As noted earlier, mental health disorders have been perceived as a "shameful" disease. In the case of severe mental illness the usual treatment was long-term hospitalisation in a psychiatric institution. Other mental health disorders, such as depression, were usually diagnosed many years after their onset. Psychiatric treatment has been, and often still is, perceived as a sad necessity, experienced with shame, and kept secret even from the patient's family.
In the past, treatment of individuals with mental health disorders by primary care practitioners or by various non-psychiatric medical specialists was usually ineffective and frequently inappropriate. It sometimes exacerbated mental health problems and had negative effects, such as unnecessary prescribed drug dependency. Only in recent years have primary care physicians ((family doctors) acquired more extensive knowledge in the field of mental health disorders. In undergraduate and postgraduate training, psychiatry now ranks as one of the five basic medical disciplines. Postgraduate training courses for family doctors acquaint them with methods of diagnosing and treating mental health disorders, especially depression. A regulation, passed in 1999, now requires that primary care physicians make decisions concerning diagnostic procedures and treatment for any self-referred patient with mental health problems. However, despite the new training initiatives, the majority of physicians are still not adequately prepared for early diagnosis and appropriate treatment of mental health disorders.
People with mental health problems can consult a psychiatrist through self-referral, without referral from a family doctor. In recent years, as the public has become more knowledgeable about the nature of mental health problems, many individuals have taken advantage of self-referral.
In Poland neither social workers (welfare officers) nor occupational medicine physicians have been trained in evaluating and diagnosing mental health disorders. Steps have been taken to correct this. The Institute of Occupational Medicine obtained the rights to a Polish adaptation of the General Health Questionnaire (GHQ) developed by David Goldberg.7 This is a widely used tool for assessing mental health status. It provides a screening scale to identify people in need of more detailed psychiatric diagnosis and care. Physicians trained in occupational medicine will be equipped with the Polish adaptation of the GHQ so that they can identify workers requiring psychiatric or psychological help during routine workplace medical examinations. Until now this type of diagnosis has been based on an interview and the doctor's intuition.
Legislation and policy
Before passage of Poland's Mental Health Act, "mental health" was defined as an "absence of mental health disorders." Therefore, activities on behalf of mental health protection consisted in treatment and rehabilitation rather than in the prevention of mental health disorders. The Mental Health Act provided the first explicit definition of "mental health" and set out goals and methods for addressing mental health promotion and the prevention of mental health disorders.
For at least two decades, efforts to pass legislation to guarantee the mentally ill their basic human rights and the rights to employment and decent living conditions were unsuccessful. Though the first draft of the Mental Health Act was completed in 1970, the Polish Parliament did not consider
