Helsinki Foundation Report

In 2009, a team of HFHR associates performed monitoring of the observance of patients’ rights and access to stationary drug addiction treatment. The research was conducted at 18 centers (over 20% of the total number) located in 6 Voivodships (provinces): Masovian, Lesser Poland, Kuyavian-Pomeranian, Lubusz, Łódź and Silesian.

In addition, in-depth interviews were held with seven former patients of different centers, currently in the care of outpatients’ clinics.

Among the monitored centers, 7 were run by the MONAR Association (about 39%) and 5 by other non-governmental organizations (28%); for 4 of them the lead authority was the local government (22%); 1 was run by a Church organization (5.5%) and 1 by a private person (5.5%).

4 centers admitted minors and 3 housed mothers with children. Most centers conducted long-term therapy – over 12 months (ca. 70%), moreover at a few of them it was possible to carry out treatment for as long as 24 months. Short term therapy (up to 6 months) was offered by three centers, including one for a period of 8-9 weeks.

Information was collected on the basis of: observation, document analysis and targeted interviews with center staff (managers and therapists) as well as patients.

The analysis of collected material shows that the state of observance of fundamental human rights (right to information, right to protection from degrading treatment, right to privacy, right to contact relatives and loved ones, right to lodge a complaint, right to education) can be regarded as faultless. Reservations and concerns relate to, in particular: the use – at some centers – of degrading treatment during body searches, not always justified restrictions with regard to contacts with relatives or in the sphere of private life, extra burdens and consequences – in fact penalties not always clearly defined, but proposed by the community or functional staff. It is disturbing that the manner of treating human / patients’ rights seems to be all for show – there are sometimes all too many formal recorded directories, but neither the staff nor the patients attach any importance to this.

Research has shown that there is no problem with access to stationary treatment. On the contrary, it’s rather the facilities that seek out clients. On the one hand, accessibility of treatment is a positive development, on the other though – it is sometimes abused. Patients often treat their stay at the center as an opportunity to improve their physical condition, survive the winter, wait out a difficult time in their life, and not as a real opportunity to break the addiction. Such terms have been used as “resort tourism”, or the need to “get a grip on oneself”. Data regarding patients, who fail to complete the therapy (approximately 70-75%) and then end up back at other resorts (record holders do so 11-12 times), are very disturbing both in terms of the effectiveness of the treatment and the costs incurred by the Polish National Health Fund (NFZ), and de facto by taxpayers. 75% of the resources allocated to drug addiction treatment are “consumed” by stationary centers, and this hasn’t changed for years, though formally there is a growing number of daytime clinics and substitutable programs. Most of the funds come from the National Health Fund and not from the state budget, because the patients are “formally” insured (those uninsured are registered as unemployed, only so they can obtain health insurance).

There are no standards and fixed mechanisms for verifying the effectiveness of drug addiction treatment, as well as the effects of actions carried out by specific centers.

Looking at the offer available to patients who decide to undergo stationary treatment, the primary difference is in fact the duration of the stay at the center. All the centers offer treatment using the therapeutic community method along with the component of individual and group therapy, which usually means psycho-educational activities. At the short-term treatment centers there are more therapeutic activities in the strict sense, while the long-term therapy involves various types of work often referred to as ergotherapy. However, we could not find confirmation that those who stay at the institutions for longer (1.5 – 2 years and more), doing various types of community work to learn responsibility, are better prepared for independent and sober life. We understand that the clean-up work done on behalf of the center may have educational value and is necessary, but it is difficult to agree that this should be considered as therapy.

In addition, our research shows that courts rarely benefit from the opportunity to direct drug addicts sentenced under the Act on prevention of drug abuse and the Act on juvenile delinquency proceedings to these centers.

Directors and therapists from the monitored centers indicated the lack of cooperation, and often even competition, between stationary and outpatient treatment institutions. There is no cooperation and there is no flow of information about patients between outpatient and stationary centers.

In our view, there is a need to perform an assessment of the Polish model / system of drug addiction treatment. It would be good to verify and diversify the offer in the scope of stationary treatment. Perhaps the long-term residence facilities, at which clean-up work occupies the majority of the residents’ time have a raison d‘etre, but as guardianship institutions under the Ministry of Social Welfare and not the Ministry of Health. Undoubtedly, the range of therapeutic offers should be more diversified, not only based on the duration of the stay. Those who want to “mend” their physical condition could be sent to guardianship facilities, which are cheaper and at which they would have to perform work for the benefit of the center and to earn their keep.

It is necessary to ensure cooperation between outpatient and stationary treatment institutions. Perhaps there should be a database with information (appropriately protected of course) about patients, their problems, the course of their therapy, so that successive therapists dealing with a given person have the appropriate information.

Maybe there is no need for such a large number of stationary centers and emphasis should be put on developing the system of outpatient treatment, where such an important element consisting in family therapy could be carried out.

Perhaps the stationary treatment centers in the strict sense should admit those who have been subject to therapy at outpatients’ clinics and are more motivated to undergo treatment. Maybe access to stationary treatment should be in some way regulated, so that patients do not treat their stay at the center as a way to temporarily “mend” their health or to find a place of temporary residence.

The effectiveness of the therapy should be assessed, also in the context of the costs incurred, especially since they vary considerably. There is a need to elaborate addiction treatment standards based on modern knowledge and economic analysis.