Psychiatric hospitals 8. Psychiatric hospitals 8.1 Introduction In 2012, the representatives of the NPM visited 8 psychiatric hospitals intended for implementing preventive measures, of which 5 under basic security conditions, 2 under enhanced security conditions and one under maximum security conditions. The visiting team paid special attention to the situation of the perpetrators of criminal offences who are placed in a psychiatric institution (hereinafter the detained patients or patients) as a preventive measure. 8.2 Systemic problems 1.  Insufficient funding of psychiatric wards According to the directors of visited establishment, the costs of the functioning of psychiatric wards in multi-specialty hospitals are underestimated in the contracts with the National Health Funds which translates into a lower standard of health care services provided in those wards. The funds allocated by the National Health Fund for the functioning of a given ward should correspond to actual costs, but the personnel of the visited hospitals often claimed that this was not the case. Moreover, the National Health Fund does not pay psychiatric hospitals for other types of treatment than psychiatric treatment. This concerns, inter alia, the socalled psychogeriatric patients or patients with somatic disorders whose treatment is not refunded to the hospitals. The problem which requires a systemic solution is the necessity to admit all patients referred for treatment in the detoxification ward, while many of them are patients with the so-called double diagnosis (diagnosed with an addiction and other mental disorder at the same time). This results in considerable organisational and therapeutic complications, increased incidence of aggressive and autoaggressive behaviour. As a result, the therapy of patients diagnosed only with an addiction is insufficient. This entails the need to increase spending on the therapy, which is not reflected in the refund from the National Health Fund. Somatic disorders treated in psychiatric wards are not additionally refunded, while in the wards of internal medicine and other specialist wards their cost is calculated and the performed procedures refunded. The National Health Fund pro89