Background. Deinstitutionalization, reduction of hospital admissions and provision of community-based psychiatric services are the commonly accepted postulates ofpsychiatry in the process of reform. In the paper an impact of both the ongoing general health care reform and the system of contracting health care services on the functioning and development of community psychiatry is assessed.
Method. An analysis is presented of changes in the structure of psychiatric care provision in Poland since the year 1970, in terms of deinstitutionalization and development of community-based forms ofpsychiatric services.
Results. In recent years the number ofpsychiatric wards in general hospitals and of day hospitals has increased, and community-based facilities providing social support to the mentally ill are being established within the welfare system. Nevertheless, the community psychiatry model implemented since the 1970s seems to be endangered at present. The index of the total number of psychiatric beds has increased in the years 1999-2003, especially as regards long-term care, which may be a symptom of the so-called transinstitutionalization.
Conclusions. There is a need for the development of integrated community-based psychiatric care forms that would co-ordinate health care and welfare services provision. An assessment of the total number of people with mental disorders admitted to inpatient facilities providing long-term care, both in the health care and welfare structures, is indicated.