A future mental health care in Archangelsk. December 2004 Stefan Meyer-Kaven

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1 A future mental health care in Archangelsk 1

2 The structure of presentation 1. The importance of the out-clinic provision of medical care and psychosocial training The meaning of integral service provision The Interaction of medical and psychological care and psychosocial training 2. Planning and monitoring of the (re-) integration into society The process of planning the individual support Possible cooperation between the Department of Health, University, Psychiatric Hospital, Dispensary and other out-clinic treatments The community psychiatric conference Casemanagement The correlation between patient and professional attendent 3. Essential elements of out-clinic service Dispensary (Polyclinic) Psychiatric Nursing Day care centre (like Moct) Assisted living Outpatient service Professional job training and integration Family support 4. Regional cooperation The communiy psychiatric alliance 2

3 The importance of the out-clinic provision of medical care and psychosocial training The meaning of integrated service provision In Germany Social-Psychiatry is the term for a certain kind, of giving professional support to people with mental health problems or mental illness. Very important to this process is the integrated approach. The human being in his individual situation takes centre stage. His personal way of living and his individual needs are incorporated in all considerations for support. For example, this includes areas like family relationships, integration into employment or participation in community life. 3

4 The importance of the out-clinic provision of medical care and psychosocial training The meaning of integral service provision In humanistic psychology following areas are constituents of human identity. Work and ability If the balance between this constituents is permanently disturbed or only single ones exist, people develop mental health problems or psychosmatic illnesses. Social education and personal qualities Mentally stable personality Material secureness This means on the other hand, as we do not take all these areas into consideration in the rehabilitation of people with mental health problems, they will not recover again. Social participation health awareness 4

5 The importance of the out-clinic provision of medical care and psychosocial training The situation of mentally ill patients, now Start of medical treatment Stabilisation through medical treatment Admission to hospital Discharge from hospital The lack of social rehabilitation measures often implicates decompensation 5

6 The importance of the out-clinic provision of medical care and psychosocial training Interaction of medical and psychological care and psychosocial training in future discharge I Hospital as crisis intervention medical care and psychosocial training - Medical therapy - Medical therapy as crisis intervention - Psychotherapy - Procurement of outclinic medical attandance and - Relationship training psychosocial training - Social and personal training - Empowerment - Integration into employment Only the interaction of medical care and psychosocial training is able to stabilise the patients. 6

7 Planning and monitoring of reintegration into society The planning of individual support Every patient is different (in age, gender, socialisation etc.). Even patients with the same dignosis need different support. Do we as professionals know what kind of help a patient really needs? Does a patient exactely knows what is good for him? Therefore the planning of individual support has to be a cooperation between patient and the professional system. Together they are be able to find out what kinds of support responds to the client s individual needs and requirements. The goal of individual help planning is to empower the patient. To give him the support he really needs and to keep him as responsible and as autonomous as he can. 7

8 The process of planning the individual help Important parts of individual planning are: - habitation, living - education, training, work - social participation - recreation - health In this context the following questions have to be considered: - What interests, abilities and resources are already available? - What kind of deficits are present? - What specific support can be given to work on these deficits? (Individual help planning of Rheinland-Pfalz 8

9 Possible cooperation in planning and monitoring of reintegration process Post clinical treatment, medical attandence and psychosocial training have to be individuell planned. Basically and essentially, all organisations which are involved in metal health care have to generate a system of planning individual support. This should be a cooperation between the Department of Health, Department of social welfare, the University, the Psychiatric Hospital, the Dispensary and all out-clinic treatments. The above mentioned institutions organise the Community Psychiatric Conference. 9

10 The planning of individual support Community Psychiatric Conference The Community Psychiatric Conference is planning the individual support (members are) The patient or his legal agent Attending psychiatrist/ physician (hospital / dispencary) Representatives of out clinic services (Funding agencies) Casemanager 10

11 Planning and monitoring the reintegration process Casemanagment When CPC has made his decision with regard to the following rehabilitation process The casemanager monitors Casemanager the clients different needs within the rehabilitation process The casemanager coordinates the different support services The casemanager is responsible for the best setting Day care center Outpatient service Forensic Support (i.e. special psychotherapy) 11

12 Planning and monitoring the reintegration process Correlation between patient and his professional attendant The relationship between patient and his professional attendant is one of the most important facts of the healing process in all out-clinic services. The attendant must be able to communicate in an open and clear way. He must be open - minded, as well as to be able to accept existing diversity and to handle conflicts. After all, he has to be a role model for social behavior. 12

13 Essential elements of out-clinic services Family support Employment service Supported living service Dispensary Patient Day care center Psychiatric nursing Outpatient service In order to supply the patients various needs for resettlement into community after discharge from psychiatric hospital, the following outclinic services should be available. Depending on the individual needs, the patient can choose a combination of different Support offers and treatments 13

14 Essential elements of out-clinic services Terms of reference Dispensary: (Polyclinic) Out clinic medicinal treatments including substance abuse prevention/service, psychotherapy and crises intervention Assisted living: Day care centre: training and support to residents who have psychiatric disabilities. Skills training includes self-care, daily living activities, interpersonal skills, and decision making and problem solving skills provides an all-day psychosocial rehabilitation program for those community members whose daily lives and functioning are impaired by mental illness, but who do not require institutionalization. Transportation should be available 14

15 Outpatient service: Psychiatric nursing: provides help for individuals and families experiencing emotional and/or situational problems medical assistance and home care Employment service: Family support: includes training on the job, vocational programme, and placement service has to be a challenge in all treatments. It comprehends advise, counseling, crises intervention and educational training for single members or the family system 15

16 Regional cooperation Community Psychiatric Alliance Its function is to plan and implement all essential treatments, to realise networking and public relations Community Psychiatric Alliance Members are all organisations which are In the provision of psychiatric care: Implements work groups like - The Department of health - The Department of social welfare - The Psychiatric hospital - The Dispancery - Outclinic services - The Patients association - The Relatives association Post operative clinic treatment conception and qualitymanagement Community Psychiatric Conference Anti stigm campaign Volunteer assistence 16

17 And if everything functions well, you will have empowered and content clients such as you can already find at Moct, a non-profit organisation of mental health care here in Archangelsk. 17

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