mental health centres, WHO polices and programmes known among mental health professionals, WHO databases better used by mental health providers.

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II.B. THE DIRECT COLLABORATION BETWEEN THE CENTRE AND WHO

The WHO National Counterpart for facilitating collaboration between the Polish government and WHO EURO in the years 2004-2007 was Cz. Czabała.

Biennial Collaborative Agreement 2004-2005

In the frame of the agreement between WHO EURO and the Ministry of Health in Poland for the period 2004-2005 the IPN implemented two priorities: no 2 - Mental Health no 5 - Ageing and Health

PRIORITY NO 2 - MENTAL HEALTH

The Agreement for Performance of Work was signed between prof. Danuta Ryglewicz, the director of IPN and dr Matt Muijen, Regional Adviser Mental Health Programme, WHO in January 2005. In the frame of the above priority IPN undertook the following activities:

1. Preparation of the report “Current problems of mental health care in Poland”

In the report, written by B. Pietrzykowska and L. Boguszewska, mental health care (primary and specialist), prevalence and incidence of mental disorders, human resources, availability of psychotropic drugs as well as mental health policy and legislation were described. In the conclusion the authors proposed some recommendations. As for a number of years the rates of prevalence and incidence have been increasing in all ICD-10 diagnostic groups, in both outpatient and inpatient settings, so

- the profound modernisation of psychiatric and alcohol/drug care should be continued more intensively, especially development of a community model of psychiatric care and various forms of intermediate psychiatric treatment.

- the number of staff ought to be increased by educating more psychiatrists, mental health nurses, psychologists, social workers and occupational therapists.

- in the area of legislation, monitoring the implementation of the Mental Health Act should be continued. There were many irregularities in the domain of respecting the rights of the mentally ill and the norms of the Act were often violated.

- persons with chronic psychotic disorders ought to have access to the second and third generation of antipsychotic, normothymic and nootropic medicines and antidepressants free of charge and the appropriate organs should introduce a system for the control of the administration of these medicines.

Recommendations: mental health in Poland needs to be modified urgently and radically and adjusted to the demands of contemporary psychiatry.

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2. Organizing the conference on the current situation in mental health care in Poland, Nadarzyn (close to Warsaw), 13 October 2005

The prominent Polish professionals working in mental health and representatives of the Ministry of Health and other departments of the government participated in the conference. Dr Eva Jane-Llopis represented the WHO EURO.

The main topics of the conference covered the most important and controversial current problems of psychiatry: financial situation of hospitals, risk faced by the out-patient psychiatric care, ethical problems related to clinical practice. The first draft of the regulation on standards in psychotherapy prepared by the Minister of Health was discussed.

Two WHO documents: Mental Health Declaration for Europe and Mental Action Plan for Europe signed during the European Ministerial Conference in Helsinki were presented by dr E. Jane-Llopis. As it was underlined, both documents corresponded precisely to the Polish National Mental Health Programme.

3. Establishing the Mental Health Centre (MHC) in the Institute of Psychiatry and NeurologyTraining professionals in organizing MHC in the other places in Poland

The Mental Health Centre was established in IPN in 2004. MHC offers community-based care for people with mental health problems, carries out research and training in the field of community-based psychiatry. Its aim is to improve the quality of outpatient forms of treatment and care through rising theirs accessibility and continuity, to shorten staying in hospital and to counteract stigmatization and social exclusion.

The workshop “Establishing mental health community-based care system in local communities”, organised by IPN took place in Nadarzyn, 12-13 October 2005. Almost 100 persons: professionals on community-based care, as well as participants of the conference on current problems of mental health, took part in two day meeting. Community-base care described in the Mental Health Programme and Mental Health Programme for the Malopolska Region as well as developing a model of the community-based care in the different region of Poland were subjects of the lectures prepared by the leading specialists in this field (from IPN: S. Pużyński, J.Wciórka, K.Prot-Klinger, M. Załuska). During the workshop, participants were trained in organizing mobile community teams, in collaborating with social care services and using special therapies in community work.

PRIORITY NO 5 - AGEING AND HEALTH

The Agreement for Performance of Work was signed between prof. Danuta Ryglewicz, the director of IPN and dr Agis D. Tsouros, Regional Adviser Healthy Cities and Urban Governance, WHO in July 2005. In the frame of the above priority IPN undertook the following activities:

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1. Organizing the experts meeting “ Public health problems in the context of ageing of the Polish population”, IPN, 13 June 2005

17 persons, leading professionals in the field of ageing: scientists, geriatricians, neurologists (IPN: A. Członkowska, D. Ryglewicz), psychiatrists (IPN: T.Parnowski), nurses (IPN: A. Indulska) and representatives of the Ministry of Health participated in the meeting. Dr L. Wagner, from the Division of Country Support Nursing and Midwifery Programme, represented the WHO EURO.

The most acute problems of ageing of the population of Poland were presented. Lectures covered a wide spectrum of areas e.g. demographic prognoses for Poland, prevalence and risk factors of cardio-vascular diseases, determinants of sclerosis, problems of patients with dementia, mental disorders of the aged and organization of the health system of the elderly, including a long term care. The most essential factors, which could negatively influence the quality of life of persons in the elderly age were identified during the round table. Proposals of procedures and activities aimed at improving the situation of persons in the elderly age in the system of health care in Poland were presented.

2. Co-organizing the conference “Healthy ageing”, Ministry of Health, 24 November 2005

In collaboration with the Ministry of Health, IPN organised a conference “Healthy ageing”. The conference took place under the auspices of the Minister of Health, prof. Zbigniew Religa. 36 persons from different scientific and clinical institutions, non governmental organizations as well as from different areas of science: epidemiology, demography, psychiatry, neurology, cardiology, biology participated in the meeting. WHO was represented by dr L. Wagner.

The main problems of ageing were presented and the activities and recommendation for the Ministry of Health were discussed.

3. Preparing the report “Public health problems in the context of ageing of the population of Poland” and recommendations: “Proposed action guidelines”

The report was worked out on the base of lectures and information prepared by the group of experts. The report was consulted with professionals and with representatives of non- governmental organizations, actively involved in the work for the elderly persons. Dr Wagner sent the most valuable suggestions.

In the report, a demographic prognosis for Poland, and the major health problems related to ageing and forms of care provided to the elderly were presented. Essential factors negatively affecting the quality of their life were identified. The authors suggested what procedures and activities should be undertaken to improve the situation of the elderly in the Polish health care system.

The final version of report and recommendations were handed over to the Minister of Health on 19 January 2006.

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The report was adapted to the requirements of the Polish scientific journal and published:

BARCIKOWSKA M., CZŁONKOWSKA A., DEREJCZYK J., GABRYELEWICZ T., GĘBKA-KUCZEROWSKA A., HERCZYŃSKA G., SIENKIEWICZ-JAROSZ H., JÓŹWIAK A., NARUSZEWICZ M., OPALA G., PARNOWSKI T., PAWIŃSKA-PRONIEWSKA M., RADZIKOWSKA M., RAJSKA-NEUMANN A., RÓSZKIEWICZ M., RYGLEWICZ D., WIECZORKOWSKA-TOBIS K., WITKOWSKA B., ZDROJEWSKI T. (2006) Problemy zdrowia publicznego w kontekście starzenia się populacji Polski, raport, Post Psych Neurol, 15 (3), 203–211.

The activities undertaken in the frame of the priority contributed to: (i) enhancing actions for promoting healthy ageing,(ii) improving quality and accessibility of health care system for the elderly,(iii) integrating efforts of different groups and people interested in problems related to the older part of the Polish society.

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Biennial Collaborative Agreement, 2006-2007

SUPPORTING THE DEVELOPMENT OF A COMPETENT MENTAL HEALTH STAFF

The Agreement for Performance of Work was signed by prof. Danuta Ryglewicz, the director of IPN, and dr Matt Muijen, Regional Adviser Mental Health Programme, WHO, in November 2006. In 2007, IPN undertook the following activities:

1. Developing the training package for implementation of the regional mental health programmers

The training package consists of two modules:

a. The guideline on community mental health - “Psychiatria środowiskowa jako środowiskowa opieka nad zdrowiem psychicznym” (“Community psychiatry as a community base mental health care”) was prepared by M. Załuska, K. Prot-Klinger and P. Bronowski.

The guideline describes the development of community psychiatry and its organization in Poland. The authors started with the history, requirements and strategies of the community psychiatry. This follows with the description of the state of art of the mental health care in Poland and in the other European countries, as well as discussion about new recommendations for the community psychiatry model. Legislation, mental health and social assistance facilities, NGO and different forms of help were also presented. Authors recommend mobile community teams as a fundamental part of the health care system on the local level.

The local care system for people with mental problems in Targówek, a district of Warsaw, as an example for developing community base mental health care, was described in the last chapter of the book.

The 85-page module was printed in 1000 copies and distributed among psychiatrists, clinical psychologists and students.

b. The module under the title “Umocnienie - nadzieja czy uprzedzenie” (“Empowerment – the hope or prejudice”), was written by J. Wciórka, M. Anczewska, J. Roszczyńska-Michta, P. Świtaj, J. Waszkiewicz, M. Klimek and M. Jamroż.

The analysis of the role of hope during the treatment and recovery is given in the first chapter. The second one deals with empowerment and partnership between a patient and the mental health staff, and is based on the current theories of recovery. Problems concerning discrimination and stigma, associated with mental illnesses, and methods of preventing and combating them are the subject of the third chapter. Personal reflections of a psychiatrist and of a person with schizophrenia close the book.

The 130-page module was printed in 1000 copies. In April 2007, 200 copies of the module was distributed during the two day workshop in Krakow.

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2. Co-organizing the workshop on implementation of the regional mental health programmes.First day, 26 April 2007, Good practice - good outcome? Second day, 27 April 2007, Psychiatry under reform. Workshop held in Krakow with app. 100 participants

The workshop gathered prominent Polish professionals in mental health community: regional consultants in psychiatry, members of community psychiatry teams as well as representatives of the local governments and NGOs.

During the first day the effectiveness of occupational rehabilitation programmes in psychiatry and local programmes for people suffering from mental problems were discussed. The second day was devoted to implementation of the mental health care reform in Poland, with special stress on community psychiatry. Presentation, prepared by dr Matt Muijen was given by Cz. Czabała. The discussion about reforms of the mental health system in Poland, seen from the local perspective, closed the workshop.

DEVELOPMENT OF MENTAL HEALTH PROMOTION AND ANTI-STIGMA STRATEGIES

The Agreement for Performance of Work was signed by prof. Danuta Ryglewicz, the director of IPN, and dr Eva Jane-Llopis, Technical Officer, Mental Health Programme, WHO, in November 2006. In 2007 IPN undertook the following activities:

1. Assessment of mental health promotion, prevention and anti-stigma programmes in Poland

The report on strategies and programmes of mental health promotion, prevention of mental disorders and stigmatization in Poland was prepared by J. Raduj. The report is published in the book with lectures presented during the conference on mental health promotion, held in September 2007. The Proceedings is expected in 2008.

Legislation, strategies, national and local mental heath programmes, which point out basic directions of action, and define appropriate priorities, were discussed in the first part of the Report; programmes of action on mental health promotion - in the second part. Standardization and evaluation of programmes, implementation of appropriate recommendations, and development of data bases by institutes, which disseminate and offer them to the potential users, should be mentioned as positive trends. Activities of institutes implemented specific projects were presented in the third part of the Report. The State Agency for Prevention of Alcohol Related Problems, the National Bureau for Drug Prevention, and some NGO and self-help organizations are vital for implementation of projects. The visible tendency is the activity of local communities and a rise of NGO’s initiatives, some of them not bounded only to one region.

2. Organizing the conference “Mental health promotion and anti-stigma strategies in different settings” 27-29 September 200780 participants. Details in Activities 4

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RESEARCH PROJECTS

WHO Collaborative Research Project on Drug Dependence Treatment and HIV/AIDS (Principal investigators of the Polish part of the project: Bogusław Habrat, M.D. and Jacek Moskalewicz PhD)

The objective of the project, initiated by the Department of Mental Health and Substance Dependence/Management of Substance Dependence, WHO Headquarters, Geneva, in 2003 was to promote evidence-based, high-quality substitution treatment of opioid dependent people and examine the effectiveness of opioid substitution treatment in developing/transitional countries in Asia (China, Indonesia, Thailand), Eastern Europe (Lithuania, Poland, Ukraine), and the Middle East (Iran).

After adapting research tools and instruments for local needs, staff of the Department of Substance Dependence Prevention and Treatment of IPN interviewed 61 opioid dependence patients in substitution therapy.

Process evaluation of two Polish substitution programmes was parallel carried out by the Department of Studies on Alcoholism and Drug Dependence in 2005. Forty interviews with individual addicts, 15 with staff and 7 focus groups with patients, staff and representatives of institutions or organizations collaborated with substitution programmes were conducted. The evaluation showed that substitution programmes improved patient’s health and their social activities. However, patients were not prepared to undertake new tasks and challenges. The formal procedures of collaboration with other institution than substitution treatment did not exist.

Polish experiences on treatment of opioide dependence were described by B. Habrat in the document „The practices and context of pharmacotherapy of opioid dependence in Central and Eastern Europe”, published by WHO in 2004, p. 85-91. (WHO/MSD/MSB/04.1).During the final meeting of principal investigators, Beijing (China) 29 May-2 June 2006, B. Habrat gave the lecture on substitution therapy programmes in Poland and J. Moskalewicz on barriers and facilitating factors in implementation of the methadone maintenance.

B. Habrat and J. Moskalewicz are among authors of the final report as well as an article: „Key findings from WHO Collaborative Study on Substitution Therapy of Opioid Dependence and HIV/AIDS”, which was submitted to Addiction in 2007.

Atlas Research: a WHO Project on Mental Health Research in Low- and Middle-Income Countries(Principal investigator of the Polish part of the project: Grażyna Herczyńska, M.A.)

In 2003 the Department of Mental Health and Substance Dependence WHO Headquarters, Geneva initiated the project on Mental Health Research and Research Infrastructure in Low- and Middle –Income Countries. Ten countries worldwide, including Poland, participated in the project. It aimed to obtain information about mental health related research and its resources in Poland in 2003.

The project was started at the end of 2003 and was carried out in 2004. Two questionnaires: country and institutional, prepared by WHO, served as the base for gathering information. Official documents and statistical data were used as sources for the first questionnaire. The

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second questionnaire was sent to 55 mental health research institutions. Information obtained from 38 centers was complied and extrapolated to provide the general picture.

In the report Mental health research and research infrastructure in Poland at the beginning of 21th century, changes in research policy in Poland in 15 years period of transformation were presented. Goals and priorities of mental health research, its financing and dissemination were described. The amount of money ascribed for this type of research was both inadequate and insufficient. In spite of difficulties, mental health research in Poland met important and actual scientific questions and was relevant to mental health practice. Aprox. 6% of the total number of researchers in medical sciences carried out mental health research. These research absorbed about 10% of total finding for research in medical sciences. About 5,5% of general health publications in Polish journals were devoted to mental health.

The report was sent to WHO in December 2004. With regard to importance of information for the Polish policy makers and researchers, after obtaining permission from WHO, the report was rewritten in Polish and published:

HERCZYŃSKA G. (2007) Badania naukowe w zakresie zdrowia psychicznego w Polsce u progu 21-go wieku Postępy Psychiatrii i Neurologii, 16, 1, 9-21.

This kind of project should be repeated periodically to evaluate existing trends.

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OTHER ACTIVITIES

Collaboration on implementation of the Helsingborg Declaration

Up to 2006 A. Czlonkowska chaired the secondary prevention group in the WHO Co-ordination Committee monitoring the implementation of the Helsingborg Declaration on stroke. In the frame of this collaboration, she participated in conferences and was a member of the group, which prepared the part of the final declaration of 2006, concerning stroke prevention.

2nd Consensus Conference on Stroke Management, Helsingborg (Sweden) 22-24 March 2006 was co-sponsored by the WHO EURO. During the conference the Helsingborg Declaration 2006 on European Stroke Strategies was adopted. A. Członkowska, I. Sarzynska-Dlugosz, M. Skowronska and M. Krawczyk participated in the conference and gave lectures on accessibility to stroke units and comprehensive early stroke rehabilitation in Poland.

Publication:CZŁONKOWSKA A. (2005) Jak wprowadzono zasady Deklaracji Helsingborgskiej w Polsce [How the Helsingborg Declaration was implemented in Poland]. Neurologia i Neurochirurgia Polska, 39, Suppl 2, 86-87.

Health Promoting HospitalsThe IPN received from the WHO EURO the Membership Certificate of Health Promoting Hospitals for the years 2006-2009. Action plan covered: educational programme on relation between nutrition and illness for patients, their families and carers; improving medical services in hospital; educational programme for families of patients threaten by bedsores; educational programme for patients and staff dependent on nicotine, alcohol and drugs.

IPN as a Co-ordinating Centre of the Mazovian Network of Health Promoting Hospital in the year 2003-2007 initiated and organized educational and prevention activities, developed local prevention and promotion programmes, participated in workshops and meetings e.g. Conference of the Mazovian Network of Health Promoting Hospitals, Warsaw, 5 October 2007. A. Indulska, M. Anczewska, J. Raduj, K. Prot-Klinger, M. Pałyska lectured on experiences of psychiatric hospital in evaluation of quality of medical services. The Network consists of 29 hospitals in the Mazovian Region.

Publications:

ANCZEWSKA M, INDULSKA A, RADUJ J, PAŁYSKA M, PROT K. (2007) Analiza jakościowa opinii pacjentów o pobycie w szpitalu psychiatrycznym [The patients’ view on psychiatric hospitalization - a qualitative evaluation]. Psychiatria Polska, t. XLI, nr 3, 427-434.

PAŁYSKA M., ANCZEWSKA. M, RADUJ J., INDULSKA A., PROT K. (2007) Znaczenie zmiennych społecznych dla różnicowania ocen jakości usług medycznych przez pacjentów [The effect of sociodemographic variables on the evaluation of medical care quality by psychiatric patients]. Postępy Psychiatrii i Neurologii, 16 (4), 309-314.

RADUJ J., INDULSKA A., ANCZEWSKA M., LECHOWICZ W., PAŁYSKA M., PROT K. (2005) Jakość usług medycznych w opiniach pacjentów wybranych oddziałów psychiatrycznych [Quality of inpatient psychiatric services as rated by patients of selected psychiatric wards], Postępy Psychiatrii i Neurologii, 14 (4), 293-298.

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III. DIFFICULTIES ENCOUNTERED IN THE COLLABORATION WITH WHO

A model of research collaboration, undertaken under auspices of WHO, based on one or two centres of excellence which elaborate research protocol and supervise technical implementation of the project in a number of other less advanced countries has its advantages as much as drawbacks. A major advantage is high methodological standard and opportunity to collaborate with most prominent scientists. Relatively low sense of project’s ownership, limited flexibility of a project are its major drawbacks.

IV. SUGGESTIONS ON INCREASED AND IMPROVED COLLABORATION WITH WHO

More comparative research projects benefiting from horizontal, partnership-oriented organisation and management could be considered to stimulate knowledge-based health policies, sharing experiences and development of expertise.

Opportunities for short-term scholarships or consultancies in WHO HQ as well as in WHO EURO could be offered to improve understanding of WHO potential and its limitations, to learn basic bureaucratic manners of large international organisation, to contribute to its potential with varying professional and cultural competence.

Prepared by Grażyna Herczyńska

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