Clinical and Social Factors of Compulsory Psychiatric Treatment in Moscow

Prof. Tsygankov Boris, MD, PhDChief Psychiatrist of Moscow City,

Head of the Department of Psychiatry, Addiction and Psychotherapy, Moscow State University of Medicine

and DentistryDr. Saveliev Dmitri, MD, PhD

Department of Psychiatry, Station of Ambulance and Emergency Medical Service named after A.S. Puchkov, Moscow, Russia

& Dr. Yaltonskaya A., MD, PhD 

Prevalence of mental disorders in Moscow

Показатель 2010 2011

Trend

Prevalence of mental disorders (per 100 thousands people)

455,3 455,3 0%

Incidence of mental disorders (per 100 thousands people)

Including children (0-14 years old)

9,9

2,3

11,6

2,7

Increased by 17,1%

Increased by 17,4%

Number of cases schizophrenia

Number of cases of disability due to mental disorders (schizophrenia)

47105

33626

47152

34036

Increased by 0,01%

Increased by 1,2%

Prevalence of hospitalizations due to schizophrenia (per 100 thousands people)

232,2 232,3 Increased by 0,4%

Mean number of days spent in-patiently due to schizophrenia

79,4 90,3 Increased by 13,7%

Re-hospitalizations (% from a total number of hospitalizations)

29,3 32,5 Increased by 10,9%

Mental Health Care System in Moscow

Outpatient service – Psychiatric DispensariesInpatient service – Psychiatric Hospitals

Emergency service - Station of Ambulance

and Emergency Medical Service named after Puchkov

Number of psychiatrists working in Moscow:

1466 – total amount of full time positions

1198 – number of occupied positions

Number of beds in mental hospitals (1981-2014)

1981 1992 1995 2006 2009 2013 20140

500

1000

1500

2000

2500

3000

ПКБ № 1 им. Н.А. Алексеева ПБ № 3 им. В.А. Гиляровского ПБ № 4 им. П.Б. Ганнушкина ПБ 15

Total:1981 – 16 5652009 - 13 857 2013 - 12 309 2014 - 10 499

Reform in Mental Health Care System in Moscow since 2012

Main purpose is to develop better connection between outpatient and inpatient psychiatric services

Focus on providing more help out-patiently through the active work of dispensaries (Day/Night Hospital, House Calls)

Focus on inclusion families into help (through education and increasing the level of legal responsibilities)

Preliminary results of the reform

Local Emergency Psychiatric Service in each dispensary was organized.

- Main purpose – to provide help to patients with relapses of psychotic disorders at evening/night time

- Includes: House Calls, Day/Night Hospitals, Local Intensive Care/Emergency Services with further referral to a local psychiatrist

As a result significant decrease the amount of calls into Emergency Psychiatric Services (after first 2 moths) that allowed to decrease the amount of beds into psychiatric hospitals by 40%.

Emergency Psychiatric Service

Part of General Emergency Service provided by Station of Ambulance and Emergency Medical Service named after Puchkov

24 hours

Receiving and reacting to a phone calls

Service provided by psychiatrists. They make decision about necessary actions and provide consultations to a) staff from hospitals and other medical settings, b) ambulances c) people

Emergency Psychiatric Service (2)

24 emergency psychiatric medical teams (1 psychiatrist + 2 psychiatric paramedics)

12 emergency psychiatric paramedical teams (for transporting psychiatric patients) (2 psychiatric paramedics)

8 stations located in the different areas of Moscow

Each team uses fully equipped modern ambulance car (Mercedes) with GPS navigation, on-line connection with the head office, medical equipment necessary for providing intensive care.

Territory

Location of

stations in

different areas of Moscow

Steps after arrival of psychiatric team to a patient

Sometimes in difficult cases Emergency Nursing Teams provide transportation of psychiatric patients (for example, to Intensive Care

Department of General Hospitals).

Upon arrival psychiatrist makes a decision about the necessity to provide psychiatric examination (art. 23, 24 «Psychiatric Assistance

and Civil Rights Act»)

Reasons for psychiatric examination EXIST (voluntary or

non-voluntary examination)

Reasons for psychiatric examination DO NOT

EXIST

- Hospitalization in Psychiatric Clinic (voluntary or non-voluntary art. 28, 29)- Hospitalization in General Hospital (Psychosomatic ward)

• Provide medical help• Provide consultation • Refer to a local psychiatrist

(active referral to a dispensary)

Main indicators of performance

2010 2011 20122013(11

month)

Calls 101 102 103 563 106 987 103 235

On- sites visits

57 469 62 700 70 611 65 830

Consultations 43 633 40 863 36 376 37 405

39% - receives help during 20 minutes

68% - during 30 minutes95% - during 60 minutes

Number of attendances and hospitalizations

Number of attendance emergency

psychiatric team

Number of hospitalization %

2010 37685 21617 58%

2011 41900 25841 62%

2012 47418 29535 62%

Conclusion

Reform of mental care system has a positive effect:

- Decrease loading on psychiatric hospitals and Emergency Psychiatric Service

- Increase in number of staff and material well-being

Problems:

- Poorly developed connection of outpatient and inpatient service