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The aim of this paper was a reflection on the most significant events in Polish psychiatry in 2003. Reform in health care financing and its realisation in 2003 introduced a risk of inhibiting further development of mental health care. The endangerment is a result of allocation of resources, which is inadequate to real costs and promotes in-patient treatment. An additional risk is seen in a project of privatisation of health care institutions. Increasing orientation towards methodology of molecular biology, which is similar to a general global tendency, influences research in psychiatry. Nevertheless the low number of publications resulting from government sponsored studies is disturbing. The situation in forensic psychiatry calls for involvement and studies. Psychiatria Polska published a report indicating low standard of psychiatric expertise for courts and high probability of corruption. The same was reflected in mass media publications later on. Polish Psychiatric Association Board had appointed a special commission to study this problem.

The aim of this paper is a reflection upon the most important issues in Polish psychiatry in 2002. In the mental health care development, an unfavorable legal regulation on the profession of the psychologist was passed and another change in health care financing in Poland. The role of Polish psychiatrists in international actions inspired by the World Psychiatric Association could be noted, especially in the de-stigmatising "Open the doors", as well as the stance towards 2nd generation antipsychotics. A positive growing interest and tendency in post-graduate psychiatric training was noticed, especially constant training. The publication of a new, large clinical textbook on psychiatry was noted, leading the probable direction of post-graduate training and development of scientific research. Special attention was drawn to the return of neuro-surgical interventions in treatment resistant obsessive-compulsive disorders, namely the nonstandard position of stereotactic operations on the limbic system in these disorders. Such a position is the result of insufficient scientific documentation on the effectiveness of such procedures and weakly documented theoretical bases.

History of undergraduate training in psychiatry at medical schools in Poland was briefly reviewed showing a traditional independence of chairpersons of psychiatry in forming programmes and deciding about forms of education. Since 1990 this independence has been controlled by the faculties and, to some extent only, regulated by the national curriculum in medicine. Goals, contents and forms of undergraduate training in psychiatry were examined (following Bilikiewicz's study in 1994) with the author's own questionnaire. Professors of psychiatry, respondents to the questionnaire were of very similar opinions in regard to the goals of training. At the same time, meaningful differences were found in the methods used, position of the subject in the curriculum and even time designed for psychiatry training (at some schools below the national minimum). There were also significant differences in the contents of the programme. The most important problem seems to be absence of child and adolescent psychiatry at some schools. Integration of psychiatry with other pre-clinical and clinical subjects was assessed too. The information received suggests that Polish professors of psychiatry approved of the way their subject had been integrated with others. This seems to be overestimation, especially if compared with the Kraków experience presented in a more detailed way.

Human rights, an issue of political debates in the last decades, listed in the United Nations Declaration of 1946 are rooted in the humanistic tradition of philosophy and religion. The UN declared their universal character and made state organizations responsible for their observation. Among all human rights that for freedom is usually perceived as crucial. Psychiatry developed in Europe primarily a caring function. The medical model developed in psychiatry through the 19th c. supplied the criteria for medical diagnosis of mental disturbance, and elaborated a system of treatment which included long term hospitalization. Medicalization of psychiatry (recently coming back) is a force which gives courage to those who suffer, to their families, and to professionals as well. This power however, can be easily abused, when a psychiatrist adopts a position of someone who knows better that which is good for his/her patient. Legal regulations of the circumstances of psychiatric treatment, especially treatment against the patient's will should prevent the abuse of the mentally disturbed person's right for freedom. The goal is usually achieved by clear description of clinical and other conditions under which a person can be committed, and by establishing the committed person's right to claim the decision to be unjust. Poland is a country without legal regulation in the area of mental health (there are only administrative acts). For more than sixty years several projects on mental health law have been worked on. The last one which came to the Sejm (parliament) in 1980 was withdrawn by the "Solidarity" Trade Union. At present, the membership of Poland in international organizations makes an introduction of mental health law an obligation. Having no legal regulation, Polish psychiatry has been a self-regulating system. It is worth to note that even in the hard Stalinist period (1947-1956) there was no abuse of psychiatry for political reasons. The main reason for Polish psychiatry staying free from political abuse is seen in the role of internalized norm of human dignity. But others should also be taken into account. It was a specificity of the political situation that the ruling powers did not insist that psychiatrists cooperate. On the other hand the integration of the Polish psychiatric community was helpful in observing the rule of non-collaboration. One of the most important factors is seen as the experience and memory of NAZI crimes in the field of psychiatry in Poland. Extermination of psychiatric patients had to leave the feeling of the importance of psychiatrist's own responsibility.(ABSTRACT TRUNCATED AT 400 WORDS)