Family placement schemes for recovery oriented acute care

Transcription

1 Family placement schemes for recovery oriented acute care Nicolas DAUMERIE Project Manager / Clinical Psychologist, WHO Collaborating Centre for Research and Training in Mental Health (Lille, France) EPSM Lille Métropole Anne LOMBART Host Family Initiative, Lille France. St Albans 15 September 2009

2 In this presentation A whole system approach for community based services development : the role of family placement (short lenght of stay) / host family Citizen psychiatry in practice :recovery and citizenship. The example of Eastern and Southern Lille Suburbs Mental Health services and network Role and advantages of family placements in a recovery process : being an host family Debate and questions

3 20th Century Model Primary Care Hospital Outpatients Psych. nurse

4 Helsinki Conference 2005: Priorities for the next decade 1- Foster awareness 2- Collectively tackle stigma, and empower and support people with mental health problems and their families 3- Design and implement integrated mental health systems 4- Create a competent workforce 5- Recognize experience and knowledge of service users and carers

5 Develop the Vision of comprehensive mental health : a a whole system approach Inclusion and recovery Interventions Prevention Well being

6 Service Model 21st Century Secure places Residential Care Inclusion and rehabilitation Acute Hospital CMHTs? Family Placement? Primary Care Self Help

7 A french example of International Networking for good practices in community mental health Citizen psychiatry in the cities of Lille Eastern Suburbs

8 DIRM EPSM Lille-Métropole 1

9 WHERE WE COME FROM 1970 for inhabitants A big psychiatric Asylum in the suburb of Lille inpatients / 1000 beds 1 Prison Ward (Pavillon de force) All services locked 24h/24 All patients on compulsory admission 300 patients per service, including 150 elderly and alcoholics Mean length of stay : 180 months 400 new admissions per year.

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11 Eastern and Southern Lille Suburb Mental Health Services (France) More than 30 years of «Citizen psychiatry» in practice Mental health services fully integrated in the community Networking and partnership with all concerned partners : users, carers, family, local elected officials, professionnals One rule : not to have partners but to be partner

12 TODAY S SITUATION (for inhabitants) 10 psychiatric care structures implemented in non specific facilities : GPs clinics, municipal, cultural or sport facilities. Intranet and phone permanent regulation system between the 10 care facilities of the service Emergency team linked with the emergency services of 2 general hospitals 60 places in associative flats 11 full time hospitalisation beds in an open ward (MLS 7 days) 11 Host Family placement instead of hospitalisation (Mean length of stay : 17 days-21days) : In the community

13 TODAY (2) A 24h/24 and 7days a week home care service Intensive home care treatment (10 places) Systematic and individual network with GPs (gps prescribe) Psychiatric Facilities totally intagrated in the cities A psychiatric service council open to users, local mayors and social workers A specific system to allow handicaped mental ill persons to get back to work, in municipal facilities (6 places available) persons in care per year (87% never hospitalized)

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15 A picture of the same woman in institutional care, and after community care was provided

16 NETWORKING Concertation platform with local elected, users, families and professionals via an NGO regarding : housing, work, leisure Work will all partners Integration in actual socio sanitary networks (emergencies in general hosptial, mobile team for people living in high precarity (homeless ), gerontology, addiction, AIDS ), culture and leisure Integration Health City Council for the 6 cities of the mental health territory. No decision regarding services creation and care organisations in the city without inhabitants consultation Local elected and citizens involvement Founding members of the International Mental Health Collaborating Network : Mental Health and Citizenship ( International networking

17 INTERNATIONAL NETWORKING : A SOURCE OF INSPIRATION From asylum to the city (Trieste example, 1976) Lille, 1977 Family placement instead of hospitalisation 1 family = 1 bed (Madison, USA 1998) Lille, 2000 Home Care Service 7j/7 (Birmingham, 2000) Lille, 2005 Totally open wards (Merzig, 1997) Lille, 1999 Nurses in first line (Mauritania, 2001) Lille, 2003 Crisis centre 72 hours in Lille University Hospital, 2001 Network with Gps (Oviedo, 2002) Lille 2003 Access to work by cooperatives (Trieste, 2003) Lille 2007 Clubs and volonteers (Quebec 1987, Luthon and Monaghan 2005) Lille 2005 Information and stigma tackling strategies in the community (Scotland 2005) Lille 2006 User expert Peer support (UK 2008, Quebec 2008, St Albans 2008, Nottingham 2 Lille

18 Today in Europe «bed» is still strongly linked to psychiatry identity even if they decrease

19 More beds? Still beds? WHY? 1 : Qu est-ce qui favorise le «lit»? Les représentations sociales de la population. Le fou comme le malade mental sont incurables. Les actes criminels, la violence leur sont attribués. Ils ne peuvent guérir, ils sont exclus et ils doivent être soignés à l hôpital psychiatrique (Enquête Santé Mentale en Population Générale ) L efficacité des soins est douteuse dans le lit Les bénéfices secondaires (prises en charge régressives) sont importants Les techniques de soins (industrie pharmaceutique) ont besoin que les gens restent un certain temps dans le lit pour pouvoir les observer Le prix de journées des institutions permet un calcul simple : les lits = de l argent La peur, la pauvreté

20 More beds? Still beds? WHY? 2 : Le «lit» favorise La perte d autonomie Un coût social et humain considérable pour réhabiliter les personnes «asilifiées». Les représentations sociales : les personnes occupant un lit sont souvent enfermées voire camisolées ou en isolement. Elles perdent leur liberté et alimentent la dangerosité. La non prise en charge par le social des problèmes sociaux des personnes ayant des troubles psychiques. La non prise en charge par des problèmes somatiques des personnes ayant des troubles psychiques.

21 Family placement schemes : being an host family for acute care in Lille France

22 Family placement schemes for acute care in Lille France Aim Prevent crisis and admission Create healthy relationships and social network Improve quality of life Target group People with MH problems who...

23 Family placement schemes for acute care in Lille France What is a host family? A new relationship different of the classical MH system An offer of contact and participation A room of recreation, relaxation and activities in the community

24 Why is it a good idea? Family placement schemes for acute care in Lille France Relationships and network are important in the recovery process An arena for development An example of how to cope with everyday life ordinary families have problems too, and they deal with them in different ways A place to unload when life is hard Host families can give Equal family relationships Integration processes Hope of independence in interdependence with others Meaning meaningful activities and relationships Respite/break without stigmatisation and hospitalisation

25 Family placement schemes for acute care in Lille France What do others experience that they have gained from it? Being part of a balanced family Being seen as a real person Being part of everyday life, pleasures and chores To forget that I am ill

26 How to get there Models, structure and framework Regulation and financing Defining the target group Referral process Matching process Documentation Practical work Recruitment of families Training Making it known Matching Contact with families Family placement schemes for acute care in Lille France

27 Thank you for your attention Contacts: ndaumerie.epsm-lille-metropole.fr