SOCIAL PSYCHIATRIC SERVICES : OUTREACH UNITS AND MENTAL HEALTH

PROMOTIONA. Frangouli : Sectionalised Community Mental Health Promotion

Continuation of care and psychotherapy of adolescentsin transition to adulthood : Concerted function of childGuidance Clinics and Community Health Care

4th European Congress of the International Neuropsychiatric Association :

“Overlap and Integration in Neuropsyciatry”

The First Interdisciplinary Congress

“Psychiatry and Related Sciences”

Athens, November 29 – December 2, 2012

EVROS

RODOPI

ATTIKI

FTHIOTIDA

FOKIDA

Mobile Psychiatric

Unit

1. Community Psychoeducation

Combating Stigma & Social Exclusion

2. Crisis Intervention

3. Meeting people wherethey live

4. Mental Health inYouth & Education

5. Deinstitutionalisation

6. Mental Health in Workplace Settings

CREATION OF LOCAL NETWORK

The Mobile Psychiatric Units Model

Community Sensitization – Psycho-education

Working Definition

Community Sensitization – Psycho-education :• Is the work that is done with the population in

order to bring a change in their attitudes towards mental illness or other disabilities

• Is the understanding of mental health promotion and early intervention

• Is the participation of the therapeutic team as an organization or an individual person in the everyday life of the community.

The target-group of community sensitization

• Community Sensitisation – Psychoeducation concerns a large population group, that extends from the psychiatric services user’s immediate environment (e.g. therapists, family, neighbourhood, local shops etc) on the one hand, to the wider population and the official authorities on a local as well as a national level (e.g. schools, Municipalities, the Church, the Police, employers, scientific community etc), on the other hand.

• We have to adapt our approaches & methods according to each target group of the population.

The basic aims of community sensitization

To bring a change in the community’s attitudes towards mental illness or other disabilities & so to facilitate the inclusion of PwD (People with Disabilities) or IwPP (Individuals with Psychosocial Problems)

To promote mental health, to ensure the prevention of mental health problems and to act on early intervention

Characteristics of Community Sensitization-

Psychoeducation• The stability of the therapeutic team in the

catchment area• The continuous training and supervision offered to

the therapists, who need to have enthusiasm and experience

• The understanding and respect of the customs, traditions, values and believes of the community

• The respect and faith in the equal rights and responsibilities of people with psychosocial problems or intellectual disabilities

• The participation of people with mental health problems or intellectual disabilities at the Community Sensitization activities

• The participation at local community activities organized by other agencies and institutions

Most important issue:• The participation of people with mental

health problems or intellectual disabilities – whenever possible- at the Community Sensitisation – Psychoeducation activities, renders these more successful and aids the combating of the fear and stigma attached to mental illness or other disabilities. It also spreads the message more effectively for the promotion of Mental Health, equal rights and social solidarity.

The work done with the families • We have to offer a stable support and psycho-

education to the families, in order to help them to understand better the needs of the family member who suffers from psychosocial problems, to recognize the early signs of a relapse and know what to do, to keep the balance between family, support self autonomy. We have to work with the immediate social environment of the individual with mental health problems

• We have to work together with families’ and users’ associations and ensure that their “voice” reaches the policy/decision making centers

Working Together…

The wholeCommunity

Individuals with MentalHealth Problems

Carers(Families,Friends,

Relatives, Siblings,Employers…)

SSP&MH(staff/volunteers/networking with other organizations)

Activities & Methodology of Community Sensitization –

Psychoeducation (1) • Bring the local community (e.g. neighbourhood,

shops, coffee places etc) into contact (in every day life activities) with individuals with mental health problems or intellectual disabilities and demystify mental illness.

• Contact with possible employers. To give a realistic view of skills/potentials/difficulties. To collaborate with the employer, in order to support PwD or IwPP to maintain their job.

Activities & Methodology of Community Sensitization –

Psychoeducation (2)

• Public speaking, Community Forum, Focus Groups – Seminars at Schools (students, parents, teachers, professors).

• Psycho-Education meetings with the official authorities (eg. Local government - Mayor, employees at the local services), the Police, the Judiciary, the Church etc.)

• Both aiming at: Mental Health Promotion/Prevention/ Early

InterventionPromoting a social inclusion attitude/fighting

stigma

Activities & Methodology of Community Sensitization –

Psychoeducation (3)

• Networking: Contact with other organisations, social solidarity networks, NGOs, Cultural Societies, as well as local Family or Users’ Networks.

• Creation of alliances, to support each other’s actions, to use all the complementary resources available and to co-organise special sensitization events

Activities & Methodology of Community Sensitization –

Psychoeducation (4)

• Contact with Volunteers. Volunteers can: support individuals with mental health problems

or intellectual disabilities become advocates of the message that

individuals with mental health problems or intellectual disabilities are equal citizens.

• Participation in scientific conferences: disseminating the effectiveness of community sensitization & Social Psychiatry

Activities & Methodology of Community Sensitization – Psychoeducation (5)

• Contact with journalists in order to fight the stigma & to show people a realistic image of PwD or Individuals with Mental Health problems.

• Distribution of Printed and other electronic Material in each event that the organisation participates

We make the Community Sensitization an inseparablepart of our every day work.

20% of our work-load is offered to community sensitizationprojects

Results of Community Sensitization – Psychoeducation (1)

• It leads to a change in the prejudism towards mental illness and intellectual disabilities and combats the stigma attached to these.

• It leads to the effective integration (equal social inclusion) of people with mental health problems and intellectual disabilities in the community.

Results of Community Sensitization – Psychoeducation (2)

• It is a necessary condition for prevention and early intervention; through education of the population and of the key personalities of the community we serve the aim of Mental Health Promotion.

• It helps to avoid the onset of a crisis, as well as involuntary admissions to psychiatric hospitals; the sensitized environment of a PwD or Individuals with Mental Health problems knows how to recognize the early symptoms and how to help him/herself.

Let me bring an example of how we work on the primary prevention level with adolescents :• Obligatory education in Greece is 9 years in

duration - Six years elementary and 3 years high school education. In elementary school, special education provisions (special or parallel classes, individual teaching…) were and are available for students needing it. But the 3years of high school these special provisions for the students were not planned, not available. So, students who were thoroughly supported at elementary school, were in high risk of social, educational, family problems because they were abandoning high school education. Consequently, the Mobile Psychiatric Unit, discussing it with the key personalities of the region, the parents and the students, created the adolescents department.

• It started 1988 and ended in 2000, with no separate budget. Periodically, a municipality could give some subside to support the program. It was functioning on a daily basis by a teacher, social worker and psychologists. Speech and language therapy was offered individually. The program was, continuation of education (grammar, syntax, maths, written language, history), training of social skills, cognitive skills, individual and group empowerment, pre-vocational training, employment in the open market. It as a successful program, a small book was published at the end. The department closed because, the public education system provides the service ever since.

BIBLIOGRAPHY• Frangouli A. (2008), Mobile Psychiatric Unit at the Prefecture of Fokida:

Psychosocial Intervention in the Community, Papazisis Publishing House:Athens. • Jones J., Lowe T. (2003). The education and training needs of qualified mental

health nurses working in acute adult mental health services. Nurse Education Today, 23(8): 610-9.

• Joulis Α. and Frangouli Α. (1994), “Community Sensitisation in Thrace for the participation of the population in the mental health services”, Psychiatric Notebooks, No. 44.

• McCulloch A. (1998), “Public Education in England” in Presenting Mental Illness, Mental Health Promotion in Primary Care, ed. R. Jenkins & T. Badirham, England, Ustun.

• Monitoring and Support Unit for the “Psychargos II Program “ (MSU) (2005)[1], “Methodological Guide for the Mobilization of Volunteers in mental Health”, Athens.

• Sakellaropoulos P. et Coll. (2003), “Desinstitulization and its relation with Primary Care”, Papazisis Publishing House:Athens.

• Sakellaropoulos P. et Coll. (2010), “The foundation stone of Psychiatry is the emotional bond between the therapist and the patient”, Papazisis Publishing House:Athens.

• WHO-WAPR (2007). Ψυχοκοινωνική Αποκατάσταση: Συναινετική Διακήρυξη, ελλ. μετάφραση με ευθύνη του ελλ. κλάδου της WAPR, σ.σ. 2-3. Προσβάσιμο στο: http://www.msu.gr/article.asp?actmen=Layer3&menuID=28

•[1] The Psychargos Program was created as part of the National Psychiatric Reform Program.