Module Thirteen PSYCHIATRIC SERVICES

Lesson 1: Psychiatric reformation

Lesson 2: the role of psychiatric services

Lesson 1

PSYCHIATRIC REFORMATION

Step 1: Introduction Transferring the care for people with psychiatric problems

from a big psychiatric institution to the community requires the development of supporting structures that can offer prevention, diagnosis, therapy and psychiatric rehabilitation.

International experience has proved that the organization of these services for the first time is a difficult issue and can be achieved only when:

There is politic determination, The society supports the effort, There is secure funding, the appropriate organisms can be found.

Step 2: Theory presentation The dominant situation before the Reformation: In Greece, until the middle 80’s, the only public

offer of psychiatric care was done in asylums (Psychiatric clinics).

Asylums usually hosted people with severe psychoses or antisocial behavior and the hospitalization aimed firstly to discharge the community from a person with undesirable behavior and secondly offer treatment to the person.

Step 2 (continued)The conditions in the asylums were miserable: Tenths of patients were rushed in large wards which had

no other furniture apart from beds. The hygiene rooms were unacceptable. The personnel (included the doctors) was small in number

and not trained. People of all ages lives together. People with Mental Retardation and other Organic Mental

Disorders lived with psychotic patients. Any sense of personality, decency, personal choice was

reduced to a state Of rigid hierarchy, uniformity and flattening.      

Step 2 (continued)

The duration of stay in the asylum was always long with undefined end.

There were no service of psychiatric care for people with milder disorders or problems.

Step 2 (continued)The period of Reformation On 1981, Greece became the 10th member of the

European Economic Community (EEC). It was acknowledged that the sector of Mental Health

among others needed upgrade. After the submission of a concrete proposal an important

financial support was approved for the reformation of psychiatric health based on the principles of Community’s Psychiatric Health (standards)

This proposal after its approval constituted the regulation 815/84 of EEC and the same year was legislated in Hellenic Republic (law N.1397/84) in the context of application and National Health System.

Step 2 (continued)The context of the ReformationThere were four basic targets:Ι. The development of complete networks of psychiatric

services throughout the country. This required the separation of the country in Psychiatric

Sectors. Each Sector was responsible to offer all psychiatric

services required in a determined geographic department. This should have necessarily service of first aid mental

care (Mental Health Center), hospitalization service (psychiatric department of central Hospital) and services of psychiatric rehabilitation (work and residence).

Appropriate services for children and adolescents should had to be developed.

Step 2 (continued)

ΙΙ. Minimize the number of Asylums. This would be achieved by: Minimizing of hospitalization, as the

services would be offered to the community and to the specific area.

The reintegration of people and groups of patients from asylums to new rehabilitation units in the area of their origin.

Step 2 (continued)

ΙΙΙ. Ameliorate the conditions in asylums. With the creation of modern hotel

structure. With better personnel. The separation of persons with Mental

Retardation and Organic Mental Disorders. The separation of elders.

Step 2 (continued)

IV. Give the opportunities of training and further specialized studying, for suitable staff for all psychiatric services to exist

Step 4: Theory presentation (20΄)

The progress of the Reformation The initial schedule for the completion of the

reformation was set to five years. During its application there were serious delays

and serious problems occurred. (f ex Lero’s issue).

Several extensions were given and the validity of the regulation 815/ 84 over passed the decade.

Unfortunately during this period it the application of Psychiatric Sections was not achieved .

Step 4 (continued) Random psychiatric community services were developed

in several regions where the conditions permitted and there were well trained and experienced personnel, but mainly will and determination.

A new law for Mental Health came into force, the law N 2071 / 92, which simply determined the legal frame for the function of these services naming them Units of Mental Health.

The asylums even if they improved their structure, the conditions of hospitalization and their general function, they were not substantially decongested and continued to receive the majority of patients.

Step 4 (continued) The few existent psychiatric departments of

general hospitals functioned but not as effectively as to keep the persons for hospitalization in their place of origin.

The next law for Mental Health, law N. 2716/99 gave again priority to the organization and function of Psychiatric Sections. Its application is promising, as well as the application of the program PSYCHARGOS, through which the psychosocial rehabilitation of many persons that live in psychiatric clinics is intended again.

Step 5: Questions and comments (5΄)

Lesson 2

THE ROLE OF PSYCHIATRIC SERVICES

Step 1: Introduction

Every minute about 1 out of 6 suffer from a mental disorder.

Not all of them are severe. Despite their rate of incidence and the

important consequences in people’s life, only recently was emphasized the development of services for their efficient treatment.

Step 2: Slide projection Slide 13.2.1: The role of Mental Health Services  Te services of Mental Health must: Offer high quality treatment and care to the

society. Satisfy the needs of people who use them and not

to discriminate them. Be easily accessed and offer services wherever

there are needed. Offer opportunities that promote independence

Step 2 (continued) Offer continuous care and treatment. Offer support to he families of the persons who

use them. Collaborate and keep good coordination with

other services. Offer training and experience and contribute to

the training of skillful staff. Support their personnel and secure its rights. Be held responsible to society.

Step 3: Slide projection Slide 13.2.2: Communal Psychiatric Services: Centre of

Mental Health  Prevention

in schools, work places, neighborhoods etc.in their families, new parents, couples and people that are liable to mental disordersin sensitive population groups, (f ex immigrants, patients of physical diseases)

Evaluation and diagnosis Therapeutical treatment

MedicationPsychotherapy Social interventions

After hospitalization observation Cooperation with other Mental Services. Training of all the sectors of professional in mental health.

Step 3 (continued)

Slide 13.2.3: Community Psychiatric Services: Psychiatric department of General Hospital  

Intervention in social stigma Offer of short hospitalization Treatment of emergency psychiatric problems Diagnostic and therapeutical service Cooperation with other Psychiatric Services Training of all the sectors of professionals in

mental health

Step 3 (continued)Slide 13.2.4: Community Psychiatric Services:

rehabilitation services   Evaluation of social needs, problems, inabilities

and abilities of the patients Planning , organization and observation of

residence Units Planning , organization and observation of

Working Units Creation of new communication means with other

social and working organizations Collaboration with other Psychiatric Services Training of all professionals in mental health

Step 3 (continued)Slide 13.2.5: Community Psychiatric Services: units of

Partial HospitalizationDay Hospital Offer of all services of any psychiatric department for

people that require hospitalization but their state does not demand 24 hour stay in the hospital and have supportive family environment

Diagnostic and therapeutical services Development of group activities Promotion of the stay in the community for the person

and involvement of the family in the problem. Help to eliminate the stigma

Step 3 (continued)Day Care Centre Support service additional to the rehabilitation

services Offer of training in social skills Organization of programs of pre-professional and

professional training Offer of creative occupation and entertainment to

the persons that are not able to work Development of group activities Cooperation with other Psychiatric Services Training of all professionals in mental health

Step 4: Brainstorming

The functions of various Services of Mental Health can possibly overlap and the choice of the most appropriate one is not always obvious.

Step 5:Questions and comments (5΄)