XVI Symposium of the APQR Quebec City 30/10 to 2/11/2012

Transcription

1 XVI Symposium of the APQR Quebec City 30/10 to 2/11/2012 Why should a local elected representative be interested in the mental health of his fellow citizens and what form should this interest take? Doctor Laurent EL GHOZI Municipal councillor of Nanterre, France President of the National Association of Cities for the Development of Public Health (Association nationale des Villes pour le développement de la santé publique) Elected Representatives, Public Health and Territories (Élus, Santé Publique & Territoires - ESPT) 1

2 Elected Representatives, Public Health & Territories National Association of Cities for the Development of Public Health Created in October 2005 by a dozen local elected representatives To reduce social and territorial health inequalities through local health policies, in a contractual framework with the State. Following a preliminary study: Elected Representatives and Psychiatrists, Regional Observatory on Mental Suffering Related to Exclusion (Observatoire régional sur la souffrance psychique en rapport avec l exclusion - ORSPERE), Lyons And funding from City Health Workshops (Ateliers Santé Ville - ASV). Conviction that progress in population health can occur only with the commitment of Communities and citizen involvement. 2

3 Elected Representatives, Public Health & Territories Currently 65 cities, all colours, sizes, regions = 7 M inhabitants Awareness-raising and training for local elected representatives, their collaborators and partners Discussion and pooling of experience Two National Study Days per year + Reports, dissemination 1000 to 1500 Permanent seminar, with the Health Commission of the Association of Mayors of Île-de-France (Association des Maires de l Île-de-France AMIF) Communications, symposiums, training courses Legislative oversight, answers to elected representatives questions Dissemination of information to members Headend for the General Directorate of Health (Direction générale de la santé DGS) and the General Secretariat of the Interministerial Committee of Cities (Secrétariat général du Comité interministériel des Villes - SG-CIV). Site: 3

4 Elected Representatives, Public Health & Territories Out of 13 National Study Days, SIX on mental health: Mental Health and Public Order, Grenoble The Mayor and Psychiatry, Together for Mental Health, Nantes Mental Health, Safety, Freedom, Paris Lower-risk Drug-use Room, Paris Health and Citizenship, European Conference, Paris First meetings of Local Mental Health Boards (Conseil local de santé mentale CLSM), Paris, January 2012 Upcoming: 2 meetings of Local Mental Health Boards, Lyons, March

5 Why take action in mental health in the City? Local elected representatives solicited, pressured, sought out, made to feel guilty in regard to: Public peace Neighbourhood disturbances Psychosocial distress Involuntary hospitalization Discrimination Difficulties with integration Social cohesion Democracy and equality

6 How to respond? Powerless alone - holds true for every party concerned Distress for the sick person, for the professional and for the elected representative Refer to someone else or take charge together? From individual concern to collective policy: For a local mental health policy. >> Health is first and foremost a political issue 6

7 The elected representative who is solicited and who is in a position to respond From psychiatric illness to mental health Many municipal services work towards improving mental health Vast number of stakeholders - in healthcare, prevention, the medical-social sector, the social sector, civil society - to be brought together in synergy The mayor s power to convene : All the parties concerned with a person in difficulty Notion of shared secrecy Requires trust: notion of charter, time, proving oneself, win/win approach 7

8 Public hospitals and the Sector Comprehensive territory-specific population management approach In-hospital: beds, departments and non-hospital: Medical and Psychological Centres (Centre médical et psychologique CMP), Part-time Therapeutic Centres (Centre d accueil thérapeutique à temps partiel CATTP), medical-social services The sector: utopia or failure? The mayor s role 8

9 Public health measures City Health Workshop Local Health Contract Youth Health Space (Espace Santé jeunes) Adolescent Centre (Maison Des Adolescents) Crisis, watch, warning, follow-up units Progressive construction of a new organization 9

10 City Health Workshops Operational framework for the health component of City Policy since 2000 Mandatory in all Urban Social Cohesion Contracts (Contrats urbains de cohésion sociale CUCS) (approximately 280 City Health Workshops) Tool developed under the Act to combat exclusion to implement Regional Prevention and Healthcare Access Programs (Programmes régionaux d accès à la prévention et aux soins PRAPS) and Universal Healthcare Coverage (Couverture maladie universelle CMU) At the interface of City and public health policies Based on needs and local resources Legitimize Cities commitment to health 10

11 The City Health Workshop s objectives To reduce social and territorial health inequalities To coordinate health policy with City policy To promote access to health: care, prevention and health determinants To encourage the active participation of health stakeholders and the population itself To diversify means of intervention in accordance with needs and resources per site, based on a very detailed analysis of the territory. To facilitate assessment of the actions carried out and the tools put in place and management of the policies implemented To promote the consideration of health in all policies 11

12 The procedure HEALTH DIAGNOSIS: needs analysis: with inhabitants and professionals and local resources: professionals, associations, history, local dynamics Identification of PRIORITIES Consistent with regional priorities: Regional Health Projects (Projets régionaux de santé PRS), Regional Healthcare Organization Plans (Schémas régionaux d organisation des soins SROS), Regional Healthcare Education Plan (Schéma régional d éducation pour la santé - SREPS), Regional Medical-Social Services Organization Plans (Schémas régionaux d organisation des services médicosociaux SROMS) Co-responsibility: City and Regional Health Association ACTIONS carried out: Primary, secondary prevention Mobilization of the population and stakeholders And EVALUATION 12

13 Main issues addressed in City Health Workshops EXAMPLE Access to care (75%) Nutrition, diet, excess weight (56%) Mental health (47%) Suicide prevention (33%) Comprehensive prevention (33%) Coordination of networks (28%) Substance abuse and risk behaviour prevention (25%) Health promotion (22%) 13

14 The four diagnoses of Nanterre s. Underprivileged Urban Zones (Zones urbaines sensibles - ZUS): From diagnosis to action Some examples Problems: - psychosocial distress - delay in seeking healthcare associated with an inadequate culture of prevention and inadequate healthcare services Problems: - pregnancy / early childhood - psychosocial distress - nutrition / diabetes Programs/actions: - Mother and Child Protection Services (Protection maternelle et infantile PMI) and Hospital in the neighbourhood - annual neighbourhood party - diabetes screening day Priority clienteles: - seniors - youth Programs/actions: - one-off actions, Local Public Health Plan under construction Problems: - lack of a network - psychosocial distress - developing prevention - environment Programs/actions: - women s health program - mother-child massage workshops - neighbourhood party theme health Environment Dr Laurent Docteur EL Laurent GHOZI, EL President GHOZI - of ESPT Quebec - City, IEP Paris, 2/11/ /02/2011 Problems: - psychosocial distress - developing prevention - parenthood Programs/actions: - listening points set up - annual neighbourhood party - nutrition workshops - health meetings forum 14

15 Mental health The 4 health diagnoses highlighted the issue of mental health and psychosocial distress, supported by the Mental Health in the General Population survey (Enquête Santé mentale en population générale Enquête SMPG) with the French Collaborating Centre of the World Health Organization for Research and Training in Mental Health (Centre Collaborateur français de l Organisation Mondiale de la Santé pour la recherche et la formation en santé mentale CCOMS- SM) reinforced by inhabitants and professionals increasing demand: Involuntary hospitalizations, public disturbances, Diogenes syndrome, homelessness, addictions, work- and unemployment-related distress led to the municipal decision to create, in 2009, a Local Mental Health Board Watch and follow-up unit: identification and prevention of individual situations; Housing for psychiatry users; Access to and follow-up of healthcare through improved collaboration between professionals Psychosocial rehabilitation, Mutual Support Group Shared procedure and prevention with respect to involuntary hospitalization Equal access to services and destigmatization. 15

16 Increasing understanding and awareness The different stakeholders Local realities: Mental Health in the General Population survey Joint training courses Dedramatize Accompany Evaluate Report Communicate 16

17 The Local Mental Health Board: based on CCOMS-SM, Lille recommendations and Île-de-France Regional Health Agency (Agence régionale de santé Île-de-France ARS-IF) specifications Objective: to bring together the efforts and competencies of professionals in the fields of mental illness, social services, prevention, safety, housing, and those of elected representatives... Around the mayor and the head psychiatrist of the sector To jointly organize Prevention Access to healthcare Follow-up Social and professional rehabilitation Access to all city services Full citizenship of mental healthcare users 17

18 The Local Mental Health Board: forces the decompartmentalization of services, sectors, institutions, professional operations and improves all stakeholders practices, supports psychiatric sector policy and its anchoring in the territory, outside hospitals and the harmonization of means and needs, promotes the full citizenship of users in the city, mobilizes all stakeholders and the population itself, contributes to local democracy. 18

19 Their development requires that the following conditions be met: Strong and sustainable political voluntarism, Converging commitment of elected representatives and psychiatry professionals, but also of municipal services: social sector, housing, education, fight against exclusion, home services Presence of legitimate, trained representatives of local users and caregivers, Build on what was learned at the City Health Workshop, if any, and mandatory integration in the Local health contract. Ongoing funding in order to recruit a stable facilitator/coordinator. 19

20 Definition of the Local Mental Health Board: Territorial platform for consultation and coordination between local elected representatives, public psychiatry, health professionals, social stakeholders, users, caregivers and all local stakeholders concerned (funding agencies, education, justice, police ) To promote the decompartmentalization of mental health and public policies at the local level. It conducts its activities on a local, infra-communal, communal or intercommunal territory that must be relevant for local stakeholders. 20

21 Mission of the Local Mental Health Board: To implement a strategy for observation in mental health in order to: Identify available epidemiological and sociodemographic data Determine and share information about the status of existing resources on the territory, as well as health needs and their determinants as identified by stakeholders, inhabitants and users. To coordinate the partnership To develop a local strategy that meets the population s needs with respect to prevention, access to and continuity of care, as well as social inclusion. 21

22 Objectives of the Local Mental Health Strategic objectives: Board: To organize a local diagnosis of the mental health situation. To allow equal access to prevention and healthcare as well as continuity of care. To promote social inclusion, access to citizenship and user empowerment. To contribute to the destigmatization of individuals suffering from mental disorders. 22

23 Operational objectives: Cont. To prioritize areas of work based on the diagnosis To develop and support the necessary partnerships between the stakeholders concerned. To implement an action plan to better meet the needs of the local population. To improve the flow and accessibility of local resources for stakeholders and inhabitants. To improve professional practices. To facilitate user and caregiver participation. 23

24 Governance of the Local Mental Health Board The mayor or president of the group of Municipalities (or his representative) presides over the Local Mental Health Board. The person in charge of public psychiatry and the Mayor cofacilitate the Local Mental Health Board. User and caregiver representatives are full participants in the Local Mental Health Board from the time of its creation. The Regional Health Agency is represented on the steering committee. 24

25 Organization of the Local Mental Health Board: The plenary assembly: It brings together: elected representatives, health professionals, social workers, establishments, institutions, associations, users, inhabitants, and any professional who contributes to the work of the Local Mental Health Board. It is a forum for exchanges and consultation. It is a source of proposals. It sets out the Local Mental Health Board s priority objectives, work program, the terms of the partnership and the different working groups. It meets at least once a year to assess the Local Mental Health Board s work and adapt the objectives and the work program in accordance with the results obtained. 25

26 The steering committee: It is made up of the mayor, president, all the elected representatives concerned, the heads of the public psychiatry sectors, user and caregiver representatives, the Local Mental Health Board coordinator, representatives of the Regional Health Agency, of national education, of private healthcare professionals, of social workers, the City Health Workshops coordinator, the Local Health Contract coordinator and any relevant person designated by the general assembly. It meets at least twice a year and prepares the plenary assembly. It determines the objectives and the composition of working groups. It informs the Regional Health Agency of the needs identified for the territory and the actions implemented to meet those needs. It sets out assessment procedures and reports on the results of the assessment to the plenary assembly. 26

27 The coordinator: Under the hierarchical and functional responsibility of the mayor, president of the Local Mental Health Board (or his representative). He is responsible for the routine operation of the Local Mental Health Board: implementation of its work program, management of the partnership, preparation and follow-up of the plenary assembly, steering committees, working groups, assessment of the Local Mental Health Board s work. The director of the Hospital Centre, the coordinator s employer, organizes his recruitment with the mayor of the municipality where the Local Mental Health Board is located. He makes the coordinator available to the local community. 27

28 Priority actions of the Local Mental Health Observation: Board Based on a diagnosis of mental health needs and resources. Mental health status of the population and its determinants, use of voluntary and involuntary care, mental health representation, local health policies, status of partnerships, resources and supply in the territory With a watch and warning function. Prevention and improved access to healthcare: Early identification of disorders to facilitate access to healthcare and early, appropriate management, including crisis situations. Facilitate the coordination of emergency stakeholders. Prevent the aggravation of disorders and their consequences for the individual s health and social inclusion. Encourage mental health promotion. Help reduce socio-territorial mental health inequalities. 28

29 Priorities, cont. Social inclusion and the fight against exclusion: Make it easier to obtain and remain in housing, as well as professional inclusion and training. Promote user access to recreation and culture. Promote user access to citizenship. The fight against stigmatization: Develop a positive representation of mental health Destigmatize individuals suffering from psychiatric disorders, Prevent and provide information about psychiatric disorders. Develop various communication media aimed at the general public. The promotion and support of the creation of health and social structures to accompany individuals suffering from psychiatric disorders, e.g., Mutual Support Group, Medical-Social Support Service for Adults with Disabilities (Service d accompagnement médico-social pour adultes handicapés SAMSAH), Social Support Service (Service d accompagnement à la vie sociale SAVS), Centres and Services providing Assistance through Work (Établissements et services d aide par le travail ESAT), accessible housing. Efforts to find funding for these actions. 29

30 Assistance in resolving complex psychosocial situations Crisis, follow-up, warning and watch unit: The Local Mental Health Board creates a work unit to resolve complex psychosocial situations in a partnership-based approach, to intervene at the earliest stage possible of disorders, to avoid breaks in treatment and relapses and to establish a social watch for ill, isolated and vulnerable individuals. To do so, it sets out rules of professional conduct to ensure a balance between the exchange of necessary information, the observance of professional secrecy as well as respect for individuals and, in particular, to ensure the latter s compliance with the measures that concern them. The creation of such committees requires the implementation of an ethics charter. 30

31 With citizen users Elected representatives Caregivers Families All professionals Mutual support groups Associations Work, sport, culture The ill in the city, the city for all 31