Elainna Simpson

Dr. Grinde

Cross-Cultural Psychology

4/16/2020

Region Journal #2: Mental Health in the Czech Republic

The Czech Republic (Czechia) is rated 20 th out of 156 countries in the World Happiness Report,

yet the country struggles to modernize its mental health facilities (Helliwell, Layard, Sachs, & De Neve,

2019). Mental health stigma is apparent in Czechia and affects the ability of those with mental disorders

to get the care that they need. Even if people sought the psychiatric care they needed, NIMH researcher

Miroslava Janouskova stated that those with mental health problems do not, at the time, have an

adequate support system in Czechia (Lazarova, 2016). The prevalent mental health stigma in Czechia has

led to overloaded, old psychiatric hospitals, but new reforms hope to create more out-patient facilities

that can improve the chances for people to have a smooth discharge and integrate successfully back into

society.

There appears to be a considerable lack of epidemiological studies for the Czech Republic and

other Central and Eastern European countries. Older research shows an increase over the years of those

who sought psychiatric help, with a third more Czechs seeking help in 2006 than in 2000 (Krosnar, 2008).

In a study created to examine Czech mental health to assist the mental health reform, 21% of all

participants fulfilled the criteria for having at least one current mental disorder. This data indicated that

over 1/5th of the Czech adult population had experienced a mental disorder in 2017 (Formanek,

Kagstrom, Cermakova, Mlada, & Winkler, 2019). Also in this study Czechia appeared to have a slightly

lower reported prevalence of mental disorders than other European countries, this could be due to the

high rate of institutionalized people who were not able to be included in the study. Females were 2-3

times more likely than males to meet criteria for mood, anxiety, & psychotic disorders, but 0.4-0.6 times

less often than males to have an alcohol or other substance abuse disorder (Formanek et al., 2019).
Perhaps this discrepancy is due to the strong traditional gender roles in the Czechia I discussed in my last

journal, which could cause men to be less likely to admit symptoms. Also discussed in my last journal,

was the high levels of women who had experienced sexual assault or domestic violence, these life

stressors could lead to an increase in development of mental disorders as indicated in the data. Also

reported in Formanek et al.’s (2019) research was that more than 10% of participants had screened

positive for alcohol use disorders and 6.6% had alcohol dependency. Despite this data, there was a low

level of disability associated with the alcohol use disorders which could be linked with the high levels of

drinking in Czechia’s culture, 2 liters more than the EU average (10 liters). Scott (2017) when discussing

Czech’s relationship with alcohol states, “Concerning beer, the largest section of Czech men and women

think it is a part of Czech culture and tradition, that the drinking of beer belongs to the inhabitants of the

Czech lands and that it is something we can be proud of.” This culture could affect substance abuse

disorders and the way that they are diagnosed.

Czechia does have a strong stigma against those with mental health which is most likely a strong

barrier in moving to a modern mental health system. When asked whether they would like to have a

neighbor from a particular group, the Czech people rated those with mental illness as the fourth least

popular group after those with a drug addiction, alcohol dependency, and a criminal history (Lazarova,

2016). When comparing intentional stigmatizing behavior towards those with mental health problems,

Czechia’s data is worrisome and is much higher than England (Pec, 2018). This prevalent stigma is

exacerbated by the media who only reports murders committed by the mentally ill, as well as, the

misrepresentation of mental illness is movies or television. Adding to the cycle of stigma, most people

often do not come into contact with someone with mental illness or if they do the person often hides it.

This stigma even leads to many with mental health problems to suffer from self-stigmatization, where

they are then afraid to admit their problem and seek the help that they need (Lazarova, 2016). This

stigma has even affected the profession of psychology for students and has affected the workforce. In
Lazarova’s (2016) interview with Janouskova, she states that there are only 12 psychiatrists per 100,000

inhabitants and she says the stigma that a psychiatrist isn’t a “proper” doctor effects students willing to

choose that profession. When asked in a study, most medical students stated that they would not want

to work in a psychiatric ward. To attempt to correct these stigmas around mental health, Janouskova

and NIMH created a mental health campaign with videos and seminars to highlight that those with

mental illness are normal people, but that struggle with discrimination. After students viewed these

videos and attended the seminar to ask questions, there was a change in the students’ attitudes toward

mental health and an increase in those willing to work in a psychiatric ward (Lazarova, 2016). Even

though this stigma is still a large part of Czechia, there does appear to be fewer Czech’s who are too

afraid of the stigma to seek help (Krosnar, 2008).

The stigma on mental health largely is connected to the old communist regime where those

with mental health were viewed negatively and large asylums were utilized (Krosnar, 2008; Pec, 2018).

The communist regime in Czechia did not end until the “Velvet Revolution” in 1989. This revolution is

seen as a step forward in civil rights, including those on mental health (Pec, 2018). Yet, these reforms

were slow and the Czech mental health system was under criticism for a long time due to their large

asylums and mistreatment of patients, including the cage-beds they used (Tresnak, 2014). Some

statistics demonstrate the issues within the Czech mental health system, where the 2012 average stay

for a schizophrenic in-patient was 100 days, which is several times higher than other high-income

countries, and most are readmitted within two weeks after their discharge. Another worrying aspect is

suicide rates, in a 4-year research period, 402 of 137,290 in-patients died of suicide during their stay or

within 2 months after discharge. These stats also indicate the difficult time that patients have after

leaving hospitalization and reentered society, which is only made worse by the lack of out-patient

facilities to help with this transition (Pec, 2018).

 Thankfully, Czechia is now moving away from large institutions as the only form of care and is

starting to implement community-based out-patient facilities to facilitate this transition for the mentally

ill. Other deinstitutionalization movements have been associated with better outcomes for people with

mental health in other countries and can be a start in Czechia’ s mental health reform (Formanek et al.,

2019). One hospital in Prague, Bohnice Psychiatric Hospital, has already created a hospital community

center as an addition to their in-patient hospital. This community center offers care and support to

those living at home and utilizes other professionals, like social workers, to improve the transition for

patients. A woman who has stayed in a few different psychiatric hospitals eventually went to Bohnice

and said she was surprised with the difference in her treatment which ultimately helped her to stay out

of the hospital. She states the main two differences in their treatment was they treated her as an

individual and that they focused on getting her home from the moment she got there. Czechia is moving

towards a system similar to Bohnice where there is a combination of in-patient for more severe cases

and out-patient for the less severe cases (Tresnak, 2014). This change also may help with the huge

imbalance of out-patient psychiatrists (875) and patients in their care (650,000) this overload causes

psychiatrists to refuse any new patients or adding them to 6-month waiting lists (Pec, 2018). Yet, there

still needs to be an end to the stigma that can affect the number of psychiatrists available to work in

these facilities. Although it’s only the beginning, a creation of community-based care with multi-

disciplinary professionals working together is a huge improvement on the overcrowded, large hospitals

of Czechia’s past.

Another issue with a reform in mental health is the funding to do it. One of the major

hindrances within Czechia making these reforms is the government. The predominant stigma leads to

politicians not viewing mental health as a priority, causing only 4% of the health-care-sector spending on

psychiatric care in 2008, the least of the 27 EU countries (Krosnar, 2008). Although they appear to be

spending a comparable amount to other EU countries now, but since they have a higher GDP their
economy is well-equipped to spend money on mental health (Pec, 2018). Many believe that the Czech

people are ready for a change but that the media and politicians need to take more responsibility to

help create that change (Lazarova, 2016; Tresnek, 2014). Although there is hope for a change in

Czechia’s mental health system, and the Ministry of Health decided to use part of the 2014-2020 ESF

(European Social Fund) to aid in psychiatric care reform (Pec, 2018).

 References

Formánek, T., Kagström, A., Cermakova, P., Csémy, L., Mladá, K., & Winkler, P. (2019). Prevalence of

mental disorders and associated disability: Results from the cross-sectional CZEch mental health

Study (CZEMS). European Psychiatry, 60, 1–6. doi:10.1016/j.eurpsy.2019.05.001

Helliwell, J. F., Layard, R., Sachs, J. D., & De Neve, J.-E. (2019). World Happiness Report. Retrieved from

https://en.wikipedia.org/wiki/World_Happiness_Report#2019_World_Happiness_Report

Krosnar, K. (2008). Czechs open up about mental health problems. The Lancet 371(9625).

doi:10.1016/S0140-6736(08)60710-2

Lazarova, D. (2016). Mental illness stigma still a big problem in the Czech Republic. Retrieved from

https://www.radio.cz/en/section/panorama/mental-illness-stigma-still-a-big-problem-in-the-czech-

republic

Pec, O. (2018). Mental health reforms in the Czech Republic. BJPsych International, 1–3.

doi:10.1192/bji.2017.27

Scott, R. (2017). The Czech Relationship with Alcohol - Prague, Czech Republic. Retrieved from

https://news.expats.cz/czech-culture/the-czech-relationship-with-alcohol/

Třešňák, P (2014). Taking mental health into the community. Bulletin of the World Health Organization,

92(10), 702–703. doi:10.2471/blt.14.021014