Population: 10,7 Mil.
in the health plan
Goverment lead on mental health with cross-ministerial responsibility
Systematic data collection
Data on mental health
used for planning
in national plan or strategy
Access to financial aid
Access to remote support
The Czech Republic lags far behind the EU average in terms of the number of psychiatrists per capita. The WHO recommends that countries should have at least 27 clinical psychiatrists paid by health insurance per 100,000 inhabitants. Germany has 49, Norway 73, the Netherlands 150 and even Poland has 16. The Czech Republic has only 7. Due to this lack of psychiatrists, but also a lack of psychologists, the waiting times to get an appointment are long and often lead to hospitalisation in cases of serious mental health conditions.
At the same time and despite certain efforts at awareness raising, mental illnesses are still often perceived as a taboo or a stigma. Patients are thus faced with overcoming a considerable barrier even before they seek professional help.
A key challenge remains the number of psychiatry professionals and the capacity of facilities that provide psychiatric care. Limited capacities result in long waiting times that can lead to a deterioration of patients’ condition and when they eventually get to see a psychiatrist they may require more intense treatment that increases the burden on the healthcare system.
The mental healthcare situation in the Czech Republic is rather complicated. Psychiatrist numbers are far from sufficient. The structure of mental healthcare provision has been very slowly shifting from hospitalisation of patients in serious phases of mental illnesses to an early and, if possible, out-patient therapy with joined up health and social services.
Changes to the structure of psychiatric care have been addressed in several strategic papers.
The 2030 National Mental Health Action Plan is the key document laying the foundation for further development of psychiatric care. This implementation document defines specific procedures needed to realise certain parts of the Strategic Reform of Psychiatric Care 2013—2023 (MZd, 2013). It is also one of the implementation documents of the 2030 Strategic Framework for the Czech Republic (MŽp, 2017) and develops in more detail specific areas of the “2030 Health” strategic framework for healthcare development in the Czech Republic, including the implementation plan.
The healthcare ministry in partnership with the National Institute of Mental Health (NÚDZ) and the World Health Organisation (WHO) have developed a National Suicide Prevention Plan 2019-2030 aimed at reducing the number of suicides in the Czech Republic. It is the first strategic document dedicated to the prevention of self-harm and suicidal behaviour that provides concrete implementation procedures.
Partial results of the psychiatric care reform include the creation of a network of Mental Health Centres that specialise in providing integrated services to mental health patients and have the status of a local multidisciplinary care provider.
The aim of the psychiatric care reform is to change the structure of mental health services by deinstitutionalising therapy, i.e. moving the bulk of mental healthcare to the out-patient sector to ensure early diagnosis, relevant treatment available to patients in the early stages of mental illnesses and support with coping with mental health conditions in the home environment. Another aim is to alter the public’s perception of mental illnesses and to remove the stigma that they carry. The reform also centres on a multidisciplinary approach and joining up of several services. The psychiatric care reform has been underway since 2013 but there are no concrete provisions ensuring its continued rollout.
Go to chapter
Integrated care – that is, a patient-centred system that supports the person with depression throughout their lifetime and with continuity across the health system – is essential to delivering adequate support and treatment.
Integrating mental health services into wider health and social care services is convenient and can increase treatment rates, improve comprehensiveness of care and reduce overall costs.
The mental healthcare system in the Czech Republic falls short of the comprehensive treatment concept in many respects including the treatment of depression and many other mental illnesses. The National Action Plan for Mental Health 2020-2030 provides a telling description of the state of mental healthcare in the country:
“To this day, the psychiatric care system in the Czech Republic relies heavily on large-scale in-patient psychiatric healthcare institutions where people suffering from severe mental conditions can remain hospitalised for a very long time, sometimes for more than 20 years, which is clearly not cost efficient compared with community-based care, i.e. care provided in the patients’ home environment.
Long-term hospitalisation is associated with a failure to meet the principles of the Convention on the Rights of Persons with Disabilities (WHO, 2018) but also with a higher risk of suicide after release from the hospital. The network of hospitals providing both acute and long-term treatment covers the country in a very uneven manner. The number of beds available in these facilities is inadequately low. Furthermore, this type of care is not integrated in general hospitals or connected to complementary somatic medicine services.
At the same time, the availability of psychotherapy is very limited. As for child mental health services, the out-patient care network is very sparse and plagued by long waiting times and a chronic lack of hospital beds. Pedopsychiatry wards in long-term treatment facilities for children and adolescents are very often designed for long-term care and do not admit acute cases.
Only a small number of in-patient facilities meet requirements necessary for accreditation for pre-attestation education, which creates another stumbling block in efforts to train new professions. Furthermore, child and adolescent patients are hospitalised in facilities located relatively far away from their homes, making it difficult for parents to visit their children and attend family therapy sessions.
Is depression included in either the national health plan or a specific plan for mental health?
Is there a government lead on mental health, with cross-ministerial responsibility to support a ‘mental health in all plans’ approach?
The vast majority of hospitals do not offer interdisciplinary care in their paediatric wards and some patients who clearly suffer from mental health issues are often released without any plans for follow-up care.
On the ministerial level, services for children and adolescents are the responsibility of a specialised ministry and collaboration with other departments on a more integrated approach has not been very efficient. Families are thus left to their own devices when searching for professional care and are often faced with communication barriers.
Community care is not sufficiently developed, especially in terms of prevention, rehabilitation and integration of people with mental health issues into regular society (including housing and employment). Community healthcare services for people with mental health issues are not integrated either into the healthcare system (such as primary care) or into social services and complementary services available on a regional level and rely primarily on the work of individual specialists offering only a narrow spectrum of services.
Is collaboration between primary care and mental health services supported and incentivised / encouraged / facilitated?
A multidisciplinary approach as the most efficient model for working with people with complex needs is found only in a portion of care services and multidisciplinary teams for mental health patients are currently testing this approach in pilot projects. The mental healthcare system lacks sufficient numbers of competent human resources, which stems from the structure and financing of care, the system of professional education and training as well as a lack of flexibility in terms of new approaches to working with human resources.”14
Are there guidelines on depression care developed jointly by primary care and psychiatry?
Is a range of therapeutic options reimbursed and available to people with depression, such as psychotherapy, counselling and cognitive behavioural therapy?
The concept of joined-up care provided within the patient’s usual environment is part of the psychiatric care reform initiated in 2013. So far, however, it has had only a limited impact on the services actually provided to patients.
One of the outcomes of the psychiatric care reform in terms of complex services centred on patient needs is the creation of Mental Health Centres. A larger-scale change in mental healthcare has been hampered by human resources limitation (lack of both doctors and other healthcare professionals) and financial limitations. With a new government taking office after 2021 elections, it is now unclear in what form or indeed whether at all the reform might continue.
Are depression services available and tailored for at-risk groups?
People in the workplace
Collecting and analysing robust and up-to-date data on depression is essential for ensuring the right services are available for everyone who needs them.
Monitoring patient outcomes helps to identify and inform good practice, and may give hope to service users that their mental health can improve.2 Data on services can support clinicians, policymakers and people with depression to better understand what treatment options are available and accessible. More transparent data will also facilitate shared learning across all domains of depression care. New digital tools may have the potential to facilitate documentation for transparency and research purposes while retaining the anonymity of the user.2
Data on mental healthcare are systematically gathered and processed by the Institute of Health Information and Statistics of the Czech Republic (ÚZIS). Between 2013 and 2020, the Institute published a comprehensive annual report Psychiatrická péče, zdravotnická statistika16 (Psychiatric care, healthcare statistics). Data on psychiatric care are also collected by insurance companies that make the information available for expert analyses. In addition to the ÚZIS, available data are also analysed by the National Institute of Mental Health (NÚDZ)17. The NÚDZ also carries out its own research and generates own statistical data.
Information on the type and structure of care provided, the number of providers, their capacity and expenditure is, therefore, readily available.
Data on mental illness epidemiology are also easily available and have recently been published by, for example, the NÚDZ. These data indicate that there was a considerable, nearly threefold increase in depression cases in the general population during the covid pandemic.18
The economic and societal impacts of mental illnesses are an issue that deserves much more attention. Unfortunately, studies on this topic are only rarely published. An analysis of the current economic and societal impacts could help drive the implementation of changes in the mental care system. A fundamental obstacle complicating an efficient analysis of such data is the split of services between the ministries of healthcare and social affairs and differences in the structure of data used by the two ministries (for example, calculating the true cost of healthcare services and connecting this cost to the real cost of related social services is very challenging and possible more or less only on the level of the individual).
Another area that would merit systematic data collection is service availability. However, shortcomings in this area are generally well known.
Data describing the state of healthcare, the capacity of healthcare facilities, the incidence of illnesses and desirable changes are, therefore, readily available. As for necessary changes, experts tend to be mostly in agreement thanks to efficient communication of the psychiatric care reform.
However, implementation of these changes in healthcare practice is not a priority for the ministry of healthcare and changes that are implemented are only of piecemeal nature.
Are data on people with depression systematically collected by the health system?
Are data on mental health services being used for planning?
Are patient-reported outcomes being measured systematically?
It is essential that people with depression – along with their families, friends and carers – are actively empowered to participate in depression care plans at all stages.
Empowerment involves a person gaining information and control over their own life as well as their capacity to act on what they find important, which in turn will allow them to more optimally manage their depression. Peer support, whereby a person who has previously experienced depression offers empathy and hope to others in the same position, can assist both people with depression and their peer supporter in their recovery. Social systems, patient advocacy groups and other civil society organisations with access to underserved communities are critical in ensuring that mental health services reach everyone, including those who have ‘slipped through the net’.2
Psychiatric care currently treats patients mostly as consumers of care without any power to influence the management, control or administration of this care20. In fact, this approach to patients permeates the entire healthcare system in the Czech Republic in general. While ingrained processes are slowly changing situations where patients are involved in the decision-making on and provision of healthcare are still mostly exceptions and generally come about if the specific healthcare professional is willing to go beyond the framework of usual practices.
It is only recently that we can see a more active role of patient organisations that advocate for patients being more than mere recipients of services and becoming active participants in the setup and provision of these services. Patients have thus become members of advisory boards of certain institutions (e.g. insurance companies). The ministry of healthcare created its patient board in 2017 and in recent years representatives of patient organisations have been invited to join several other of the ministry’s advisory bodies. A number of organisations focusing on mental health participate in the activities of the ministry’s patient board. Thanks to this involvement, patients can bring forth suggestions based on their experience and propose changes to the system. They can also comment on proposed new measures including legislative changes.
Do guidelines or care pathways for depression recognise the importance of patient empowerment?
Do guidelines on depression recognise the role of families and carers in making decisions on the planning and delivery of care?
Were patient and carer representatives involved in the most recent national plan or strategy covering depression?
Do carers have access to financial aid to help them support their loved ones with depression?
Peer consultant involvement in services provided within the Czech healthcare system is unusual. In the area of psychiatric care, peer consultants, i.e. people who have personal experience with mental illness and, at the same time, have the necessary qualifications (e.g. for social work), have been included in the multidisciplinary teams created in newly established Mental Health Centres.
Mental Health Centres use a case management approach in their work. Each patient is assigned a specific team member as their key case manager responsible for both direct care and coordination of other services. The case manager also seeks support from other team members if and when the situation and patient’s needs require.
Within these teams, peer consultants use their own life story and experience with coping with mental illness.
However, small changes in the status of patients have had only limited impact. This is true both in terms of patient involvement indecision-making on the systemic level and in terms of patient involvement in care provision, e.g. in the form of peer consultation.
In the area of psychiatric care, this shortcoming has been explicitly laid out in conceptual and strategic documents created in relation with psychiatric care reform, including the National Action Plan for Mental Health and other documents.23
Is peer support recommended in depression care guidelines?
Are peer support roles reimbursed?
Are there national associations advocating for the rights of:
people living with depression?
carers of people living with depression?
Digital platforms such as those which facilitate remote therapy sessions and online prescription requests, as well as other depression-focused software, smartphone applications and virtual platforms, can allow greater choices of treatment for people with depression while supporting them to take more control of self-managing their condition.
While virtual sessions cannot replace in-person therapy, they may be a flexible option to support people with depression between regularly scheduled visits. Health and social services may also use digital tools to facilitate data collection and monitor care. In addition, people with depression may find it helpful to use digital tools to connect with others and reduce feelings of isolation.
Technologies that could help improve access to healthcare are not being used in the Czech Republic. Telemedicine is not being actively implemented and still lack a conceptual framework. Standard procedures have not yet been defined for this form of healthcare service delivery and this type of services is not covered by public health insurance.
During the pandemic, various means of remote communication between doctors and patients were used on a temporary basis. This included general tools for online communication without adequate adaptation for the healthcare setting. In some medical fields (including psychiatry), such remotely provided healthcare services were reimbursed by insurance companies as a temporary measure during the pandemic. However, this practice has not been maintained after pandemic restrictions were lifted and no telemedicine standards have been defined.
Can patients access depression support remotely (via telephone or the internet) in addition to services delivered face-to-face?
Do professional societies or guidelines recommend the use of remote services alongside face-to-face services?
The only technological innovation that has been implemented over the past decade is the introduction of electronic prescription system. This tool is fully functional (doctors have learnt how to issue electronic prescriptions, patients have gotten used to receiving electronic prescription and pharmacies have no problem issuing medications based on them). Patients thus no longer need to use prescriptions on paper.
The utility of such technologies in the area of mental health care is not apparent. Personal appointments are indispensable for psychiatric treatment and cannot be replaced by remote communication.
In the context of fundamental issues with care capacities, long waiting times and a service structure not suited for a modern approach with a maximum use of multidisciplinary care within the patient’s community, harnessing technologies seems as a rather marginal matter.
Is remote support for depression reimbursed?
Are people with depression able to use telephone or online platforms that allow them to renew their prescriptions from home?
The Czech Republic is struggling with serious issues both with the structure of services provided to mental health patients dominated by hospitalisation and with the overall capacity of the system where patients often need to wait for months before they can receive out-patient care. The problems are even deeper in child psychiatry. Similar capacity constraints also apply to psychologist, which only exacerbates the problem.
Go more in-depth on mental health in Czechia and download the full scorecard in PDF hereDownload PDF
Share this report and get the conversation about mental health care started
As part of the psychiatric care reform, the above issues have been adequately described and a pilot project was launched establishing Mental Health Centres that provide a comprehensive care with a multidisciplinary approach including the involvement of peer consultants. Furthermore, these centres provide services near patients’ place of residence and in conjunction with other support services.
Psychiatric care is not sufficiently funded and no measures were adopted with view of increasing the system’s capacity in the medium or long term and strengthening the position of mental health within the overall healthcare system.
Increase the number and capacity of psychiatric out-patient services for children and adults
Increase availability of modern treatment
Put mental health on an equal footing as physical health
Establish a connection between social and healthcare systems in order to monitor social care expenditure linked to healthcare expenditure and assess the benefits that medical interventions bring to the state’s overall expenditure on patients
Support deinstitutionalisation of metal health care (strengthen the out-patient sector)
Support joined up health and social services
Destigmatise mental illness
As new telemedicine technologies are introduced to other medical fields, make these tools available also in those areas of psychiatry that they may be suitable for
1. WHO. Depression and Other Common Mental Disorders; Global Health Estimates, WHO 2017
2. Český statistický úřad. 2022. Statistika a my. https://www.statistikaamy.cz/2022/02/09/sebevrazednost-v-cesku-setrvale-klesa
3. Ng CWM, How CH, Ng YP. 2017. Depression in primary care: assessing suicide risk. Singapore Med J 58(2): 72-77
4. Ústav zdravotnických informací a statistiky. Psychiatrická péče 2020. ÚZIS. Available at https://www.uzis.cz/res/f/008375/psych2020.pdf
5. Národní ústav duševního zdraví. Ekonomické hodnocení ve zdravotnictví: Zaměřeno na duševní zdraví, NUDZ, 2020, Available at https://www.nudz.cz/files/pdf/monografie_ekonomicke-hodnoceni_final.pdf
6. Ehler, E., Bednařík, J., Höschl, C., Winkler, P., Suchý, M. & Pátá, M. 2013. Náklady na poruchy mozku v České republice. Cesk Slov Neurol.
7. Ústav zdravotnických informací a statistiky. Psychiatrická péče 2020. ÚZIS. Available at https://www.uzis.cz/res/f/008375/psych2020.pdf
8. Beezhold J, Destrebecq F, grosse Holftorth M, et al. 2018. A sustainable approach to depression: moving from words to actions. London: The Health Policy Partnership
9. European Patients Forum. 2015. EPF Background Brief: Patient Empowerment. Brussels: EPF
10. Repper J, Carter T. 2011. A review of the literature on peer support in mental health services. J Ment Health 20(4): 392-411
11. European Commission. 2018. Tackling depression with digital tools. [Updated 04/06/18]. Available from: https://ec.europa.eu/research/infocentre/article_en.cfm?id=/research/headlines/news/article_18_06_04_en.html?infocentre&item=Infocentre&artid=48877 [Accessed 06/11/20]
12. Hallgren KA, Bauer AM, Atkins DC. 2017. Digital technology and clinical decision making in depression treatment: Current findings and future opportunities. Depression and anxiety 34(6)
13. Prescott J, Hanley T, Ujhelyi K. 2017. Peer Communication in Online Mental Health Forums for Young People: Directional and Nondirectional Support. JMIR Ment Health 4(3): e29-e29
14. Ministerstvo zdravotnictví ČR. National Action Plan for Mental Health 2020-2030. Available at https://www.reformapsychiatrie.cz/reforma/narodni-akcni-plan-pro-dusevni-zdravi-napdz
15. Ministerstvo zdravotnictví ČR. Reforma psychiatrie. Available at www.reformapsychiatrie.cz/projekty/centra-dusevniho-zdravi-cdz
16. Ústav zdravotnických informací a statistiky. Statistika vybraných oborů lékařské péče. Available at https://www.uzis.cz/index.php?pg=vystupy--statistika-vybranych-oboru-lekarske-pece--psychiatrie
17. Národní ústav duševního zdraví. Výzkumné programy. Available at https://www.nudz.cz/vyzkumne-programy/resene-projekty/narodni-projekty/
18. Winkler, P., Mohrová, Z., Mladá, K., Kuklová, M., Kågström, A., Mohr, P., Formánek, T. Prevalence of current mental disorders before and during the second wave of COVID-19 pandemic: An analysis of repeated nationwide cross-sectional surveys. Journal of Psychiatric Research. 2021, 139(July), 167-171. ISSN 0022-3956. DOI: 10.1016/j.jpsychires.2021.05.032. IF 4.791
19. Ehler, E., Bednařík, J., Höschl, C., Winkler, P., Suchý, M. & Pátá, M. 2013. Náklady na poruchy mozku v České republice. Cesk Slov Neurol.
20. Ministerstvo zdravotnictví ČR. National Action Plan for Mental Health 2020-2030. Available at https://www.reformapsychiatrie.cz/reforma/narodni-akcni-plan-pro-dusevni-zdravi-napdz
21. Ministerstvo zdravotnictví ČR. Pacientská rada. Available at https://pacientskeorganizace.mzcr.cz/index.php?pg=pacientska-rada--pacientska-rada-2021-2025
22. Ministerstvo zdravotnictví ČR. Pacientské organizace. Available at https://pacientskeorganizace.mzcr.cz/res/file/dokumenty/seznam-clenu.pdf
23. Ministerstvo zdravotnictví ČR. National Action Plan for Mental Health 2020-2030. Available at https://www.reformapsychiatrie.cz/reforma/narodni-akcni-plan-pro-dusevni-zdravi-napdz
24. Nevypusť duši. Available at https://nevypustdusi.cz/