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Health service research and economic evidence for the mental health care reform in the Czech Republic

Student thesis: Doctoral ThesisDoctor of Philosophy

Background Mental health care reforms have been proposed in Central and Eastern Europe (CEE), including the Czech Republic (CZ). However, this process is hindered by a lack of relevant evidence. Aims The objectives were: 1) to synthesise information about the psychiatric care in CEE and in CZ specifically, 2) to estimate the scale of institutionalisation of people with schizophrenia in CZ, 3) to find out whether deinstitutionalisation was associated with homelessness and criminality, 4) to estimate cost-effectiveness of care for people with psychosis in psychiatric hospitals as opposed to the community care in CZ, 5) to develop an economic model for a selected scenario of CZ reform. 
Methods The WHO Mental Health Atlas was analysed and a scoping review was conducted and complemented with an expert survey to assess the development of care for people with severe mental illnesses in CEE. Czech national databases were analysed and relevant publications and policy papers reviewed to further describe the state of psychiatry in CZ. Czech registers were used to assess long-term hospitalizations for schizophrenia in CZ. A systematic review was conducted to investigate whether deinstitutionalization was associated with criminality or homelessness. Users of both, community services and psychiatric hospitals, were followed up for a year; their consumption of services was assessed with the Czech version of the Client Service Receipt Inventory, and outcomes with EuroQol Five Dimensions Questionnaire (EQ-5D), Global Assessment of Functioning (GAF), and Camberwell Assessment of Needs (CAN). Decision models were built to estimate costs associated with adopting early intervention services in CZ. 
Results Reviews demonstrated that mental health care systems in CEE are outdated and ineffective. In CZ, hundreds of people with schizophrenia stay in psychiatric hospitals for more than 20 years. Deinstitutionalization has not been associated with criminality or homelessness worldwide. Care in the community was demonstrated to be cost-effective when compared to psychiatric hospitals in CZ. Decision models suggested that adopting early intervention and/or early detection services in CZ might be cost-saving. 
Discussion Health service and economic evidence provided by this thesis suggest that mental health care system in the Czech Republic is ineffective and deinstitutionalization should help to achieve a better value for money. This evidence is also helpful to decision makers in other countries of Central and Eastern Europe.
Original languageEnglish
Awarding Institution
Supervisors/Advisors
Award date1 Apr 2020

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