Mental Healthcare 2

KEY DATAMental IN HEALTHCARE HealthcareEdition 2021 CONTACT INFORMATION Galileelaan 5/2–1210 Brussels Tom Auwers, RESPONSIBLE PUBLISHER and the‘Psychosocial healthcare’ unit. &policyinformation’care, inparticularthe‘Data unit The membersoftheDirectorate-Generalfor Health EDITORIAL COMMITTEE some key figures. departments of general hospitals (PDGH) through ing ofpsychiatric hospitals(PH)andpsychiatric This reportprovides an SUBJECT Colophon Legal deposit:D/2021/2196/13 and www.health.belgium.be Environment: Federal Health,Food Public Service ChainSafety and This documentisavailable onthewebsite ofthe ted provided thatthesourceisacknowledged. Any partial reproduction ofthis document is permit T. CenterGezondheid) +32(0)252497(Service Galileelaan 5/2–1210 Brussel Directorate-General Healthcare www.healthybelgium.be

overview ofthefunction

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KEY DATA IN HEALTHCARE Mental Healthcare 2. 1. HOSPITALISATION ALTERNATIVES TO REGARDING INITIATIVES 4. 3. 2. 1. FOR ADULTS MENTAL HEALTHCARE in PHandPDGHforadults for adults for adults First-line psychologicalfunction(FLP) Decommissioning orfreezingofbeds Patient flowsinPHandPDGH The mostcommonprimarydiagnosis Hospital activitiesinPHandPDGH Organisation ofthecareoffering

24 21 38 35 35 16 6 6 2. 1. Internment 2. 1. YOUNG PEOPLE FOR CHILDRENAND MENTAL HEALTHCARE ADDICTION CARE FOR FORENSIC CARE HOSPITALS PSYCHIATRIC STAFF IN HOSPITALS PSYCHIATRIC FINANCING OF subject toacourtorder(ForK) with psychiatricproblemswhoare for childrenandyoungpeople for childrenandyoungpeople Specialised careforyoungpeople Hospital activitiesinPHandPDGH Organisation ofthecareoffering

50 49 44 44 42 40 31 26 26 3

KEY DATA IN HEALTHCARE Mental Healthcare comprehensible manner. keythe most important for data each sector in a which we aremainlyactive. We chose topresent for eacha periodicsummary ofthefour sectorsin healthcare’.‘mental In2019, we decidedtopublish ‘healthcare professionals’, ‘urgent medical care’ and four sectorswheretheDGGSisactive: ‘hospitals’, We have especiallyinthe ahugeamountofdata, of highlightingwhatisessential. Information” but,above service all,ithadthebenefit led tothedevelopment ofa andStrategic “Data ships oftoday andtomorrow. This exercise notonly approach, intoaccounttheexternal partner taking inaprogressivethe managementofcurrent data egy, organisational structure, building and capacity was carried out:areview ofthemission,vision,strat in this regard. Two years ago, astrategic exercise Several initiatives have beensetupwithintheDGGS aswell andexploitation.data asitsaccessibility multi-faceted: boththetechnical management of tutions, strategy. is defining a stronger data This is for Healthcare(DGGS),asfor numerousotherinsti One ofthechallenges for theDirectorate-General PREFACE and development of focus isontheuse analysis. Todaythe “Figures allow for Annick Poncé comparability.” andtheir interpretation ontheir these data,

- - - data inhealthcare”data reinforces ourbelief. We have a The interestgeneratedby thefirstedition of “Key • • • • general hospitals Today’s reportisdedicatedto our next decisions. something fromittousefullyandwiselyapply thetimetotake andtaking and assimilatingthedata if it is shared, and that’s what’s sharing important: But such anabundanceofknowledge isonlyvaluable wealth and thisknowledge of data is for everyone. In ourfirstreport,entitled “ Acting Director- General Annick Poncé We wishyou happy reading, develop theminthefuture. ambition is tosharetheseanalyses withyou andto that we canindicatedevelopments andtrends.Our We aimtoperiodicallyrepeatthese “key so data” tioning ofasector. a comprehensive picture of the structure and func is thefirstandmodeststepinanalysis toprovide of general hospitals(PDGH) ric hospitals(PH) We acloselookatthefunctioningof take P4Q, etc.) of physicians, pharmaceuticalplatforms, IHAB, safety programmes,BAPCOC, BELMIP, colleges and programmes(pluriannualquality of quality number ofindicatorsavailable tous in terms forKey example relatedtoquality: the data and amountofcare Key related to care: for data example ofcare types and partsofthebudget Key relatedtofinancing: data for example budget etc. ofhospitals, types pitals, Key relatedto organisation: number of hos data

”, we presented: andthe psychiatric departments Key inhealthcare data . Presenting the figures mental healthcare psychiat

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KEY DATA IN HEALTHCARE Mental Healthcare INTRODUCTION hospitals (PDGH). hospitals scape and the functioningof psychiatric (PH) and psychiatric hospitals departments ofgeneral networks, but we will focus on the effect thatthisway of working can have land on the hospital This editionoftheKey willnotcover data therangeofcareproviders thatarepartoftheseMHC care pathways, basedontheindividualhealthcareneedsofpatients. Network collaborationmeansthatcareproviders andactorswork togethertorealisepersonalised possible. This careisintensified. principleimpliesthatthehospital be asshortpossible. The follow-up care istransferred toextra-mural careproviders asrapidly ment, includingfor severe psychiatric isunavoidable, disorders.Ifhospitalisation should thestay Socialisation meansthatasmuch careaspossibleisprovided inthepatient’s immediateenviron healthcare Two themesaretheguidingprinciplethroughthesereforms, namelythe “ the group. “Elderly” target in newStepsarecurrently beingtakentoprepareanew regulationsandfunding. MHCpolicyfor basis.Ultimately,policy isgraduallyputintopracticeonavoluntary theseprojectsshouldresult “Children and Young people” have already been translated into pilot projects in which this new The reforms focus groups according to their age. on target As such, the reforms for “Adults” and this IMCform thebasisfor thevarious reformshealthcareinBelgium. inmental the Inter-Ministerial Conference onPublic Health(IMCPublic Health)was setup. The protocolsof nities andregionspartlythecompetenceoffederal government. To encouragecohesion, The healthcare (MHC)inBelgium policyregardingmental is partlythecompetenceofcommu such adifferent groups. scale,thatitwas accordingtothesetarget decidedtobreakdown thedata The careoffering for “Adults” and “Children and Young people” differ tosuch anextent, andareon ” and “ ” Network collaboration .”. Socialisation of mental Socialisation ofmental - - - 5

KEY DATA IN HEALTHCARE Mental Healthcare FOR ADULTS MENTAL HEALTHCARE 1. 1.1. every Belgian ispartofonethe20MHCnetworks. municipality and a number of networks were redesigned, which left works were (MHCnetworks) setupandsystematically expanded. An evaluation was madein2017 healthcare (MHC)for adults. Various pilotprojectswere launched inwhich healthcarenet mental Ten years ago,theInterministerialConference (IMC)onPublic Healthlaunched thereform ofmental Networks inmentalhealthcareforadults Organisation ofthecareofferingforadults N mental health care: initiatives inthefield of Learn more abouttheseveral N N N R www.psy107.be R H C N AKT AD HA R N RA E 20 MHC networks for adults LT T K N R Mental healthcare for adults L R N . Currently, L RE - 6

KEY DATA IN HEALTHCARE Mental Healthcare C R R R PDGH PDGH PDGH 1.2. 1 PH PH PH 0 number ofbeds,which often primarilyprovide day care. or morepsychiatric small bedsfor adults.Inaddition,therearealimitednumberofPHwithvery 1 and30bedsinthisregard.Nevertheless, thereare11 inBelgium generalhospitals thathave 100 One third of the PDGH have a limited offering of psychiatric care for adults, and have only between hospitals (PDGH) Belgium has Hospitals The Walloon Region alsohaslargePDGH,withtwohaving beds. more than200 asmanythere arealmost twice PDGHasPH. Almost half of thePDGH have 100 beds ormore. only regiontohave 5PHwith roomfor patients. IntheBrussels-Capital region, morethan500 The Flemish regionclearlyhasmorePHandPDGHcompared totheotherregions.Itisalso Source: CIC,FPSHealth, Food Chain Safety andEnvironment (1/01/2020) psychiatric problems NUMBER OFPH AND PDGH PERREGION BROKENDOWN ACCORDING TO NUMBEROFBEDS can gethelpfrom hospitals adults 5 118 51 psychiatric hospitals(PH) for adultswithpsychiatric problems with 10

15 N (01/01/2020) and psychiatric hospitals 67 psychiatric departments withingeneral 20 PH 51 [1] .

25 within general departments departments Mental healthcare for adults 30 psychiatric PDGH hospitals 67

KEY DATA IN HEALTHCARE Mental Healthcare 1.3. the districtsof Thuin, Philippeville, Dinant,Marche-en-Famenne, Neufchâteau andBastogne. on theaxis Tournai, Charleroi,Mons,Liège,and Verviers. Inaddition,therearenoPHorPDGHin In the Walloon region,thesituation iscompletelydifferent. Almost allPHandPDGHfor adultsare thatthereisaPHorPDGHateverylocationwithinradiusof50kilometres. can observe followed by thePajottenland, andtheKempenNonetheless,we region,andthenorthofLimburg. supply ofpsychiatric for adultsisratherlimitedinthe services Westhoek, theFlemish Ardennes concentrations aroundmajorcitiesincludingGhent, Antwerp andLeuven. Ontheotherhand, In theFlemishRegion, thedistributionofPHandPDGHfor adultsisthemostbalanced. We see In additiontothesupply, thedistributionofPDGH andPHalsodiffers accordingtotheregion. the type ofcareprovided: the type provided. Ineach unit, thereareanumberofrecognisedbedswithspecific codeletter reflecting Psychiatric institutions areoften divided intodifferent unitsaccordingtothetherapy orpathology TYPES OFBEDSFORRESIDENTIAL HOSPITALISATION is referred toaspartialhospitalisation. addition, itispossible that apatient stays intheinstitution onlyduring the day oronly atnight. This patient stays intheinstitution day andnight. This isreferred In toasresidentialhospitalisation. In psychiatric care,itispossiblefor apatienttobeadmitted toapsychiatric wherethe service Types ofhospitalisation C R INDICATING THE NUMBEROFBEDSFOR ADULTS (01/01/2020) DISTRIBUTION OFPH AND PDGHINBELGIUM DH H

Mental healthcare for adults 8

KEY DATA IN HEALTHCARE Mental Healthcare C R R R PDGH PDGH PDGH PDGH PH PH PH PH 0 in thisdocument. family care” (code letter Tf). These of the Belgian landscape and are not covered are atypical hospital The publicPHinGeelandLierneux alsohave bedsandplaces for “Family placementorpsychiatric see thatPDGHprimarilyconsistofbedsfor acute care(codeletter A). The above figuresshow thenumberofpsychiatric beds for adultsinabsolutenumbers. We can • • • • C TT A A night) oflong-termandchronic problems inadults,withafocus onsocialre-adjustment.Inthis Beds for chronic care (code letter T): ment (day andnight)ofadultpatientsinneedurgentcare; Beds for acute care (codeletter A): for adultpatientswithsevere behavioural disordersand/oraggressive adultpatients. Beds for intensive care (codeletter IBE: pilotproject since2009): foritation patientswithpsychogeriatric andchronic conditions; Beds for specialisedcare (codeletter Sp6): are includedinthiscategory; document, bedsfor the 1,000 NUMBER OFRECOGNISEDBEDSFORRESIDENTIAL HOSPITALISATION 2,000 3,000 PER REGION AND PER TYPE OFCARE(01/01/2020) neuro-psychiatric treatment ofgeriatric patients(codeletter Tg) 4,000 5,000 N The forand treat neuro-psychiatry observation service I IE The neuro-psychiatry for treatment (day service and 6,000 Specialised service for treatmentandrehabil Specialisedservice 7,000 8,000 9,000 Intensive treatmentunit Mental healthcare for adults 10,000

11,000 - - 9

KEY DATA IN HEALTHCARE Mental Healthcare per 100,000 inhabitants. Onaverage,100,000 inhabitants. Belgium has130 residential bedsinPHandPDGHcombined the regionsislesspronounced,butthatFlemishregionstillinleadwith138 bedsper figures arepresentedintermsofthenumberinhabitants, we seethatthecontrastbetween We thedifferent canalsoseeasignificantdiscrepancybetween regions.However, whenthe C R per 100,000 inhabitants have we in PHandPDGHaltogether, On average inBelgium, R NUMBER OFRECOGNISEDBEDSFORRESIDENTIAL HOSPITALISATION 123 108 130 PER 100,000 INHABITANTSPER 100,000 PERREGION (01/01/2020)

residential beds

138 R

Mental healthcare for adults

KEY DATA IN HEALTHCARE Mental Healthcare N 2 1,000 2,000 3,000 4,000 5,000 6,000 0 the federal government introducedprogrammingcriteria. The numberof beds andtheirdistributionhas grown historically. To achieve aneven distribution, Explanatory note for beds programmingofhospital Explanatory general supplyofpsychiatric beds. hospital residential beds for acute care (code letter in PH, which inhabitants of the is atypical A) per 1,000 1000 thanenvisaged by inhabitants theprogrammingcriterion.However, theregionhasfewer The Brussels-Capital Region hasmoreresidential bedsfor acutecare(codeletter A) inPDGHper More information onthe programmingfigurescanbe found on the following website NUMBER OFBEDSENVISAGED IN THE PROGRAMMING AND NUMBEROFRECOGNISEDBEDS Code letter A (PDGH) Sp6 + Tg Sp6 A (PH) IBE C R T FOR RESIDENTIAL HOSPITALISATION PERREGION (1/01/2020) R 0.50 Programming criterion 64 0.23 0.90 0.27 bedsfor Belgium beds per 1,000 inhabitants bedsper1,000 beds per 1,000 inhabitants bedsper1,000 inhabitants bedsper1,000 inhabitants bedsper1,000 C T A DHA A HA R Figures for beds programming ofhospital I IE T R Mental healthcare for adults [2] and 11

KEY DATA IN HEALTHCARE Mental Healthcare N N 10,000 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 0 0 without phasingouttheprovision ofotherbeds. the context ofthereforms healthcare. tomental This stipulatedthatnonew bedscouldbecreated from bedsfor chronic caretobedsfor acutecarefrom2015 on. This reflects theefforts madein If we lookattheevolution ofthenumberbedsbycare,we type seethattherewas ashift Region, anincreaseof9.3%intheFlemishRegion andof24.0%intheBrussels-Capital Region. fluctuates little very over time.If we lookatthelast20 years, we seeastatus quointhe Walloon The number of psychiatric total beds for adults in PH and PDGH for residential hospitalisation FOR RESIDENTIAL HOSPITALISATION BY TYPE OFCAREINPH AND PDGH 2000 2000 FOR RESIDENTIAL HOSPITALISATION INPH AND PDGH EVOLUTION OF THE NUMBEROFRECOGNISEDBEDS EVOLUTION OF THE TOTAL NUMBEROFBEDS 2005 2005 2010 2010 2015 2015

2020 2020 Mental healthcare for adults R C R R IE I T T C A A 12

KEY DATA IN HEALTHCARE Mental Healthcare C R R R PDGH PDGH PDGH PDGH PH PH PH PH 0 places inday (t1beds). hospitalisation care (a1beds). There isonlyonePDGHintheBrussels-Capital Region thatprovides 17 chronic care beds) intheFlemishRegion. For for day thePDGHmainlyprovides acute hospitalisation, services areprovided, withtheexceptionhospitalisation (a2 of2bedsfor acutecareinnighthospitalisation foraremainlylocatedinthePH.InPDGH,nobeds The partialhospitalisation night services For adistinctionismadebetween thefollowing partialhospitalisation, ofbedsandplaces: types TYPES OFBEDS AND PLACES FORPARTIAL HOSPITALISATION • • • • A A Places for acute care for day hospitalisation(codeletter a1): for for nighthospitalisation adultswithlong-termandchronic problems; Beds for chronic care innighthospitalisation(codeletter t2): for dayfor hospitalisation adultswithlong-termandchronic problems; Places for chronic care inday hospitalisation(codeletter t1): for andtreatmentfor ofadultpatientsinneed urgent care; observation night hospitalisation Beds for acute care for nighthospitalisation(codeletter a2): andtreatmentforfor ofadultpatientsinneedurgentcare; day observation hospitalisation NUMBER OFRECOGNISEDBEDSFORPARTIAL HOSPITALISATION 500 PER REGION AND PER TYPE OFCARE(1/01/2020) (01/01/2020) 1,000 N C C 1,500 The neuro-psychiatry service The neuro-psychiatry service The neuro-psychiatry service The neuro-psychiatry service 2,000 Mental healthcare for adults

2,500 13

KEY DATA IN HEALTHCARE Mental Healthcare N 1,400 1,000 1,200 200 400 600 800 R R 0 hospitalisation islowesthospitalisation inthe Walloon Region. the Flemish Region, both for day andnighthospitalisation. The provision of both day and night more places for are providedIn proportion tothe number ofinhabitants, partial hospitalisation in in anevolution ofthesupplyfrommorechronic caretoacutetreatmentorday therapy. number of places for acute day In practice, (a1) this is is reflectedclearly increasing. hospitalisation Over theyears, we aslightdecreaseinthesupplyofplacesnighthospitalisation. observe The FOR PARTIAL HOSPITALISATION BY TYPE OFCAREINPH AND PDGH 2000 D 27 13 EVOLUTION OF THE NUMBEROFRECOGNISEDBEDS NUMBER OFRECOGNISEDBEDSFORPARTIAL HOSPITALISATION 2005 PER 100,000 INHABITANTSPER 100,000 PERREGION (1/01/2020) 18 R C 2010 R 2015 R N 5 1

2020 Mental healthcare for adults A C C A 4 R C

KEY DATA IN HEALTHCARE Mental Healthcare N 3 1,000 1,500 2,000 2,500 3,000 500 0 figures. PH, only less thanhalf of thebedsand/or places are recognisedthandescribed in the programming areprovidedtalisation inPDGHthandescribedtheprogrammingfigures.Onotherhand, In theBrussels Region, Capital wethat morebedsand/orplacesfor observe day andnighthospi Explanatory note for beds programmingofhospital Explanatory More information onthe programmingfigurescanbe found on the following website a1 +a2(PDGH) a1 +a2(PH) Code letter t1 +t2 C R AND NUMBEROFRECOGNISEDBEDSFORPARTIAL HOSPITALISATION R 0.40 0.075 0.15 Programming criterion NUMBER OFBEDSENVISAGED IN THE PROGRAMMING beds per 1,000 inhabitants bedsper1,000 inhabitants bedsper1,000 beds per 1,000 inhabitants bedsper1,000 DH H PER REGION (1/01/2020) R [3] Figures for beds programming ofhospital HDH R Mental healthcare for adults

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KEY DATA IN HEALTHCARE Mental Healthcare N 40,000 50,000 60,000 70,000 2.1. 2. 5 4 parallel tothatinPH. PDGH. Inaddition,wethattheevolution canobserve ofthenumberstays inPDGHisalmost the number ofthat, stays in comparison with 2005, increased by 13.3% in PH and by 16.3% in adults inPHandPDGH.Ofthese,66,142 were stays inPHand56,261PDGH In 2018, of122,403 atotal stays (residentialandpartial)were registeredinpsychiatric for services Hospital stays Hospital activitiesinPHandPDGHforadults year inquestionregardless oftheyear ofadmissionandregardlesswhether thepatienthasalreadybeendischarged. This concernsthenumber ofregisteredresidentialandpartial stays inbeds for adults(allcodeletters except K,k1,k2, Tf) inthe Source: MinimumPsychiatric (MPD),FPSHealth, Food Data Chain Safety andEnvironment 2005 IN PSYCHIATRIC SERVICES FOR ADULTS INPH AND PDGH EVOLUTION OF THE NUMBEROFHOSPITAL STAYS 2010 2015

2018 Mental healthcare for adults DH H [4] , [5] . This means . This 16

KEY DATA IN HEALTHCARE Mental Healthcare N N 10,000 20,000 30,000 40,000 50,000 60,000 10,000 20,000 25,000 30,000 35,000 40,000 45,000 50,000 55,000 60,000 8 7 6 0 0 2013 and2016 (19-64 years old),whereby we astrongincrease in thegroupof19 observe to40year oldsbetween The increase inthenumberofstays inPHandPDGHissituated withintheactive population Namely, we seemenaremorelikely tobeadmitted toaPH. a cleardifference whereamanorwoman offacility istreatedfor inthetype his/herproblems. We number of stays that the total is the same observe for men and women. We do however observe registration. may beadmitted toapsychiatric for adults.Furthermore, service stays inthe0-18 year-old may betheresultof incorrect category Stays for which theageofpatient isnotknown, have notbeentakeninto account. For of0-18 thesake year ofcompleteness,thecategory oldsisalsoindicated.Inexceptional cases,children andyoung people Stays for which thesex ofthepatientisnotknown, have notbeentakenintoaccount.

2005 EVOLUTION OF THE NUMBEROFHOSPITAL STAYS INPSYCHIATRIC SERVICES FOR ADULTS EVOLUTION OF THE NUMBEROFHOSPITAL STAYS INPSYCHIATRIC SERVICES FOR ADULTS 2005 [7] .

2010 DH H 2010 IN PH AND PDGHBY GENDER

IN PH AND PDGHBY AGE 2015

2018 2005 2015 [8] [6]

2010 2018 Mental healthcare for adults 2015 DH H

2018 17

KEY DATA IN HEALTHCARE Mental Healthcare 2.2. 10% 15% 20% 25% 30% 35% 0% 5% more regularlyinthePDGH. one week. We that in PH, few can also observe stays end on the same day, while this happens PDGH, almost 80% of stays last less than one month. One third of the stays even last less than 14.4% ofthestays inthePHlastlessthanoneweek. Inthepsychiatric for adultsin services Three quartersofstays inpsychiatric for adultsinPHlastlessthan3months. services Around Duration ofstay 0 days DURATION OFSTAY INPSYCHIATRIC SERVICES FOR ADULTS INPH AND PDGH Psychiatric services 1-2 days one month for adultsin 80% 3-6 days last PH ofthestays less than 7-13 days

DH D H 14-29 days 3 months less than of thestayslast Three quarters

1-3 months PDGH for adultsin Psychiatric services

3-6 months

Mental healthcare for adults

6 months-1year

>1 year 18

KEY DATA IN HEALTHCARE Mental Healthcare N

10,000 15,000 20,000 25,000 30,000 35,000 A 10 9 2.3. 5,000

80 10 20 30 40 50 60 70 0 0 are becomingmorecommon. This isusuallylimitedtoasinglereadmissioninthesameyear, butmorefrequentreadmissions that, after discharge, patientsarereadmitted thesameyear, tothesamehospital. On theonehand,weareductionindurationofstay, observe butontheotherhand,we see Readmissions shortened by anaverage of20days (26%)comparedto2005. number ofoccupantdays peryear remainsaboutthesameover theyears, whileinthePHitis in a PDGH. In addition, theaverageis duetothe acute treatmentofpatientsthat takes priority The average numberofoccupantdays peryear result inanunderestimation ofthenumberreadmissions. cannotbeaccountedfor. andreadmissions inotherhospitals patient canonlybe monitoredwithinthesamehospital, This may year was nottakenintoaccount.For thiscalculation, bothpartialandresidentialstays were takenintoaccount. tions inagiven year. As aresult,thisdoesnotrelatetotheaverage durationofstay asthenumberofoccupant days inaprevious It shouldbeborne in mindthatthereisnouniquepatient identificationnumberwithinMinimum Psychiatric Data. As aresult, The average numberofoccupantdays was numberofoccupantdays calculatedas thetotal inrelationtothe numberofhospitalisa IN PSYCHIATRIC SERVICES FOR ADULTS INPH AND PDGHBY AGE 2005 NUMBER OFREPEAT ADMISSIONS TO PSYCHIATRIC SERVICES Admitted once EVOLUTION OF THE NUMBEROFHOSPITAL STAYS Admitted twice H FOR ADULTS INPH AND PDGH(2018) Admitted 3 to 5 times

Admitted 6 or more times [10] 2010

Admitted once [9] inaPDGHissignificantlylower thaninaPH. This

Admitted twice DH 2015 Admitted 3 to 5 times Admitted 6 or more times

2018 Mental healthcare for adults DH H - 19

KEY DATA IN HEALTHCARE Mental Healthcare N 2.4. 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 0 is essential. reinforces ourbeliefthatcrisispsychiatry,observation bothinoutpatientandresidentialsettings, especiallyintheFlemishRegion.The admissionsisclearlyincreasing, numberofinvoluntary This or herselftoothers. These patientsareusuallyadmitted toaPH. admissionby amagistrateifheorsheisdangertohim patient canbeorderedintoinvoluntary admission,sometimescalledacollocation,isintendedasprotective measure. An involuntary A Involuntary admissions 2005 PH andPDGH: More information aboutstays in IN PSYCHIATRIC SERVICES FOR ADULTS PERREGION INPH AND PDGH www.health.belgium.be C R 2010 EVOLUTION OF THE NUMBEROFINVOLUNTARY ADMISSIONS H

2015

R 2018 1,000 200 400 600 800 0

2005 R

2010 DH Mental healthcare for adults

2015

2018 20

KEY DATA IN HEALTHCARE Mental Healthcare 3. 12 11

11.8% 14.3% 26.7% are similar. disorders, we can see that the top 10 problems for which people are admitted to a PH or PDGH thatthereareproportionallymoreadmissionstoPDGHforBesides depressive theobservation diagnosis. disorder isthenext mostcommon primary common. diagnosisofadepressive diagnosis. ThisA primary isalsothemostcommonsecondary find thatproblemsrelatedtotheuseofalcoholandotherpsychoactive arethemost substances diagnosesofpatientsinPHandPDGHasthebasis,we nation ofproblems.Ifwe theprimary take A diagnosisintheevent ofpsychiatric israrelyunequivocal. hospitalisation There isusuallyacombi PDGH foradults The mostcommonprimarydiagnosisinPHand personality disorders personality disordersandclusterCincludes dependent,avoidantanti-social, narcissisticandhistrionicpersonality andobsessive-compulsive Stays for which themaincondition ofthepatientisnotknown, have notbeen takenintoaccount. Cluster disordersincludesparanoid,schizoidA personality andschizotypal disorders,clusterBincludesborderline, personality 3.0% 3.3% 3.4% 4.7% 5.5% 8.7% 9.0% 9.6% PRIMARY DIAGNOSIS UPON ADMISSION OFPATIENTS TO PSYCHIATRIC SERVICES [11] A D AC A D 66,142 H FOR ADULTS INPH AND PDGH(2018) 13.9% 25.6% 29.1% 1.1% 1.5% 2.6% 3.1% 4.0% 4.1% 5.1% 9.8% D AC A A D 55,701 DH [12] Mental healthcare for adults

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KEY DATA IN HEALTHCARE Mental Healthcare 13

13.6% 36.4% lems primarilyoccurinmen,whilethedepressive disordersareprimarilydiagnosedinwomen. and otherpsychoactive anddepressive substances disorders),we prob seethatsubstance-related diagnoses(Problems relatedtotheuseofalcohol a closerlookatthetwomostcommonprimary We acleardifference canobserve between theproblemsthatoccurinmenandwomen. Ifwe take Stays for which themaincondition andthesex ofthepatientarenot known, have notbeentakenintoaccount. 2.1% 2.4% 2.5% 3.0% 3.9% 8.3% 8.6% 9.4% 9.8% OCCURRENCE OFPRIMARY DIAGNOSES BY GENDERINPSYCHIATRIC SERVICES AC D A A D 60,490 FOR ADULTS INPH AND PDGH(2018) 14.2% 19.6% 25.4% 2.0% 2.2% 3.9% 4.4% 5.4% 5.8% 7.5% 9.8% D A AC A D 60,092 [13] Mental healthcare for adults

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KEY DATA IN HEALTHCARE Mental Healthcare

D AC A D A 14

is morecommoninpatientsofmiddleageandolder. primarily diagnosedintheagegroup65years andolder. diagnosisofbipolardisorder The primary the youngest age groups, whereas delirium, dementia, amnestic and other cognitive disorders are Problems predominantlyaffecting children andyoung people We pathologiesoccurmorefrequentlydependingontheageofpatient. canalsoseethatcertain child psychiatric problems. This groupincludesdevelopmental disorders,autism,attention deficitandbehavioural disorders,relationshipdisorders and other D or PDGH: made during admissionto PH More information ondiagnoses AC A D OCCURRENCE OFPRIMARY DIAGNOSES BY AGE INPSYCHIATRIC SERVICES A www.health.belgium.be 0% FOR ADULTS INPH AND PDGH(2018) 20% 40% [14] are most commonly diagnosed in aremostcommonlydiagnosedin 60% Mental healthcare for adults 80%

100% 23

KEY DATA IN HEALTHCARE Mental Healthcare N 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 4. 15 100% 20% 40% 60% 80%

0% 0 their areacouldhave agreaterneedforbedsasresult. hospital Brussels Region. that structurally Capital Hospitals attract alarge number of patients from outside example, itispossiblethatapatientlivingintheFlemishRegion isadmitted inthe toahospital A psychiatric patientisnotnecessarily admitted (PHorPDGH)inhisherregion.For toahospital Patient flowsinPHandPDGH of residence.Each region admits anequalshareofthisgroup. We canseethat1.5% ofthepatientswhowere admitted toapsychiatric unit inaPHorPDGHhave noknown, ornoBelgian, place (SHOWN BY THE REGION OF THE PATIENT'S PLACE OFRESIDENCE) Brussels-Capital Belgium AND PERREGION IN WHICH THE HOSPITAL ISLOCATED (2018) IN WHICH REGION DOES A PATIENT CHOOSE THEIR HOSPITAL? Region PER REGION OFRESIDENCE THE PATIENT Brussels-Capital NUMBER OFSTAYS INPH AND PDGH Region Flemisch Region Flemish Region Walloon Region Walloon Region

Unknown

Unknown [15]

L L Mental healthcare for adults R R R R R C R C 24

KEY DATA IN HEALTHCARE Mental Healthcare 100% 20% 40% 60% 80% 0% Fewer outsidetheFlemishregion. than2.5%ofFlemishpatientsarehospitalised 2% intheFlemishRegion. Of thepatientsfrom Walloon intheBrussels Region, Region 3.6%arehospitalised and Capital Walloon Region and4.6%totheFlemishRegion. If Brussels patients are admitted outsidetheBrussels Region, Capital 8.8% ofthemgotothe Walloon patientsisalmostthesame. almost onequarterofthepatientscomefromoutsideregion. The proportionofFlemish or withintheirregion.IntheBrussels Region, inahospital Capital Most ofthepatientsarehospitalised Belgium (SHOWN BY THE REGION IN WHICH THE HOSPITAL ISLOCATED) flows: More information aboutpatient IN WHICH REGION IS THE PATIENT'S PLACE OFRESIDENCE? www.health.belgium.be Brussels-Capital Region L Flemish Region Walloon Region

Mental healthcare for adults I R R R C 25

KEY DATA IN HEALTHCARE Mental Healthcare PEOPLE CHILDREN ANDYOUNG MENTAL HEALTHCARE FOR 16 1.1. 1.

Capital RegionCapital The areasofaction ofthesenetworks coincidewiththeterritories oftheprovinces andtheBrussels- GMCY networks were setup,focusing onchildren andyoung peoplewithintheirareaofaction. to a new healthcare policy for mental children and young people (GMCY)”. Almost immediately, 11 On 30March 2015, theInterministerialConference onPublic Health(IMC)approved the “Guide Networks inmentalhealthcareforchildrenandyoungpeople young people Organisation ofthecareofferingforchildrenand REALiSM, theGMCY network oftheProvince ofLiège. andpsychiatricmental problems financed by the federal government, thisdoesnot form a separateGMCYnetworkbutispartof Although in the German-speaking Community thereisaspecific pilotproject Although intheGerman-speaking Community for following-up of children and young peoplewith IN [16] . RHEA RTAR RADAR AN ARCHIEL KIRIK YNEC Mental healthcare forchildrenandyoungpeople ATILDA LIANT REAL I 26

KEY DATA IN HEALTHCARE Mental Healthcare 17 1.2.

the codeletter Beds, for reserved children andyounghealthproblems,arerecognisedunder peoplewithmental Hospitals additionalFTEsaremadeavailableproblems). Morethan300 tothenetworks tise and knowledge exchange) combined with psychological disability and dual diagnosis (a mental federal government, andliaison(exper namelycrisiscare,long-termintersectoralconsultation To optimisethe care, investments are madeindeveloping various programmesfinanced by the etc. ofthesectorsinvolved working togetherandcoordinatingtheirpolicies. as possible.Each network consistsofalltherelevant institutions, careproviders, actors,services, needs ofthesechildren, young peopleandtheircontext orenvironment asquickly andcontinuously and/orpsychiatricyoung peopleaged0-23withmental problems. The aimistorespondthe A GMCY network provides for a comprehensive all children and integrated range of services and with mental healthproblems. with mental paediatric departmentfor somaticcare,whilethereisadepartmentfor children andyoung people not have apsychiatric for adults.Inaddition,afurtherthreeofthesePDGHdonothave service a 25 psychiatric SixofthesePDGHand8thePHdo (PH)have hospitals oneoftheseK-services. with a psychiatric including 26 general hospitals of 51 hospitals, A total department (PDGH) and This fundingisnotdone by freezing beds(seechapter ‘Initiatives regardingalternatives tohospitalisation’). have adepartment young peoplewith youngsters: health care for children and initiatives inthefield ofmental Learn more abouttheseveral for childrenand mental health K hospitals (residential hospitalisation), (residentialhospitalisation), problems www.psy0-18.be 51

PDGH 26 PH 25 k1 (day hospitalisation) and (day hospitalisation) Mental healthcare forchildrenandyoungpeople k2 (nighthospitalisation). [17] . - 27

KEY DATA IN HEALTHCARE Mental Healthcare has a very limitedoffering.has avery and intheprovince of Walloon whiletherestof Brabantisparticularlystriking, Walloon Region intheregionsaroundCharleroiandNamur graphical distribution,theconcentrationofK-services PDGH andPHhave abetter balanceintermsofthedistributionbedcapacity. Intermsofgeo for adults,psychiatricIn contrasttotheservices for children services andyoung people within people (K,k1,k2). Nevertheless, for thereare2PDGHandPHwithmorethan50bedsreserved children andyoung for adults. isusuallymorelimitedcomparedtotheservices The numberofbedsinK-services C R INDICATING THE NUMBEROFBEDSFORCHILDREN AND YOUNG PEOPLE (01/01/2020) DISTRIBUTION OFPH AND PDGHINBELGIUM DH H Mental healthcare forchildrenandyoungpeople

- 28

KEY DATA IN HEALTHCARE Mental Healthcare C R R R 1.3. PDGH PDGH PDGH PDGH PH PH PH PH compared toplacesfor day hospitalisation. than inaPH. As isthecasefor adults,therearegenerallyfewer placesfor nighthospitalisation located in the PH. In the Flemish Region, there are clearly more places for day admissions in a PDGH Compared totheotherregions,bedsfor child psychiatry inthe Walloon Region areprimarily Types ofbedsandplacesforresidentialpartial hospitalisation NUMBER OFBEDS AND PLACES FORCHILDREN AND INHABITANTS YOUNG PEOPLEPER100,000 0 3.24 K NUMBER OFBEDS AND PLACES FORRESIDENTIAL AND PARTIAL HOSPITALISATION N OF CHILDREN AND YOUNG PEOPLEINPH AND PDGHPERREGION (01/01/2020) 100 K R C 5.60 1.89 200 2.35 300 N 3.36 R 400 Mental healthcare forchildrenandyoungpeople 1.81 500 R 0.30 600 N 0.75 700 0.14

KEY DATA IN HEALTHCARE Mental Healthcare N 100 200 300 400 500 600 700 800 0 can lastuptotheageof23.However, for only thenumberofchildren theprogramming, uptothe that asolutionwithinjuvenile psychiatry shouldbeprioritised.Expertsrefer toatransitionagethat people fromtheageof15 canbeadmitted toadultpsychiatry. Yet groupissospecific thistarget Care for young people in particular merits special attention. Under the current regulations, young problems. of the programming criteria wouldAn adaptation therefore not appear to be unjustified. This trend may indicate an increased need for care for children and young health people with mental the Walloon andFlemishRegions. increasing but,unlike residential beds(code letter K),there is still programming roomfor thisin The number of bedsand places for day (code letters and night hospitalisation k1 and k2) is also thandescribedintheprogrammingfigures. inhabitants already morebedsrecognisedper1,000 To date, the number of beds for has increased, even residential hospitalisation though there are YOUNG PEOPLE EVOLUTION OF THE NUMBEROFBEDS AND PLACES FORCHILDREN AND age of14 istakenintoaccount. EVOLUTION OF THE TOTAL NUMBEROFBEDS AND PLACES FORCHILDREN AND YOUNG PEOPLE 2000 2005 IN PH AND PDGH( 2010 K, k1 Mental healthcare forchildrenandyoungpeople 2015 AND k2 ) 2020 R C R R 30

KEY DATA IN HEALTHCARE Mental Healthcare N N 2.1. 2. 20 19 18 1,000 1,500 2,000 2,500 3,000 3,500 4,000 1,000 1,500 2,000 2,500 3,000 3,500 4,000

EVOLUTION OF THE NUMBEROFHOSPITAL STAYS INPSYCHIATRIC SERVICES were admitted toPHandPDGH. increase in the number of admissions of girls, to such an extent that in 2018 more girls than boys We can also see that more boys were admitted initially. In recent years, we have seen asteady increasing sharplyinrecentyears, bothinPDGHandPH The numberofstays inpsychiatric for children services andyoung people(K,k1andk2)hasbeen Hospital stays and youngpeople Hospital activitiesinPHandPDGHforchildren less oftheyear ofadmission andregardlessofwhetherthe patienthasalreadybeendischarged. Stays for which thesex ofthepatient isnotknown, have notbeentakenintoaccount. This isthenumberofregisteredresidential andpartialstays inbedsfor children (codeletter K,k1,k2)inthe relevant year, regard Source: MinimumPsychiatric (MPD),FPSHealth,Food Data Chain Safety andEnvironment IN PSYCHIATRIC SERVICES FORCHILDREN AND YOUNG PEOPLE 2005 2005 FOR CHILDREN AND YOUNG PEOPLEINPH AND PDGH EVOLUTION OF THE NUMBEROFHOSPITAL STAYS IN PH AND PDGHBY GENDER 2010 2010 [20] Mental healthcare forchildrenandyoungpeople 2015 2015 [18] , [19] .

2018 2018 DH H - 31

KEY DATA IN HEALTHCARE Mental Healthcare N N 22 21 1,000 2,000 3,000 4,000 5,000 6,000 1,000 1,500 2,000 2,500 3,000 3,500 500

0 0 It isstrikingthatchildren andyoung peopleincreasinglyneedresidentialpsychiatric care. upto23years old. age isacceptable for childrenservice andyoung people even after their18th birthday. It isassumedthatthistransition people (K, k1 or k2) is still often preferred. cases, a patient is still admitted In certain to a psychiatric allowed tobeadmitted toadultpsychiatry fromtheageof 15, for children aservice andyoung Most admissionsareintheagecategories10-14 and15-18 years old. Although young peopleare incorrectly. older than18 stayinapsychiatric for children service andyoung people.Itisalsopossiblethatthesestays have beenregistered attends aday(k2). and atnight,butotherwise programmeoutsidethehospital There areonlyafew admissionswherethechild intheevening oryoung personisonlyinhospital admissions (k1),whereby thechild oryoung personoften stays athome duringtheweekend. We anincreaseinboththenumber ofresidentialadmissionsandthenumberday canobserve Stays for which theageofpatient isnotknown, have notbeentakeninto account. Note: Numberofstays ofpersonsolderthan18 arenotincludedinthisgraph.Inexceptional cases,itispossiblethat persons IN PSYCHIATRIC SERVICES FORCHILDREN AND YOUNG PEOPLE 2005 2005 IN PSYCHIATRIC SERVICES FORCHILDREN AND YOUNG PEOPLE EVOLUTION OF THE NUMBEROFHOSPITAL STAYS IN PH AND PDGHBY TYPE OFHOSPITALISATION EVOLUTION OF THE NUMBEROFSTAYS IN PH AND PDGHBY AGE 2010 2010 [21] [22] Mental healthcare forchildrenandyoungpeople 2015 2015

2018 2018 N D K R 32

KEY DATA IN HEALTHCARE Mental Healthcare 2.2.

10% 15% 20% 25% 30% N 0% 5% 10 20 30 40 50 0 3 months.2.4%staylongerthanayear. More than80%ofallendedstays for children andyoung peopleinPHandPDGHareshorterthan of day isincreasing. ornighthospitalisation On the other hand, weis decreasing. can see that the average number of occupant days in a year the average numberofoccupantdays inagiven year for inaK-service aresidentialhospitalisation weAlthough thenumberofadmissionsisincreasing, see-ascaseinadultpsychiatry -that Duration ofstay IN A YEAR IN A PSYCHIATRIC SERVICE FORCHILDREN AND YOUNG PEOPLE EVOLUTION OF THE AVERAGE NUMBEROFOCCUPANT DAYS PERSTAY <1 day 2005 1-2 days FOR CHILDREN AND YOUNG PEOPLEINPH AND PDGH 3-6 days DURATION OFSTAY INPSYCHIATRIC SERVICES IN PH AND PDGH 2010 7-13 days D 14-29 days R K Mental healthcare forchildrenandyoungpeople 2015 1-3 months 3-6 months 2018

6 months-1year >1 year 33

KEY DATA IN HEALTHCARE Mental Healthcare N N 2.3. 23 2.4. 1,000 1,500 2,000 100 150 200 250 500

50 0 0 the Brussels Region Capital andtheFlemishRegion. This legalmeasureisincreasinglyappliedinthe Walloon Region, butshows adecreasingtrendin Of the7,197 admissionsfor children andyoung peoplein2018, 164 admissions(2.28%). were involuntary Involuntary admissions thesameyearthe samehospital Around 16% ofthechildren andyoung peopledischarged fromaPDGHorPHwere readmitted to Readmissions readmissions. Figures areonlyavailable for which readmissions tothesamehospital, may leadtoanunderestimation oftheactual numberof IN PSYCHIATRIC SERVICES FORCHILDREN AND YOUNG PEOPLE 2005 EVOLUTION OF THE NUMBEROFINVOLUNTARY ADMISSIONS FOR CHILDREN AND YOUNG PEOPLEINPH AND PDGH Admitted once DURATION OFSTAY INPSYCHIATRIC SERVICES H Admitted twice PER REGION INPH AND PDGH

Admitted 3 times or more 2010 [23] . Admitted once DH Mental healthcare forchildrenandyoungpeople

2015 Admitted twice Admitted 3 times or more

2018 R R C R

KEY DATA IN HEALTHCARE Mental Healthcare HOSPITALISATION ALTERNATIVES TO INITIATIVES REGARDING 24 1.

for thatdecommissionsbeds. thehospital As of1/01/2020, 2,178 bedswere decommissioned. partners andsubjecttoapproval by thefederal government. Approval impliesabudgetguarantee freeze them. This ‘bedfreeze’ basisfollowing betweenthenetwork isonavoluntary consultation cantemporarilydecommissionsomeoftheirbedsor In concreteterms,thismeansthathospitals and networks”. basis andlimited in time, the prospectivemental and programme-oriented funding ofcare circuits Act which that states “The Kingmay provide for specificfundingmethodstoenable,onan experi The MHC reform for adults is often called “Project 107”, referring to the article 107 of the Hospital Decommissioning orfreezingofbeds For thistobesuccessfulanumberofalternatives areavailable topatients. isunavoidable,possible and,whenhospitalisation itshouldbeasshortpossible. We earlier thatthereform stated ofMHCinBelgium aims to prevent asmuch hospitalisation as Source: Psycho-social FPSHealth,Food Healthcare Service, ChainSafety andEnvironment C C C C A A A NUMBER OFBEDSDECOMMISSIONEDPERREGION (01/01/2020) T T A T 0 R C 200 400 N 600 Initiatives regardingalternatives tohospitalisation R 800 1,000 R 1,200 [24] 1,400 - 35

KEY DATA IN HEALTHCARE Mental Healthcare 25 1.1.

This isalso possibleimmediatelyafter anadmission. This makes itpossibletokeep thehospital After several weeks ofcareby thecrisisteam,along-termcareteamcantakeover theaftercare. whereby may hospitalisation beavoided. inthehomeenvironment, byRapid thecrisisteammeansthattreatmentcanbestarted intervention up to provide specialised care in the home environment of patients with severe psychiatric disorders. needs andpreferences inthebestpossibleway. To mobileteamswere set thisend,multidisciplinary The aimoftheMHCreform istobringcareasclosepatientspossible,andrespondtheir after-carethe necessary canbeprovided quickly andefficiently. that, firstly, theresidentialadmissionisasshortandintensive aspossible,andsecondly, that neighbours and caregivers, and they temporarily lose their social contacts. As such, it is important often astressfulevent. Patients find themselves in astrange,clinicalenvironment withunfamiliar inapsychiatricA stay (PH)orinapsychiatric hospital (PDGH)is departmentofageneralhospital Mobile functions staff isdeployed toresidentialcare(see1.2.). practice, thesearemobileteamsfor specialisedcareinthehomeenvironment (see1.1.) ormore The staff freedupby thedecommissioningofbedscanbedeployed inalternative care.In restored morequickly. isation period as short as possible, so that the link with the patient’s home environment can be Source: Psycho-social FPSHealth,Food Healthcare Service, ChainSafety andEnvironment mobile teams decommissioned 2,178 beds R NUMBER OFCRISIS TEAMS PERREGION (01/01/2020) 22 andintensified healthcare infavour of 7 C R were Initiatives regardingalternatives tohospitalisation

54 R [25] - 36

KEY DATA IN HEALTHCARE Mental Healthcare 1.2. 27 26

networks canreceive fromthe afinancialintervention federal government torecruit additionalstaff. not have enoughresourcestocreatesufficiently largemobileteamsontheir own. Insuch cases,the The facilities within each MHC network are not proportionally distributed. Some networks simply do staff available tothemobile teams. various forms. For example, itmay bethecasethatpartners(even withoutabedfreeze) make facility withinthesamegeographicalareaispartofMHCnetwork. The collaborationcantake We above stated thatthehealthcarelandscapewas splitupintoMHCnetworks. Each healthcare patients admitted toaresidentialsetting canbedeployed inoneofthesemobileteams. of theHospital Act, theso-calledbedfreeze. The staff thatnolongerneedtobedeployed totreat Both the crisis team and the long-term care team came about through the application of Article 107 therapeutic programmeare provided, asshortpossible,butlongnecessary. A crisisadmissionispossible inanintensive care unit(IC)wherebothanindividualandagroup and follow-up care. appropriate treatmentplan(for bothacuteandchronic problems)andpreparesthereturn home teamofspecialisedcare workers worksHere, amultidisciplinary withthepatienttowork outan in aPHorPDGHisthenthemostappropriatesolution. healthproblems. centre (MHCC)issometimesnotenoughtotreatmental Admission andtreatment In crisissituations, toacareworker talking healthcare fromamobilecrisisteamormental Residential intensivetreatmentunitsHICand IC Source: Psycho-social FPSHealth,Food Healthcare Service, ChainSafety andEnvironment Source: annualreports ‘Article 107’ pilotprojects supervised by a supervised In and a long-term care team 2018 R 8,204 234.24 , 8,894 NUMBER OFFTESPERREGION (01/01/2020) patientsby crisis team patientshave been 53.80 C R [26] Initiatives regardingalternatives tohospitalisation

533.59 R [27] 37

KEY DATA IN HEALTHCARE Mental Healthcare 2. screens. The phase. projectisstillinthestart-up sedatives. For young people,thesecanincludebehavioural orsocialproblemsandaddictionto to anxiety, depressed mood, moderate to serious alcohol abuse or misuse of sleeping pills and healthproblemsrelated Mild andmoderatelysevere healthproblemsaredefinedasmental mental care provider whomay ormay notwork atanadvantageousrate. requires moreintensive, thecareworker long-termcounselling, canrefer thepatienttoanother aimed atgeneralpsychological care,solution-focused treatment,etc.Inaddition,ifthepatient a diagnosisofthepatient’s psychological problems,treatmentsessionsareorganisedwhich are The treatmentconsistsofaseriesindividualdiscussionsessions. After with anintake interview been refundedfor peopleinallagegroups. Initially, thiswas onlyenvisaged for the18 to64agegroup.Since2 April 2020,thesessionshave short-term, first-line psychological treatment that is largely reimbursed by the health insurance fund. ately severe health problems to a clinical psychologist mental or clinical remedial educationalist for In April 2019, a pilot project was set up in which doctorscan refer patientswithmildand moder First-line psychologicalfunction(FLP) and self-reliance.Inany event, coercive measuresshouldbeavoided asmuch aspossible. ofworking withone-to-onetreatments,afocusment withthepossibility onrestoringautonomy (High &Intensive Care)isanalternative. The patientstays inasecureroom,peacefulenviron If theseverity oftheproblemissuch thatadmissiontoICdoesnotmeettheneeds,anHICunit NUMBER OFPROVIDERS OFFRONT-LINE PSYCHOLOGICAL CAREPERREGION (01/11/2020) R 574 103 C R Initiatives regardingalternatives tohospitalisation 282 R - - 38

KEY DATA IN HEALTHCARE Mental Healthcare A 1,000 2,000 3,000 4,000 5,000 6,000 0 are beingheldwiththesectoronhow tousetheseresourcesefficiently. lems. Additional recurrent budgetswere setasidefor this enhancement.Intensive consultations and parentsinvulnerablefamilies, young adults,andpeoplewithpre-existinghealthprob mental pandemic was concluded. The agreementsetsoutseveralgroups,such target priority aschildren dinated approach healthcare offering to strengthening the mental in the context of the COVID-19 offering infront-linehealthcare.Indeed,on2December 2020,theProtocol agreementonthecoor Recently, anagreementwas reached intheIMCPublic Health,primarilyonstrengtheningthecare August AMOUNT OFCAREPROVISION FRONT-LINE PSYCHOLOGICAL FUNCTIONPERREGION September Initiatives regardingalternatives tohospitalisation October R C R R - - 39

KEY DATA IN HEALTHCARE Mental Healthcare PSYCHIATRIC HOSPITALS FINANCING OF on theonehand,anddoctors’ fees ontheother. Inaddition,therearealsoreimbursementsfor As regards the PH, the main sources of funding are the healthcareisnotcoveredin mental inthisdocument. This chapter focuses onthefinancingofpsychiatric (PH). hospitals The financingofotherinstitutions budget for operatingcostsandonefor corrections orcatch-up amounts. We will look at BFR in more detail. This consists of a budget for infrastructure and equipment, a pharmaceutical andconsumableproducts,NIHDIflat-rates androomsupplements. psychiatric hospitals almost since 2003 doubled Budget

for Budget of Financial Resources (BFR) 2003 FINANCING OFpsychiatric hospitals 2020

KEY DATA IN HEALTHCARE Mental Healthcare 28

0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 hospitals (€18.66hospitals billion) of €0.69 billion. The budget for amount allocated to PH corresponds to 6.8% of the total general budgetforThe thePHin2020was total €1.30 billion,which budget isroughlydoublethe2003 Source: Budgetfor Financial Resources, FPSHealth,Food ChainSafety andEnvironment EVOLUTION OF THE BUDGETFORFINANCIALRESOURCES(BFR)OFPSYCHIATRIC HOSPITALS 2003 of psychiatric hospitals: Learn more aboutthefinancing 2004 2005 www.health.belgium.be 2006 2007 [28] 2008 2009 2010 2011 2012 2013 2014 2015 2016 FINANCING OFpsychiatric hospitals 2017 2018 2019 2020 41

KEY DATA IN HEALTHCARE Mental Healthcare PSYCHIATRIC HOSPITALS STAFF IN A TE 10,000 29 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000

0 2006 More thanhalfofthestaff memberscanbe found inthe “nursing andcarestaff” category. thenumberofFTEinpsychiatricSince 2006, (PH)hasincreasedby hospitals 9.4%. Source: Finhosta, FPSHealth, FoodSource: Finhosta, ChainSafety andEnvironment EVOLUTION IN THE NUMBEROFFTEINPSYCHIATRIC HOSPITALS 2010 BY TYPE OFPROFESSION

2015 2018 Staff inpsychiatric hospitals A T N [29] 42

KEY DATA IN HEALTHCARE Mental Healthcare Amount of FTE 4,000 1,000 1,500 2,000 2,500 3,000 3,500 500 0 2006 is increasing. We seethatthenumberofhealthcarestaff isdecreasingandthenumberofgraduatesorbachelors If we lookatthequalificationofnursingandcarestaff, we findthat71%ofthemarenurses. EVOLUTION IN THE NUMBEROFFTES OF NURSING AND CARESTAFF 2010 2015

2018 1,132.16 1,148.76 2,822.03 3,645.08 289.52 Staff inpsychiatric hospitals Other Care staff Unquali ed staff Certi ed nurses bachelor's degree and nurseswitha Graduated nurses 43

KEY DATA IN HEALTHCARE Mental Healthcare FORENSIC CARE 1. various convictions fromtheEuropeanCourtofHumanRights Torture andInhumanorDegrading Treatment orPunishment. Ultimately, theBelgian received State was inadequate, Belgium was regularly criticisedby theEuropeanCommittee for thePrevention of of correctional institutions prisons.Because oreven thecareprovided intheseinstitutions ordinary practiceforIt was many standard years for indefinitelyinthepsychiatric inmatestostay departments been committed. measure should notbeconfusedwith the civil-law admission, in which involuntary no crime has been in control of their actions, and who also pose a danger to society. This criminal internment illness who have committed a crime but who are deemed by the criminal court judges to have not measureorderedby thecriminalcourtforInternment isalegalsecurity personswithmental In 2013, therewere 1,169 inmatesstaying inaBelgian prison. The figurehassince fallen to609. Internment psychiatric (PH)inthisregard. hospitals care programmeimplementedinnetworks. The forensic psychiatric centrescooperatewithregular Forensic Psychiatric Centres(FPC). An FPCisresponsiblefor thereceptionofinterneesinaforensic has the right to a place in an appropriate structure. As such, investments were made to set up The ‘Masterplan for Internment’ focuses on forensic psychiatric that every inmate care. It states by theMinistersofJustice andHealth,theso-called “Masterplans” cameintobeing. Under thisEUpressure,thegovernments invested inforensic careand,following new investments Belgian prisons to Decrease 609

mental detainees since 2013 from 1,169 in

Forensic care 44

KEY DATA IN HEALTHCARE Mental Healthcare 31 30

They receive astaff upgradefor careoftheseinmates. taking The otherfacilities for inmatesintheregularPHare generally “Medium Risk/MediumSecurity”. care ofsuch patients. Chêne auxHaiesinMons,withtheirspecialunitsof11 and20bedsrespectively, canalsotake inmates, including2crisisbeds. The Psychiatrique Hôpital duBeau Vallon andLe inSaint-Servais was setupinthepsychiatric centreSint-Jan-Baptist inZelzate.Levanta has roomfor 20women For women inmates,withbothahigh-risk Finally, a “Long StayFPC”isplannedin Aalst, which willbeabletohouse120 inmates. The Walloon regionhas2FPC,oneinPaifve andonein Wavre, each with250places. 18 ofwhomfemale. years later, in2017, asecondFPCopenedin Antwerp, where182 patientscanbeaccommodated, In 2014, thefirstFPC,which accommodates264malepatients,becameoperationalinGhent. Three Need for security Risk ofrecidivism OVERVIEW OFFORENSICMENTAL HEALTH CAREINBELGIUM 264 20 20 120 A 250 [30] 182 A andahigh-security 11 [31] profile,thespecialunit Levanta 250 Forensic care

KEY DATA IN HEALTHCARE Mental Healthcare 32

Source: Psycho-social FPSHealth,Food Healthcare Service, ChainSafety andEnvironment a dualdiagnosisforaddiction Beds forpersonswith Crisis beds/Timeout Beds forlong-termstays Beds forwomeninmates Beds mediumrisk NUMBER OFBEDSINPHRESERVED FOR A SPECIFIC TARGET GROUP Brussels (NL) Brussels (FR) 120 232 Ghent 82 BY COURT OF APPEAL Beds forsexoffenders non-congenital braininjury Korsakoff Beds forpersonswith an intellectualdisability Beds forpersonswith dual diagnosisofintellectualdisability Beds forpersonswith [32] Antwerp 119 139 Mons Liège 72

Forensic care 46

KEY DATA IN HEALTHCARE Mental Healthcare 33

housing (ISH),for anumberofbedsorplacesfor thereceptionofinmates. A staff upgradeisalsograntedinpsychiatric nursinghomes(PNH)andinitiatives for sheltered Source: Psycho-social FPSHealth,Food Healthcare Service, ChainSafety andEnvironment AND PSYCHIATRIC NURSINGHOMES(PNH) TO ACCOMMODATE INMATES, NH NH NH NUMBER OFBEDSININITIATIVES FORSHELTERED HOUSING(ISH) NL R A 162 36 87 BY COURT OF APPEAL IH IH IH [33] 154 L 23 61

Forensic care 47

KEY DATA IN HEALTHCARE Mental Healthcare 34 A TE

10 15 20 0 5 Finally, anoutpatientcareoffering for inmatesisbeingsetup: of inmates. for amoreflexible procedurethatbetter judicialandimplementation meetsthespecificcareneeds of careinpsychiatric departmentsofprisons andtheinternmentlaw hasbeenamendedtoprovide Besides carefacilities outsideprisonwalls, initiatives have beendeveloped toenhancethequality Source: Psycho-social FPSHealth,Food Healthcare Service, ChainSafety andEnvironment • • • TE care network). (psychiatric department of a prison, Institution for the Protection or after of Society) (outpatient Outreach achieving oflife. personalrecoveryandquality ing psychological andsomaticsymptoms,promotingsocialfunctioningparticipation psychiatric disordersandoffers treatmentandsupportinvarious areasofrecovery, by reduc A (N andF),MonsLiègehave each appointed1full-timecoordinator. partners in health care, the judiciary, etc. The courts of appeal of Ghent, Antwerp, Brussels the judiciary. The teamprovidesadvice,ensuresfollow-up orientation andgives support to in regularcare,anddraws upatailor-made careplanfor each inmate,incooperationwith The Ghent Fact team (Flexible Assertive Community Treatment) NUMBER OFFTEINOUTPATIENT CAREFORINMATES BY COURT OF APPEAL mobile team ‘Care programme for inmates’ isaspecific form of extra-mural follow-uptake andcan placebefore hospitalisation Antwerp TE CI Brussels (NL) C A Brussels (FR) TE must guide inmates towards integration focuses onpeoplewithsevere Mons [34] Liège Forensic care - 48

KEY DATA IN HEALTHCARE Mental Healthcare N 2. 35

10 15 20 25 0 5 ognised K-beds. Moreover, each projecthasanumberofK-crisisbedsthatarenotcountedin thenumberofrec described asacrime(MOFinDutch) orfor young peoplewithatroubledupbringingsituation (TUS). Intensive treatment units have been set up for young people who have committed an offence specifically for young peoplewithpsychiatric problemswhoare subjecttoacourtorder. The pilotproject “For K”provides, for each Courtof Appeal, for thedevelopment ofacarepathway order (ForK) psychiatric problemswhoaresubjecttoacourt Specialised careforyoungpeoplewith people withpsychiatric problemswithacourtorder. In Brussels, thisprovision is complemented by aform ofShelteredHousing(8places) for young Source: Psycho-social FPSHealth,Food Healthcare Service, ChainSafety andEnvironment C CK T NUMBER OFBEDSPERCOURT OF APPEAL IN THE CONTEXT OF THE "FOR-K"PROJECT judicial controlhaving apsychiatric problem 156 beds Ghent Antwerp Flemish Brabant for youngsters under C A Brussels Mons

Liège [35] Forensic care - 49

KEY DATA IN HEALTHCARE Mental Healthcare CARE FORADDICTION SUBSTANCE ABUSE CRISISUNITS Sciensano. The fundingfor thiswas includedintheBudgetfor FinancialResources (BFR). istration (RD15/10/15) isorganisedwithinaEuropeanframework (EMCDDA) andismanagedby drugs. year, Every around 115 register 20 epidemiological variables. hospitals reg This mandatory TDI istheregistrationoftreatmentquestionsrelatingtoalcoholabuseordependenceonillegal TREATMENT DEMANDINDICATOR (TDI) to tackle thisproblem: diagnosesinotherdiagnoses. secondary The FPSPublic Healthhasanumberofongoingprojects nosis for patientsadmitted toPHandPDGH.Inaddition,drug-related disordersareoften listedas diag disorders(Alcohol,Medication,Drugs)indicated thatsubstance-related arethemainprimary In thechapter diagnosisinPHandPDGHfor adults”,“The mostcommonprimary we already treatment. model thatincludesallsteps, fromscreeningandearlydetectiontomotivational discussionsand Hasselt andLantin.Experience gainedonthegroundwillbeusedtodevelop abroadassistance To thisend,pilotprojects were launched inDecember2017 intheprisonsofSint-Gillis/Berkendael, Minister ofHealthproposedthedevelopment ofanadapteddrug modelfor assistance prisoners. As such, attheInterministerialConference onPublic Healthon20November 2017, theFederal illegal drugs similarfiguresin inprison,withvery Belgium. According studies, torecentinternational survey anestimated20to45percentof allprisonersuse Indeed, drug various use entails health risks and can place significant pressure on prison security. ication useinBelgian prisonsremainshigh. The situation isnothealthy inany senseoftheword. Despite the daily efforts of care providers and the intense efforts of the Judiciary, drug and med “DRUGS AND DETENTION” PILOT PROJECT affinitytarget groupofpatientswhousepsychoactive withthe substances. feature ofthis projectisthatthefollow-up isdoneby casemanagement,andthatthereisacertain team (11intensive and multidisciplinary FTE) cares for patients annually. around 3,500 A specific Nine crisisunitseach with4bedsaccommodatepatientsincrisisfor alimitedperiodof5days. An project: More information regarding this workspaces.wiv-isp.be Care foraddiction - - - 50

KEY DATA IN HEALTHCARE Mental Healthcare 36

Below isabrieflistofsometheactionsthathave alreadybeentaken: of thehistory, status, context, various problemsandprioritiesoftheplatform. the rationaluseofpsychotropics inBelgium. A comprehensive visionpaperprovided anoverview platformBelPEP consistingof3expert isamultidisciplinary working groups which aimstopromote BELPEP (BELGIANPSYCHOTROPICS EXPERTS PLATFORM) (Sint-Gillis/Berkendael), CADLimburg(Hasselt)andFédito Wallonne (Lantin). Three non-profit organisationsspecialisedindrug provide assistance supportontheground:iCare ofcare. helps toensurethecontinuity care workers insideandoutsidetheprisonwalls witheach arealsoinclosecontact other, which upon arrival, sothatthey canbeguidedtotherighthelpmorequickly ifnecessary. The relevant more personalisedsupport.Furthermore, inmates are now systematically screened for drug use prison staff have sothatprisonerswithadrug received additionaltraining, problemcanreceive In each of the three prisons, additional care staff have been recruited and the existing care and improve ofcare. thequality Local group:agroupof doctorsorpharmacist-biologistswho shareandcriticallyevaluate quality theirmedical practiceinorderto • • for theFrench-speaking offering). medica.be/vorming of benzodiazepines, butalsoonthebestways tomanagedepression. ( Online training( - - two websites were setuptocollectrecentscientificinformation: Various tools have been developed to support professionals in their practice. For example, comprehensive visionpaper: More information onthe - - ( A website relatedtotheproperprescriptionofsleepmedicationsandsedatives A website onthediagnosisandtreatmentof ADHD ( www.slaapenkalmeermiddelen-hulpmiddelenboek.be www.health.belgium.be www.e-learninghealth.be for theDutch-speaking offering, ) intheLOKs https://dmgulb.be/formation-specifique/ [36] isprovided toGPsontherationaluse www.trajet-tdah.be ). https://www.domus ) Care foraddiction -

KEY DATA IN HEALTHCARE Mental Healthcare