Population: 5,5 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 low number of psychiatrists in Slovakia is a sign of the seriously lacking quality treatment for people with depression. There are 306 outpatient psychiatrists in total in Slovakia, or 4.9 psychiatrists per 100,000 inhabitants,12 as compared to the EU average of 17. 17
The country also has a shortage of psychotherapists, which is largely due to systematic barriers.12 An average waiting period for a psychiatric examination is more than seven weeks in Slovakia.18
Some data about depression are collected at a nationwide level, but they are either not collected systematically or only the very basic data are collected, for example, the prevalence of depression. The real incidence of mental disorders has yet not been documented in Slovakia.12
The total number of suicides follows a downward trend since 2008 in Slovakia. According to the most recent data, there were 9 deaths from suicide per 100,000 inhabitants in 2020.14 However, these data, too, may be distorted by an inadequate or overcomplicated way of their reporting.
Slovakia spends 3.1-3.3% of total health care expenditure on mental health treatment; this accounts for 0.2% of GDP (2017) whereas the OECD average is as much as 6-7%.12
Although Slovakia introduced the National Mental Health Programme as early as 2004, it discusses depression only marginally.22
Even though the formal framework for the integration of health care for patients with depression already exists, its practical application is still insufficient.20 Over 80% of patients with depression are treated by psychiatrists while general practitioners only treat less than 10% of cases.26
There are several patient organisations in Slovakia that provide support and assistance to people with depression and their family members, and are also partially involved in the planning of national mental health programmes.22 Technology-based forms of support and assistance are also available in Slovakia, such as phone and email consultations and remote therapy sessions.
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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 first National Mental Health Programme, prepared by the Ministry of Health of the Slovak Republic and adopted in 2004, is a strategic document responding to the system-level shortcomings and deficiencies in mental health care. The programme does not pay particular attention to specific diagnoses but depressive disorders are mentioned several times under major groups of diseases on which the proposed measures should focus.22
The current Slovak Cabinet considers mental health one of the main priorities for the health care sector; therefore, the Ministry of Health set up the inter-ministerial and intersectoral Council of the Slovak Government for Mental Health in February 2021 to act as a permanent advisory body to the Slovak Government.
The main document that defines the attributes of the provision of mental health care services in the coming years, including a multidisciplinary approach to patients and their needs, is the Concept of Psychiatric Care which entered into force in 2022. The new concept has introduced several major changes – for example, it lays down the basis for the development of community-based care and defines the term ‘peer consultant’, their roles and competencies as part of a team working in a facility of community-based psychiatric care.24
Mental health is also addressed in the Recovery and Resilience Plan which responds to the consequences of the COVID19 pandemic.23
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 Council of the Slovak Government for Mental Health is gradually starting its work, but no major changes have yet been brought about in the sector. Patient organisations are largely dissatisfied with its functioning, as they, though being represented in the Council, do not in fact have many possibilities to influence its activities and direction.37,38
According to the National Health Information Centre data, depression is predominantly treated in an outpatient setting in Slovakia (95% of interventions). 21,41
The availability to health care services for people with depression has several substantial limitations in Slovakia. The total number of psychiatrists is far below the EU average, psychiatric offices are unevenly distributed across the country, and waiting periods for examination exceed seven weeks on average.18 Patients, therefore, must seek therapies outside of the public health care sector. However, such therapies are quite expensive and many patients cannot afford the necessary follow-up care.
More than 80% of patients with depression are treated by psychiatrists in Slovakia, while less than 10% of patients receive treatment by general practitioners.26 However, it is very often general practitioners or specialists other than psychiatrists whom patients with depression contact in the first place.39
Experts also draw attention to the fact that while the provision of acute care is at a very high level, Slovakia considerably lags behind in the delivery of follow-up care. This is linked to the underdeveloped capacities in the community-based care, non-engagement of experts with a lower degree of qualification in the treatment, as well as the non-use of so-called peer consultants.
The shortage of experts on psychotherapy represents a serious problem in the provision of necessary health care to people with depression. The psychotherapist profession as such does not officially exist in Slovakia; psychotherapy may only be provided by certified physicians and psychologists. The National Health Information Centre had 440 clinical psychologists in its official database in 2018, but the exact numbers on psychotherapy specialists are unavailable – the data on private therapists are particularly missing. This deficit is caused by system-level barriers, such as, for example, long and expensive training.
Is collaboration between primary care and mental health services supported and incentivised / encouraged / facilitated?
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 overall shortage of qualified doctors is also felt in the necessary medical specialisations. According to the official data, there were less than 60 paediatric psychiatrists in Slovakia in 2018 and only 29 of them provided outpatient care. The main cause is the low attractiveness of this specialisation, which considerably narrows other options for specialists in this field – child psychiatrists can treat children and adolescents only. In addition, there is now just one day care centre specialised in paediatric psychiatry working in Slovakia.12
The need to increase the number of school psychologists has long been discussed in Slovakia. Since not all schools have the necessary funds for this purpose, only some of them are able to provide psychology services and consultations to their students.
Slovakia has few geriatric psychiatry specialists; this specialisation cannot even be studied in Slovakia at the moment. The shortage of specialists is also linked with the low number of psychiatric departments for senior citizens and no day care centre for this at-risk group exists at all.12
Promoting and supporting mental health of employees is in the hand of employers, non-governmental organisations and educational institutions.12
According to the National Mental Health Programme, mental health care services need to be made available and affordable to the groups of population that are at risk of social exclusion, including the homeless people.22 However, practical support and assistance to the homeless people with depression is limited. Some assistance is provided through prevention and support programmes for homeless people delivered by non-governmental organisations (e.g., Vagus, DePaul, Nota Bene, Odyseus, Prima). 12
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
Systematic collection of medical data is provided by the National Health Information Centre (NHIC) in Slovakia. Among other things, the NHIC regularly publishes annual data on mental illnesses. The data are based on the reports about hospitalisations provided by hospitals and on the information about visits to outpatient specialists – psychiatrists.41,42 Even though they provide quite an accurate picture of the treated and/or registered cases and patients, they give less information about the overall prevalence of mental illnesses in the Slovak population. This category of data thus remains distorted, according to experts, because many people with mental illnesses do not seek and/or do not receive specialist help.12 We may thus conclude that the actual prevalence of mental illnesses has not been documented in Slovakia so far.
Only one epidemiology study focused on these disorders was conducted in Slovakia so far, in 2003.19
Just as the data on the prevalence on mental illnesses are not systematically collected in Slovakia, the outcomes of treatment and the quality of health care provided, which could be reported by patients themselves, are not measured, either.
One of the first recommendations made by the Council of the Slovak Government for Mental Health called for the implementation of a project to collect and process data on mental health which should also involve the establishment of a National Registry of Mental Illnesses.44 Implementing this expert proposal would help better map and assess the actual situation in mental health and, among other things, contribute to meeting the objectives set under the current National Mental Health Programme, too.
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
The two existing framework documents – National Mental Health Programme and the Concept of Psychiatric Care – recognise the need to engage people with mental illnesses and their family members or carers in the planning, delivery and evaluation of health care.22,24 However, the involvement of patients and/or patient organisations in the preparation of strategic documents and reform plans has so far been rather limited. Even though, formally, some patient organisations are invited to participate in inter-ministerial task groups that prepare strategic plans,22,36 their actual impact is negligible when compared to other professional associations.
Family members or carers of people with depression also face a complicated situation. Slovakia does not currently have a system-level state financial mechanism in place to support people who provide care to patients with depression. Financial assistance is only available to carers of people with severe disabilities.45
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?
The peer support scheme for patients with depression is not yet sufficiently developed in Slovakia. Although diagnostic and treatment guidelines mention community-based care as an ideal way to provide care to patients with depression, they do not offer any specific information about this form of support.46,47 Sociotherapy clubs in which peer support roles can be engaged provide help mainly to people with substance addictions. Also, peer consultants are not entitled to any financial compensations for their services in Slovakia.
There are dozens of nationwide mental health support organisations in Slovakia. Some of them provide help to people with the whole spectrum of mental health issues (e.g., Liga za duševné zdravie, No more stigma), others concentrate on selected risk groups.12 However, these organisations often encounter a barrier in the form of insufficient funding which considerably limits their possibilities and the outreach – being non-profit organisations, they rely on the limited financial support from the state, grants and voluntary financial donations from the public.
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.
Digital tools and modern technologies are increasingly involved in the provision of health care. Their uptake has considerably increased in Slovakia in response to the COVID-19 pandemic, including with respect to mental health care, where regular face-to-face therapeutic sessions were largely limited. Nevertheless, traditional means still remain to be used to a large degree, such as, for instance, hotlines which mainly provide free consultations and advice.
These hotlines are usually operated by non-profit organisations; a state-sponsored hotline resumed its operation in 2021. The state expects that the relaunched hotline will make professional support accessible to a group of people who have not so far sought such support mainly due to a social stigma.27 Thousands of consultations are provided through support hotlines each year.12 Online therapeutic sessions with psychologists or psychotherapists are much less available.
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 existing National Mental Health Programme and diagnostic and treatment guidelines have long failed to respond to the need of providing remote health care services.22,46,47 However, standing face-to-face with the COVID-19 pandemic, professional associations and the health ministry responded by amending methodology guidelines and procedures. In 2020, the Ministry of Health of the Slovak Republic published the Standard Procedure for the Provision of Psychiatric Care during the Pandemic, which expressly specifies that psychiatric patients who tested positive for COVID-19, but do not require hospitalisation for psychiatric indication should receive psychiatric treatment in their home setting with the use of telemedicine options – telepsychiatry and telepsychotherapy.48
The applicable standard diagnostic and therapeutic guideline on the comprehensive psychological management of adult patients with a depressive episode and recurrent depressive disorder, in force from July 2021, contains recommendations to use computer-based cognitive behavioural therapy (cCBT) in the first-line treatment of subclinical, mild to moderate depression.49 The current rate of use of cCBT in practice is unknown, however.
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?
A relatively advanced technology solution is used for the renewal of drug prescriptions in Slovakia. Patients with mental illnesses (including depression) can request a renewed prescription by phone and collect their prescription drugs directly in a pharmacy (through the eZdravie platform).28 Thanks to the available apps and health insurers’ online platforms, patients get an overview of the received medical care and of prescribed medical drugs. These tools are user-friendly and secured by encryption.
Generally, however, the use of advanced technologies in the provision of health care to patients with mental health issues in Slovakia falls short of the possibilities and potential of today’s technological development. Experience of other countries shows that their wider practical application could make the necessary therapeutic options available to a larger group of patients, decreasing the costs for patients, health care providers, as well as health insurance companies. Moreover, treatment would become more effective and the collected data could contribute to improved policy-making in the area of mental health and to an overall better setting of the system’s functioning.
Acute health care available to patients with mental illnesses, including patients with depression of various grades, is currently functioning very well in Slovakia. However, there seems to be a problem with the provision of follow-up care and long-term patient management. The key reasons are capacities, funding but, most of all, the system as such.
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Even though patients are entitled to therapeutic care covered from the public health insurance scheme, its actual provision encounters barriers in the form of limited personnel and financial capacities available in the system, while therapeutic options available outside the public health care system are expensive for patients. Patients must wait a long time for therapy and their treatment often comes late. The situation is further complicated by a social stigma that people with depression have to bear.
Moreover, Slovakia still does not have an established system of community centres and comprehensive – integrated care. Patients are also little involved in decision-making processes and peer support programmes. Yet the experience from other countries shows that exactly this kind of solution to the follow-up care proves to be working and effective in delivering the necessary assistance and support to people with depression. It is positive that this fact is recognised both by the representatives of patient organisations and health care providers. Both groups, therefore, seek adoption of necessary system-level changes in this area.
Several strategic documents were adopted in the recent months in response to the current state of affairs, and the cross-ministerial Council of the Slovak Government for Mental Health was established in order to help improve the functioning of the system. Despite the fact that changing the way health care is provided to people with mental health issues struggles with a number of problems, e.g., the lack of data, the start of change processes gives hope that the situation will improve in future.
Slovakia has a long-lasting problem in the area of prevention and provision of follow-up care to people with depression. It is, therefore, necessary to expand integrated care services in the system, e.g., by developing community centres for patients. Community centres could also help with prevention and shortening the time of hospitalisations, or post-treatment of residual symptoms of depression. Their indisputable benefits also include better coordinated and comprehensive health and social care services, which the system is notably lacking today.
The shortage of personnel in the system and related problems with availability of follow-up care could be addressed by easing qualification requirements and shortening the duration of professional training to provide therapy to people with lighter depression, systematic engagement of family members, relatives and friends, and by developing peer support.
Prevention and assistance projects and programmes need to be implemented, focusing on at-risk groups such as young people, seniors and marginalised (vulnerable) groups of population. Such programmes are now virtually absent both at the national as well as community level.
Slovakia could benefit from more intensive promotion of specialised awareness-raising campaigns to encourage people with depression to seek the necessary medical care, as well as campaigns to eliminate the social stigma associated with mental health issues.
Slovakia has a long-lasting problem with health data. The country is missing patient registers, as well as systematic epidemiological studies. However, pressure is mounting both from within the health care system and among patients to improve the existing conditions. The announced preparation of a new epidemiological study on mental health under the Slovak Recovery and Resilience Plan is also good news in this respect.
The lack of relevant data complicates the efforts to introduce system-level changes in mental health care. More intensive sharing and analysing of health insurers’ data, results of expert studies and patients’ feedback on the quality of life is needed. The aim is to better monitor and understand the real needs in the system and to respond more actively to the shortcomings in the treatment of depression.
Slovakia could considerably benefit from the establishment of a central database, or an information hub, that will contain information about the available health services, as well as about comprehensive care options for patients with depression.
Patients and/or patient organisations are today formally involved in projects aimed at reforming the existing system of mental health care. However, they only have limited possibilities to actively participate and shape the content and direction of such projects. Their engagement in defining the system-level changes could contribute to a more effective setting and higher quality of health care services.
Standard medical guidelines on depression have recently been updated to respond to the latest therapeutic trends. However, they still do not cover good practices from a number of countries where specialists with lower qualification, people with depression, their carers and families are encouraged to actively engage in therapy. Future updates should cover this area, too.
Slovakia currently has no scheme to provide financial and material support to carers and relatives who provide care to people with depression. It is desirable to make such support mechanisms a part of comprehensive system reforms.
No national or regional list of digital tools that health care providers can use exists in the Slovak health care system today. No special grant schemes are in place to coordinate or fund their implementation into practice. The current situation requires introducing standardised guidelines and professional training for working with digital tools, including the cyber and data security.
Given the expected increase in the number of people with various grades of depression and the limited professional capacities, it is necessary that the number of digital tools continues growing. We must prepare for this in technical terms, as well as in terms of funding of online therapy options, professional consultations and multidisciplinary care.
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