Recommendations for the Treatment of Clients with Schizophrenia in the Mental Health Care Outpatient Service in Carinthia
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JAMK University of Applied Sciences Carinthia University of Applied Sciences School of Health and Social Studies School of Health Sciences and Social Work Health Care and Social Services Development and Health Management Management Recommendations for the treatment of clients with schizophrenia in the mental health care outpatient service in Carinthia Submitted in partial fulfilment of the requirements of the academic degree Master of Arts in Business (MA) Author: Achtschin-Stieger, Sigrid Anna, BA Registration number: 1510519003 Supervisor: Katja Raitio JAMK University of Applied Sciences Second supervisor: Dr.in Klein, Regina Carinthia University of Applied Sciences Feldkirchen, August 2017 Statutory Declaration I hereby declare that: − the Master thesis has been written by myself without any external unauthorized help and that it has not been submitted to any institution to achieve an academic grading. − I have not used sources or means without citing them in the text; any thoughts from others or literal quotations are clearly marked. − the electronically submitted Master thesis is identical to the hard copy. − one copy of the Master thesis is deposited and made available in the CUAS library (§ 8 Austrian Copyright Law [UrhG]). _________________________________________________________ (Place, Date) (Student´s signature) II Abstract Purpose: This thesis considers the wishes and needs of service users of the outpatient mental health treatment structure of Carinthia. The aim was to find out what kind of treatment structure and support people with diagnosed schizophrenia need in order to have self-determined and satisfied lives. Which established facilities, services and approaches from different countries could meet these wishes and needs and which of them could be implemented in the current mental health outpatient structure. Finally, these considerations should lead to recommendations to improve the future mental health outpatient treatment structure. Methods: This thesis was set up on three methods; a literature review about international recommendations, facilities and services for people with a diagnosed schizophrenia. An ethnographic research to have a closer look on the mental health care in Finland and focus groups with the three groups of service users, people diagnosed with schizophrenia, relatives of people diagnosed with schizophrenia and professionals of the mental health outpatient treatment in Carinthia, to find out about their wishes and needs. Results: Carinthian people diagnosed with schizophrenia need to get more respect and recognition within the mental health treatment. They want to be seen as individuals and outstanding humans with individual and unique needs and problems. They request to be equal partners and involved in the planning and decisions regarding their treatment plans and the organization of their lives. Conclusion: The current mental health outpatient treatment structure in Carinthia is not enough person-orientated and client-centred. For people with a diagnosed schizophrenia it is important to be taken seriously, to be heard and to make their own decisions according to their own personal aims concerning their lives. Therefore the whole system has to change the current attitude towards a recovery orientated attitude, to improve the system towards more empowerment and person-involvement means to give people diagnosed with schizophrenia more self-determined and satisfied lives. Key words: Mental Health Treatment, outpatient, people diagnosed with schizophrenia, relatives of people diagnosed with schizophrenia, professionals of the mental health outpatient treatment, Carinthia, wishes and needs, stigmatisation, recovery approach III Table of contents Statutory Declaration ................................................................................................... II Abstract ...................................................................................................................... III List of Abbreviations .................................................................................................. VIII List of Figures .............................................................................................................. IX List of Tables ................................................................................................................ X Preface ........................................................................................................................ XI 1. Introduction ........................................................................................................ 1 2. The challenging situation of people diagnosed with schizophrenia ....................... 6 2.1 Clinical perspective - Schizophrenia as a disease .................................................. 6 2.2 Stress-Vulnerability Model .................................................................................. 8 2.3 Social-psychiatric perspective – Schizophrenia as stigma ..................................... 9 2.3.1 Types of stigma ..................................................................................................... 10 2.3.2 Discredited and discreditable ................................................................................ 11 2.3.3 Self-stigma ............................................................................................................ 12 2.3.4 People who are affected by stigma ........................................................................ 13 3. Conditions and current mental health treatment structures for people with mental health problems ......................................................................................................... 15 3.1 Mental health and wellbeing in the European context ....................................... 15 3.2 The Austrian health care system ........................................................................ 19 3.2.1 Funding of the system ........................................................................................... 20 3.2.2 Insurance system .................................................................................................. 20 3.2.3 Access to the health care system ........................................................................... 21 3.3 The challenging situation of Carinthian mental health care ............................... 22 3.3.1 Topography and geography of Carinthia ................................................................ 22 IV 3.3.2 Inpatient treatment facilities ................................................................................. 23 3.3.3 Outpatient treatment facilities .............................................................................. 23 3.3.4 Pro mente Kärnten................................................................................................ 29 3.3.5 Summary of the current treatment structure ......................................................... 32 4. Development of Mental Health Care.................................................................. 36 4.1 Treatment of people with a mental disease during the centuries ....................... 36 4.1.1 Antiquity .............................................................................................................. 36 4.1.2 The Middle Ages ................................................................................................... 38 4.1.3 The Modern Era .................................................................................................... 38 4.1.4 The 19th century ................................................................................................... 40 4.1.5 The early 20th century .......................................................................................... 40 4.1.6 The dark period of National Socialism .................................................................... 41 4.1.7 Post-war years ...................................................................................................... 42 4.1.8 Anti-psychiatry and social psychiatry ..................................................................... 43 4.2 Recovery approach ............................................................................................ 44 4.2.1 A vision of recovery .............................................................................................. 45 4.2.2 Recovery versus supply ......................................................................................... 48 4.2.3 Values and dimension of a recovery orientated mental health program (ROMPH) .. 49 4.2.4 Recovery in Austria ............................................................................................... 50 4.3 Models of professional support ......................................................................... 52 4.3.1 Soteria - an inspired idea in the USA and Switzerland ............................................ 53 4.3.2 Run away from traditional psychiatric treatment – Weglaufhaus “Villa Stöckle” ..... 55 4.3.3 Just living – The Hotel Magnus Stenbock ............................................................... 56 4.3.4 Diagnosed free zone – possibility for changing the role – the Clubhouse ................. 58 4.3.5 Interface management by psychiatric outpatient nurses in Finland ........................ 60 4.3.6 Open Dialogue approach – the Western Lapland treatment system ........................ 63 V 5 Methodology ......................................................................................................