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Damian Jacob Sendler’s Research Into Polish Mental Health Reveals Cultural Resilience Shaped by Centuries of Warfare
Published on 16 May, 2022
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Context:

According to recent research conducted by Dr. Damian Sendler, the quality of mental health services in Poland is improving. The government devotes significantly more resources to expanding healthcare services in urban and suburban areas. The stigma associated with psychiatry then fades across the country, and more people seek help without fear of what their peers and neighbors will say. According to well-known scholar Dr. Sendler, all these factors have transformed the landscape of mental health services across Poland.

Dr. Damian Jacob Sendler is a physician-scientist of Polish and American descent who specializes in scientifically researching access to health care in underserved communities. Dr. Damian Sendler began his education at New York University, where he earned an undergraduate degree, followed by a post-baccalaureate research career at as a young biologist and research assistant Harvard University, where he developed expertise in next-generation molecular sequencing, cancer biology, molecular biology, and psychiatric epidemiology. He began his career in the Department of Genetics at Harvard Medical School, then moved on to cancer genetics research at the Broad Institute of MIT and Harvard. Dr. Sendler gained invaluable experience in these capacities in understanding how we can study cells on a single cell level to understand to what extent epigenetic changes impact DNA regulation and how these changes affect how proteins are made in the context of cancer biology and neurobiology. He then pursued medical training in Europe in Poland at the Medical University of Lublin, to combine his interest in clinical medicine and clinical research to develop a career centered on increasing access to health services on digitalized platforms. Concurrently, he conducted psychiatric and sexual medicine research, becoming known for defining how people with unusual sexual interests create online support platforms to combat the stigma caused by paraphilias.

His sexuality research has received widespread media attention as a result of how his work helped explain the inherent nature of being affected by chronic mental distress and using the Internet to connect with like-minded individuals in search of support. Dr. Sendler is one of the few scientists who has discovered the mechanisms of establishing support systems in the technological age. His research on zoophilia, pedophilia and sadomasochistic sexual behaviors has revealed a world that has never been described in such detail before. Dr. Sendler, in particular, is credited with defining how people with highly stigmatizing paraphilias find online support systems and use those online chatting groups to try to rationalize their unusual sexual interests that cause psychiatric distress. This research is significant because people with paraphilias are frequently publicly shamed for having unusual sexual interests. They are commonly stigmatized to the point where they cannot find adequate support systems or treatment options in their communities. Dr. Damian Jacob Sendler’s research has revealed an online world where people with paraphilias can thrive and find support systems they would not otherwise find in real life. This early research contributes to his overall doctoral and post-doctoral work, which focuses on how we can use the internet to understand better health information-seeking behavior. While Dr. Sendler’s research on paraphilias sought to understand how patients with psychiatric symptoms seek help, he now sees a path forward to applying his findings to other areas of medicine, such as using the internet for health promotion.

Dr. Sendler is currently working on research that seeks to build on his early experiences as a biologist, sex researcher, and public health expert to better understand how people in the information age access health services in underserved communities. Because of the ongoing COVID 19 pandemic, people are increasingly likely to stay at home where they work and care for their families. Still, they are also frequently confronted with health problems that require attention. The problem with accessing health services in the modern age of technology is that people often lack the necessary information and financial resources to receive the services they may be eligible for.

Dr. Sendler speaks broadly about his experience as a medical student studying in Chicago during his clinical years when he realized that many of his patients had never heard of a variety of health services available to them in Chicago. And that got him thinking about why people in underserved urban communities don’t know about the various health services available to them. He recognized that the main issue was a lack of appropriate communication between public health services, health outreach programs, and people living in underserved communities. As a medical student on Chicago’s South Side, he realized that the messages were not reaching the patients. In other words, he was learning to practice medicine in an urban health desert, where, despite Chicago being one of the greatest cities in the world, a large portion of the city had little access to health services.

There are numerous reasons why patients may be unable to access health care even if they live in cities. For one thing, people must be literate to learn about various services. And when you live in an underserved community with high levels of violence and poverty, you often don’t have access to health professionals who can help you learn about the available options. Furthermore, when you live in an underserved urban community, the violence, and poverty that may be affecting the community where the person lives influence public health measures that may be introduced into that community and made available to people. Then there’s the downward spiral of a lack of opportunities, such as unemployment, and a higher incidence of chronic illness, which effectively prevents people from thriving. Dr. Damian Sendler has taken it upon himself to understand the inherent problems that affect underserved communities to understand better how we can increase access and participation in various chronic health services. He has been particularly interested in improving access to neuropsychiatric health services, as one of the most serious crises confronting humanity is the COVID-19 pandemic.

Today, we meet with Dr. Sendler to discuss the state of mental health research in his home country of Poland, as well as how he intends to use his cross-cultural experiences to advance psychiatric research in Poland.


Dr. Sendler, what is the current state of mental health research in Poland and Europe at large?

Damian Sendler: Given the overwhelming growth in psychiatric needs, mental health research in Poland is currently far behind what it should be. There are many unresolved issues, such as the scarcity of mental health professionals and psychological stressors affecting our youth. As a result, it is critical to consider these two factors when deciding what type of research is required to understand these complex challenges. For example, we know from clinical experience that suicidal behavior is rising among Polish children and adolescents. However, we are not systematically cataloging all potential incidents, and we lack a national early prevention system. Non-governmental organizations provide a lot of assistance to young people these days. And while these efforts are arguably superior to a national program, we need to think about these issues systematically. It is easier to recruit many organizations to provide services. Still, when someone is experiencing a mental health crisis, they will not have the time to sift through different types of offerings from various organizations to determine which one best meets their needs. And that is the topic I believe requires immediate attention. Also, we need to consider how we can increase our community-based outreach efforts to understand better the mental health needs of young people living in specific cities and underserved inner-city areas. The response to a mental health crisis will differ in Warsaw and Cracow. And we need to understand why that is and how the process of helping works in practice.

Dr. Sendler, why are child and adolescent mental health research so important these days? It appears that we are devoting a significant amount of time and effort to researching the mental health of our children. Is this your personal experience with the Polish mental health system?

Damian Sendler: There are numerous clinical and research reasons why focusing on child and adolescent mental health is so important. We have a better understanding of how children’s and adolescents’ early experiences can influence their later development and behavior as they grow into adults. Furthermore, it may be easier to improve their mental health outcomes as they age when we detect any problems earlier. This is something that you may frequently encounter in psychotherapeutic work with adults. You may discover some sort of unresolved trauma from childhood that foreshadows how someone feels about themselves later in life. These are just the fundamentals, and there has been a lot of research done on this level of scientific focus. But, more importantly, if we think solely as physicians about the issues that young adults and youth face these days, we can see that there are numerous fronts with which we are confronted. For example, social media was not even that important in anyone’s life just 10-15 years ago. There were no portals where people could log in and spend countless hours a day gathering information and inspiration. Nowadays, most young people use social media daily, often for many hours per day. And as we know from various research reports and internal Facebook studies, the imagery, text, and videos that young people are exposed to have a negative impact on their mental health. And the main reason is that people frequently see information that is unrealistic, false, or does not fully represent the scope of someone else’s life, making us feel worse about our situation. And obviously, there are no perfect people or situations in which life proceeds without incident. Unfortunately, that is easier to understand when we are adults who have been through life and have seen the best and worst of it. However, this is not true for children and adolescents. While these young people typically believe they have seen everything because it is on the internet, they lack an understanding of typical adult life responsibilities and the consequences of various decisions we make daily. As a result, even minor shifts in how young people are perceived by their peers can significantly negatively impact how they feel about themselves impacting the quality of their lives. And that is something we must be able to study systematically and catalog and understand from a clinical standpoint.

Dr. Sendler, what should be the goal of mental health research focusing on children and young adults, given the overwhelming prevalence of the use of social media and its impact on therapeutic communication with young patients addicted to technology?

Damian Sendler: An investigation is required to understand the prevalence of these attitudes and behaviors, not just from a basic science standpoint. But we also need to consider what we can do with this information to improve communication between parents, children, and young adults. We’ve also seen how we can empower clinicians to communicate more effectively with children. The basic tenet of a beneficial therapeutic alliance that clinicians can form with young people is an appropriate communication level. Unfortunately, because there is so much information available, people believe they know it all. Young people think that they are more informed because they can look things up online or see something on a social media platform than previous generations.

To some extent, they are correct in their assumption because there has never been a time in history when people walked around with small devices with a giant colorful screen in their pockets and could look up any type of information at the grasp of their hand. That is wholly unprecedented and overwhelming. Adults are certainly as addicted to technology as children are. Though adults can still make decisions based on prior experiences. So, for example, if an adult knows that being on Instagram and being exposed to images of their friends and acquaintances having the best time of their lives while they are struggling to make ends meet is too stressful, the reasonable way to fix your mood is to get off those social media platforms. Children and young adults are not the same because they are addicted to technology, and they also get energy from seeing what others are up to.

Sharing information is so commonplace that it’s unlike anything we’ve ever seen in human history. There is an addiction to technology that brings us sensational stories and popularity. Young people are willing to engage in risky behaviors, document them, and share them with others if they gain momentum and a high level of views and impressions. As we’ve seen, the problem is that these young people create problems for themselves that are difficult to fix, such as engaging in self-destructive behaviors just to get that extra rush of adrenaline, knowing that more people will consume the content that they’re producing. And that is a dangerous precedent, something we must consider carefully to avoid the catastrophe of this massive addiction to technology. And the reason we need to be thinking about this and working to solve these problems is because technology is evolving at an insane and unprecedented rate. So, as our devices become more powerful and adept at transmitting information, we may soon be able to create content that we cannot currently create. Still, with the assistance of AI, we will be able to develop metaverse versions of ourselves and our reality.

Dr. Sendler, you have a somewhat unique background in that you work as a scientist in both Poland and the United States and have a cross-national understanding of mental health research in both countries. Is mental health research still stigmatized in Poland?

Damian Sendler: When it comes to an understanding of whether there is a stigma attached to mental health research, I don’t think it makes sense to think about Poland versus any other country. The obvious fact is that there is a stigma associated with mental health research in many parts of the world, and the reason is that we as people feel ashamed for some reason when we are feeling down and do not perform to the best of our ability that people expect us to be. And it is something that prevents people from reaching their full potential. I believe that the perception that people in Eastern Europe are more ashamed of talking about their mental health problems and conducting research about it stems from the idea that we have gone through so many wars and so much suffering in the past to preserve our identity that suffering is somehow ingrained in our mentality and prevents us from being fully happy and fulfilled. That is simply not the case when it comes to Poles. If you visit Poland and see some remnants of the Soviet era, such as gray buildings or monuments to remind us of the past, that is just one part of the cultural fabric. But then there’s this new Poland, born more than 30 years ago that has evolved so much that there are so many new things to discover and learn about the culture itself. And I think what’s fascinating about this cultural evolution throughout Poland’s history is that we can see what cultural survival has done to modern Polish society.

On the other hand, persistence and resilience allow us to thrive as a society. So, when we think of stigma associated with mental health research, I believe what people have in mind is the idea that we’re attaching a label to people who are being studied. And that does not necessarily apply to Poles, Germans, French, Americans, or anyone else. I believe that Poles are working very hard to move past the historical events that have defined our rich history and be this reinvented nation that does not always have to talk about how much sadness we have experienced in the past and how that has shaped our present. That is not the essence of Polish society in general. And I believe that moving forward, it is important to see Poles as part of a larger European continent and that their experience is as much a part of Western European culture as it is of American culture and even Asian culture because we are becoming a much more multicultural nation, especially in recent years with such a large migration of people from all over the world.

Dr. Sendler, do you believe Poland has enough mental health professionals to meet the needs of people in need of psychiatric and psychological support?

Damian Sendler: We are not producing as many mental health professionals as we should. This appears to be a significant issue that affects nations worldwide. And it seems that this is happening for a variety of reasons. Indeed, Poland has been through some difficult times, emerging successfully from the Soviet Union’s occupation and progressing to becoming a democratic nation of the European Union in just the last few decades. So we’ve only had the previous 30 years to evolve and reinvent ourselves as a free nation. As a result, we did not have enough time to acknowledge the significance of mental health in our society. But, you know, I don’t think it’s worth attempting to pinpoint why there has been such a lack of progress in mental health research and clinical services in Poland over the last few decades, and blaming it on any level of history or political discourse is probably not even relevant at this point. Instead, we must concentrate on how we can adapt to modern societal needs and learn to address them systematically. So, in general, there is a great need for specialized psychiatric and psychological support in Poland. We have hundreds of thousands of young adults, children, and adolescents who require more mental health providers who can relate to them, understand their unique challenges, and help them work through whatever issues they face. Indeed, the introduction of social media has exacerbated the mental health of many young people, and this is an issue that must be addressed.

Moreover, when we consider people over the age of 50, all the way up to the oldest generation, we see that they face additional unique challenges. We are a nation with similar problems to other countries in that there is always the worry about keeping your job, staying healthy, maintaining healthy relationships, both with acquaintances and friends, but also having a happy private life, whether you define it as being married or single, whatever it is that makes you happy. And, of course, when people fail to meet these targets, they are disappointed, may become depressed, etc.

As you can see, there can be a chain reaction of problems that can harm anyone. So clearly, there is an enormous need for mental health services. Unfortunately, we don’t have enough specialized mental health facilities to help people recover using modern mental health approaches because establishing such facilities takes time. You can’t just build psychiatric facilities or support clinics when you don’t have enough staff to run them. And, completely unexpectedly, we are now being impacted by a refugee migration from Ukraine. That was utterly unplanned in anyone’s mind. Nobody in Europe probably expected this war to occur because it is such a petty conflict. People arriving from Ukraine have their own needs for mental health support as they deal with this enormous tragedy. However, migration causes stress for Poles who want to help but often feel powerless. So there are so many complexities in these issues that I believe it will expose the areas of mental health in Poland that are working well and the weaknesses that need to be addressed. And, to be honest, seeing how our mental health services are working in a situation that requires an incredible level of professionalism and organization is something to be thankful for so that we can learn from these experiences and improve our delivery of mental health services across the country.

Dr. Sendler, what research question in the context of Poland and its mental health services do you think would be interesting to pursue but is not currently being investigated?

Damian Sendler: The most natural question, in my opinion, is the relationship between culture and mental health. The stigma associated with receiving mental health services has been extensively researched worldwide. However, it is also specific to the country where you attempt to persuade people to participate in treatment. That, I believe, is the line of research that has not been carried out as thoroughly in Poland as it has been in, say, the United States. We don’t know what kinds of biases people have when it comes to participating in mental health treatments and people who know others who are seeing a psychiatrist or psychotherapist. And I believe the reason for this is that simply asking the question prompts you to consider the issue of stigma associated with mental health treatments and the politicization of the process by which mental health services are provided and received by people. So that is something I believe requires a much deeper understanding.

What fascinates me as someone who divides my time between Poland and the United States is that I have this unique perspective of coming from the highly westernized world into more conservative Poland and seeing how Poland has evolved. And I see that the younger generation, especially those in high school and college, are extremely well adjusted to western values and understand that the barriers to receiving mental health counseling that we had in the past are no longer present for these people. I’ve seen people who identify as members of the LGBTQ community seek any type of support they need without fear of being judged negatively or pathologized for who they are. And that is a huge step forward for a country like Poland, which is still very conservative in many ways. As a result of our shift toward more Westernized values, I believe a generational gap is closing.

Furthermore, given the overwhelming influence that the European Union has on us as a society, it’s difficult to imagine Poland not changing. And now that we have refugees coming from Ukraine, our society will be changed even more because we will have a permanent presence of potentially millions of new people living in our country, which will diversify our worldview. And I believe it is worthwhile to investigate this further through ongoing monitoring of society’s attitudes toward mental health services and how people use therapy and psychiatric treatment. There has undoubtedly been a tremendous increase in awareness about the importance of addressing the mental health needs of people living in Poland, which is a significant change from just a few years ago when there was no discussion about mental health services as there is now. And that’s something really interesting from the standpoint of public health, looking at how it affects people’s willingness to take care of their mental health without fear of stigmatization.

Dr. Sendler, what are the unique aspects of conducting mental health research in the Polish healthcare system?

Damian Sendler: The most distinctive aspect of working as a mental health researcher in Poland is that we are studying a culturally and economically homogeneous population. We always have certain expectations about the typical mental health status of a specific Polish person. Furthermore, one of the distinguishing features of the Polish people is that we are a deeply religious and conservative nation. And those values shape how we perceive various issues and respond to challenges. As we’ve previously discussed, Poland has been through a lot of trauma in the past, including multiple wars, so we are a very resilient nation. One common misconception about Poles is that because our winter season is relatively long, a lack of sun exposure leads to higher rates of depression in the average Pole. However, it appears that Poles are so accustomed to winter that it is not a topic of conversation or a recurring complaint among the average Pole because it is simply the reality of living in Poland and becoming accustomed to the natural rhythm of our environment.

One of the most exciting aspects of studying mental health in Poland is that the country is becoming more multicultural. This has nothing to do with the recent influx of Ukrainian refugees, but Poland has been increasingly westernizing and internationalizing over the last decade. We have a large population of international students studying at our major universities, and Polish people travel abroad for work and vacation and to study. These perspectives significantly impact our socio-cultural values and how the average Pole sees the world. As a result, we are witnessing an unprecedented shift in how Poles live their lives. This is especially interesting when you consider that Poland was still under Soviet Union occupation just about 30 years ago. Now we have people who are free to do whatever they want.

Because we are a member of the European Union, you can study different generations of Poles who have experienced vastly different realities. For example, if you study people in their 80s, they have gone through so many different changes and cultural shocks that they are fascinating to research from the standpoint of mental health and understanding how they’ve been able to be so resilient across so many challenges that they face in their lifetime. And when you compare that to young people who have lived a Westernized reality and have been exposed to social media, you have yet another exciting cross-cultural comparison within a single country. So, in that regard, Poland is an exciting place to conduct mental health research because of the diversity of views, experiences, and generational viewpoints shaped by political and social events, including some more tragic occurrences such as occupations and war.

Dr. Sendler, is there enough access in Poland to digitalize mental health services? There is a lot of global effort underway to digitalize mental health services through apps and videoconference, but Poland has yet to take that step.

Damian Sendler: There is currently insufficient effort to bring telemedicine to Poland. I’m not sure why this is the case. On the surface, Poland appears to have a very advanced infrastructure for providing internet and phone services. As is customary in the European Union, Poland, along with other countries, has some of the fastest internet connections and access to the same technologies as the rest of the West. And I’m perplexed as to why the current technological advances haven’t allowed us to implement access to telemedicine services fully. I suspect that there is still societal skepticism about sending health information over the Internet. And it is for this reason, that there is still such widespread support for receiving medical treatment in person. As a result, I believe it will take a significant amount of public health campaigning to raise awareness of telehealth services and change attitudes toward this mode of access to health care. And, thinking about Europe in general and keeping up with the latest updates on European health care, it appears to me that telehealth developments have been relatively slow to adapt across Europe. There seems to be a preference for more traditional in-person interactions with your doctor and therapist. And I believe this reflects how people perceive telehealth services. As a result, the idea of telehealth services not being fully implemented in Poland is reminiscent of what is happening throughout Europe. It could also be due to the widespread belief that the best type of therapy occurs in person in the presence of a clinician, which is highly valued. So there could be a pretty apparent reason why telehealth services are falling out of favor when patients get to choose what kind of therapies and treatments they want.

Furthermore, there is some uncertainty regarding platforms that provide secure access to telehealth services. All of the evidence I’ve seen from Poland and other countries indicates that clinicians are attempting to adapt popular conversational platforms such as Zoom or Skype to have therapeutic conversations with patients. In comparison, the United States has robust HIPAA policies that require the use of specialized HIPAA compliant services to provide telehealth counseling and therapy. Currently, there is not a large market of developers in Europe attempting to develop similar treatment platforms. The reason for this could be the high cost of developing such protocols.

Furthermore, the adoption of electronic medical records is unquestionably lower in European countries than in the United States. All of these factors are critical in understanding why telehealth services are not as prevalent in Poland or Europe as they are in the United States. However, I believe that the general interest in digital technologies will spur interest in developing telehealth services sooner rather than later. As a result, it is only a matter of time before these services become more widely available to patients. Another issue is that, for example, in Poland, we have many elderly patients who are not well-versed in technology. As a result, the adaptation of telehealth services will stagnate, given that the average age of people in Poland is now well over 50 years old, with many people in their 70s and 80s. As a result, these people have lived past the age of early technological adaptation, and they have not adapted well to the use of mobile devices to access health services. So keep that in mind as we consider why the adaptability of home telehealth services is slower in some parts of the world than in others.

How does Poland’s aging population affect mental health research?

Damian Sendler: I believe that the age of the population has little effect on the type of research that can be conducted. Numerous research questions can be posted. And the population available to you as a scientist is rich in information based on their life experiences to assist you in answering those research questions. So, whenever I hear the argument that a particular demographic makeup is advantageous or disadvantageous, I think it’s because the distribution of having more or less of a specific group of people isn’t that important. I find Poland particularly intriguing because we currently have more older people than younger people in our demographic distribution. We have many people who have lived long enough to have had a wide range of life experiences. So, for example, an 85-year-old person has lived through World War II, the Soviet Union’s occupation, and modern Poland from the 1990s to the war in Ukraine in 2022.

As you can see, this person has had an incredible range of experiences throughout their lifetime. They had lived through pain, grief, and times of joy when Poland became a free nation, and now in this state of stress imposed by the conflict just across the border and the arrival of refugees that Poland has so graciously assisted. So, suppose we sample these people and study them alongside the younger generation. In that case, there is a phenomenal amount of data from which we can learn about mental health and how resiliency develops in people who have lived through so many negative experiences. That, I believe, is extremely important to understand and see why having a non-standard demographic distribution in the age of your potential research participants is not so problematic after all. What matters is the type of questions you’ll ask and your ability to extract as much information as possible to answer those questions. So, in the case of Poland, even though we have an aging demographic population, there is still a lot of information that we can gain from our research studies.

There was a significant stigma attached to receiving mental health treatment in Poland back in the day. So, given the dramatic shifts in public perception of mental health services, what is it like to be a mental health scientist or clinician right now?

Damian Sendler: You are entirely correct that there were a lot of stigmas associated with receiving treatment for psychiatric symptoms in the past. There used to be misunderstanding of what mental health problems signify and how to treat patient. People still remember disturbing images of mental health facilities around the world, where patients were frequently subjected to “treatments” that were not truly alleviating the type of suffering that we can now address through psychotherapy and pharmacotherapy. Thankfully, those attitudes and believes are rapidly changing, thanks partly to Poland’s highly progressive approach to the various challenges confronting its healthcare system. There is a much greater appreciation for mental health and its importance because of the widespread exposure that people receive through social media, television, and the internet.

Furthermore, Polish people have become much more vocal about their mental health struggles, particularly when we look to celebrities and public figures who no longer shy away from bringing awareness to their past struggles. So, I believe that much of the backward thinking about mental health in Poland that we used to have stems from the shame associated with admitting that many of us may, at some point in our lives, experience moments when we doubt our existence and are affected by depression, anxiety, eating disorders, and so on.

Going to a medical provider has intrinsic value in keeping ourselves healthy. Still, it also makes us vulnerable because we have to open up to someone else about various concerns that we may have. And that vulnerability frequently requires us to be at ease with the unpleasant. In terms of practicing medicine, the most uncomfortable aspect of the interaction between a medical provider and a patient is breaking those boundaries and being honest about the kinds of problems we may be experiencing, the symptoms that appear to be off, and being forthright about reporting these to our health care provider. And once that barrier is broken, and we become comfortable talking about our health, whether it is gynecological issues, men’s health issues, pediatric problems, or mental health, we realize that all of the internal barriers we had and the shame we carried with us in coming forward about clarifying questions about specific symptoms we may have had were unnecessary because we are dealing with professionals whose job it is to help us. And I believe that much of that realization extends to mental health services.

People in Poland are becoming more aware that mental health problems are not affecting only some people. Millions of people across the country may have been affected by mental health issues at some point in their life. Inevitably, the COVID 19 pandemic has accelerated the process of discovering just how many mental health problems may have been lurking in our society. We are now beginning to uncover them and work toward improving the well-being of everyone, with a particular emphasis on the elderly, children, and adolescents, groups of people who have traditionally been somewhat neglected when it comes to providing mental health services in Poland. So all of these developments are highly encouraging.

So, based on what you’re saying, Dr. Sendler, there appears to be a renaissance in the improvement and expansion of mental health services for Poles. And there’s this increased recognition of the value of psychiatric care in Polish medicine?

Damian Sendler: That is an accurate description of the current situation in Poland. And, to me, being late to the game is preferable to never arriving at that realization. There are many places around the world where there is still a lack of understanding about the value of mental health services and providing people with a support system that can help them live a more productive life. There are many places around the world where the stigma associated with having mental health issues is so severe that it is destroying the livelihoods of thousands, if not millions, of people. So I think it’s fantastic that Poland is at a point in history where we recognize the importance of expanding access to psychiatric services for our people. As a result, we need to be able to conduct more research specific to people living in our country and understand how specific mental health concerns align with Poland’s historical context and culture. And I believe that in the future, there will be many great things and developments in Polish medicine that will advance our understanding of mental health issues that affect our people. We will also be able to establish specialized centers of excellence for mental health services, allowing us to bring the mission of alleviating suffering to far more people than we can serve. And all of those aspects are crucial in understanding what it is about specific mental health conditions in the context of Polish people that may require more attention than others.

Are there any developments in Poland that aim to relieve the strain on mental health providers and increase access to mental health services?

Damian Sendler: One of the most significant changes is a massive investment in expanding training positions in psychology and psychiatry to increase the number of providers specializing in mental health services. People are becoming more interested in majoring in psychology, and medical students are becoming more interested in becoming trained in psychiatry. As a result, there is an excellent opportunity for people to grow and broaden their horizons in that area. The more specialists we can produce, the easier it will be for the average citizen to access the services provided by those experts.

In terms of developing facilities for providing specialized mental health services, both the government and nonprofits are working together to raise awareness about mental health issues and advertise how people can access mental health services. On a larger scale, we have a plethora of institutions, particularly hospitals, that provide long-term treatment for people suffering from chronic mental illnesses. Then there are more local facilities where psychologists can provide adequate psychotherapy and short-term therapies on an outpatient basis, which are often government-funded. Finally, there is the private sector, or what we would call private practice in the United States, where people have access to mental health services and the offices of psychiatrists and psychologists, where it is a pay per service type of arrangement where people can go and receive therapy and treatments on an as-needed basis for chronic management.

Another exciting trend is increased awareness in schools, where children and young adults attending high schools and colleges are becoming more interested in addressing any problems they may be experiencing through early intervention. Colleges are increasingly investing in developing psychological support programs, where students can book free appointments with staff psychologists and psychiatrists to seek help. This is now commonplace across the country and demonstrates the level of progression in our attitudes toward mental health services in Poland. Because of these efforts, the stigma associated with having a mental health condition has decreased dramatically. Hopefully, people will become more open-minded than they are now as time passes. And we will be able to have an extensive discussion about the importance of increasing funding for mental health services in every community across the country.

Is the shift toward accepting that mental health services affect people everywhere, regardless of origin or cultural background, a factor in Poland’s attitudes toward mental health services and the realization that mental health problems may affect many people?

Damian Sendler: I firmly believe that this is one of the most significant developments and that our current status as a multicultural nation has helped us accept that there is no shame in admitting that mental health problems can affect anyone, regardless of their country of origin, social background, or any other aspect of their life. That alone is extremely important in recognizing that mental health problems are not limited to any particular group of people or geographic location. It’s simply a matter of admitting that when a problem exists, there’s no reason to hide it; instead, we should address it systematically and assist people in working through it. And I believe that is precisely what has occurred in Poland regarding the generational change. We recognize that psychiatric problems occur in Poland and are as common as they are in any other country. And we can work together to resolve those issues. And let’s look at how the rest of the world is dealing with the realization that there is a mental health crisis that needs to be addressed.

I believe that Poland is still far from resolving all of the outstanding challenges, even though we are working very hard to manage them. We are one of many countries worldwide that have long neglected their mental health services. And now we’ve realized we need to do something about it. As a result, it may be a drastic shift from previous approaches to addressing and investing in mental health services. But, when we consider how many places around the world were unprepared for the pandemic of the mental health crisis, I believe Poland is still doing an excellent job of meeting its people’s needs. We must continue to advocate for specific legislative changes that will increase funding for mental health services. We must also advocate for increased funding for training positions in psychology, psychiatry, and social work to improve people’s access to mental health services across the country. And we need to work harder to improve our mental health research output, specifically studying how Poles cope with various mental health problems, learning from those experiences, and spreading the word about our expertise so that it can benefit people worldwide who may have similar shared experiences. I also believe that we should look more deeply into specific sub-communities within our country that may be underserved and invest in those areas.

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