Mental health care in the Netherlands - cmhcd.cz stazeni/Centrum/me… · PowerPoint-presentatie...
Transcript of Mental health care in the Netherlands - cmhcd.cz stazeni/Centrum/me… · PowerPoint-presentatie...
Mental health care in
the Netherlands
And the new role of the peer
specialist
The system of the mental health care and the
experiences with the role and the employment
of the peer consultants in the Netherlands
History
Recovery Movement.
Recovery oriented care
Peer specialist
Recent history (till 90’s)
After 6 months point of
no return
Staff in role of guard
Doctor knows best
No perpective
Hospitalisation
Loss of roles and
competence
Goffman 1957
Closing MH institutions??
WHO
New Asylums??
Same message
We are changing our ideas
Old Belief was {Disability, being a victim,
↓ looking for someone to
take care/fix me
Empowerment {To produce the results I want
↓
Enlightenment {Ability; discovering my gifts and
strengths
Recovery (Anthony 1993)
" a deeply personal, unique process of changing
one’s attitudes, values, feelings, goals, skills
and/or roles. It is a way of living a satisfying,
hopeful, and contributing life even with
limitations caused by the illness. Recovery
involves the development of new meaning and
purpose in one’s life as one grows beyond the
catastrophic effects of mental illness."
Research
Aspects of Recovery(Droes, 2010)
Process Result
Recovery of
illness
Assertiveness
Treatment
Illness management
Less symptoms
Cure
Recovery of
roles
Rehabilitation
Stigma
Inclusion
productive member
of society
Recovery of
identity
Recovery story
Empowerment
Lived experience
Personal identity
Wellness
herstel
Rec Oriented Practice (le Boutillier, e.a. 2011)
Supporting personally defined recovery.
Promoting Citizenship
Commitment of organisation
Working relationship.
Reducing number of
long stay beds
What did we learn?
ACT History
Deinstitutionalisation
Revolving door group (1 / 3)
Wisconsin Training in community Living (TCL) (Test and Stein 1976)
TCL Assertive Community Treatment
(ACT)
19 FACT NHN
What is ACT?
An evidence-based practice (EBP) for adults with severe
and persistent mental illness
A team-based approach to providing treatment,
rehabilitation, and support within the community
Focus on working collaboratively with consumers to
address full range of needs in the community:
Obtaining housing Improving skills
Securing benefits Working with families
Engaging community Gaining employment
20
‘Netherlands
ACT (since 2003)
Flexible ACT (since 2006)
Early Intervention Psychosis
Forensic ACT
Total round 160
21 FACT NHN
Flexible ACT in the
Netherlands
FACT Teams in the heart of the
organisation for SMI
Flexible ACT
Instead of ACT and step down teams FACT
Cure and care for persons with a SMI in MH
organisation is offered in FACT teams.
Focus on social inclusion & recovery
Increasing continuity of care and a flexible
response
FACT
Flexible ACT team offers care and treatment to all SMI-population in a catchment area:
50.000 inhabitants ± 200 persons with SMI
FACT teams are working with TWO procedures;
Lower scale: state of the art treatment (casemanagement within a
multidisciplinary team)
High scale: Full ACT with teamapproach by the same multidisciplinary team
Procedure for up- and downgrading of care within the same team
Six Principles
2. Support for community participation
Fam / CSS / Stigma
1. We’ll be there where the client wants to be successful!
.
3.Binding in the MHC network. Continuity of care between Hospital and community / 7 x 24
4. ACT Flexible available when necessary
5.Treatment EBM & Guideliness.
6. Focus on recovery Peer support, WRAP, IPS
Proces
Rich Multidisciplinary team
Team (+/- 11 FTE) for 160 – 180 patients:
(community) psychiatric nurses
Psychiatrist
Psychologist
Peer specialist,
Social worker,
Substance Abuse (IDDT)
Supported employment specialist (IPS)
Manager / team leader
Since introduction ACT FACT
Peer specialists in teams:
Mainly in ACT and FACT teams, Acute wards,
Sheltered housing
Recovery coaches
Recovery trainers, WRAP facilitators
Advisors
Stigma buster
GGZ NHN
2004 Start FACT teams
2006 First Peer support worker
Now 26 most in FACT teams
Acute wards
Elderly
Autism
Long stay
Activity centre
GGZ-NHN
12 FACT teams
600.000 inhabitants
2500 SMI in FACT
Delespaul
SMI case definition
A severe psychiatric disorder in need of
treatment (not in symptomatic remission)
Severe limitations in social functioning (= not
in functional remission)
Psychiatric disorder <-> limitation
Long term condition
Indication for co-oordinated network of
professionals
ACT in Netherlands
(Mental) Health Policy
Insurance companies represent choice for
consumers
Slow start of reduction of beds Long stay and
Acute
Way: FACT and IHT
Futhermore more MH in ‘first line’
Certification and model fidelity of ACT and FACT
in The Netherlands