New Tools for Mental Health Care Into the Community
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New tools for mental health care into the community: participative health democracy, mobile teams, host families, ambulatory cares, supportive housing The experience of Eastern Lille Suburbs : Mons en Baroeul, Hellemmes, Lezennes, Faches Thumesnil, Ronchin, Lesquin Dr DEFROMONT Laurent Head of service Public Mental Health Trust Lille-Métropole Our catchment area : Eastern Lille Suburbs : Mons en Baroeul, Hellemmes, Lezennes,Faches Thumesnil, Ronchin, Lesquin Our cactchement area 1 DIRM – EPSM Lille-Métropole The territory 6 municipalities, Eastern Lille Suburbs, 26 km² 84 193 inhabitants – Urban zone Eastern Lille Suburbs: Mental Health care needs Mental Health in General Population study 2008 Number of Number of Number of people persons with inhabitants Impact Help and with a suicidal Aged of more at least one Number of perceived on Feeling of support found risk average or than 18 yars trouble at the inhabitants day life in the close high* old MINI* being ill circle * 85 300 63 790 22 710 11 482 14 662 3 636 5 592 People in care in 2014 : 3184 persons *** Mini International Neuropsychiatric Interview SMPG NPDC Care utilisation – Perceptions “Imagine you’re unhappy. You have difficulties in your life. You’re feeling dissatisfaction and discomfort. You don’t know where you stand. You don’t understand what’s happening to you. Your state of mind is deteriorating”. 100 Who would you talk about that in first ? 80 60 42,3 40 38,4 20 11,8 7,3 0,2 0 General practicionners Psychiatrists Relations Nobody Others responses WHO recommendations for Europe: offer effective care in community (Helsinki Declaration 2005) - Provide proximal care and crisis care, offering services where people live and work, preventing deterioration or hospital admission whenever possible - Plan and implement specialist community-based services, accessible 24 hours a day, 7 days a week, with mobile multidisciplinary staff, to care for People in need of MH care - Provide residential services in the community and develop rehabilitation services - Empower service users and carers to access mental health and mainstream services and to take responsibility for their care in partnership with providers. - Design programmes to develop the caring and coping skills and competencies of families and carers. - Forster mental health promotion, prevention and information - Effective partnership with primary care services and general hospitals - Develop training and research activities in community mental health - Cross sectorial linkage : Health, social protection, enployment, housing, justice, education, leisure… AN EFFICIENT SYSTEM OF CARE: a whole system of care . A: Facilitating access to care Decrease the number of severe troubles leading to hospitalisation . B: Early and continuing community based care Adjust to people needs: provideacceptable cares Prevent relapses, reccurences… it happens in the city Coordination with every care providers, emergency department, general practionner… . C : Supporting social integration considering the disability Ensure the maintenance of health and the recovery Leisure, culture, employment, housing 1. Social perceptions in general population: a brake on access to care The “insane”, the “mentally ill”: it’s always someone else, it cannot be me Mental health in general population study conclusions: • Being “insane”, “mentally ill” is still strongly linked with violent and transgressive behaviours (murder, rape, incest, being violent against others…) • Psychiatric hospital is still perceived as a place where “insane” and “mentally ill” persons must be locked. It is widely consider as the only care option • Anyone can accept to identify his/her self to a “depressive” The general population consider that a “depressive” person must be cure at home with the help of his/her GP and family or other carers • The general population think that a family can welcome back at home someone “insane”, “mentally ill” or “depressive” if he/she has been cured 2. Link with other partners Or why it is impossible to work alone… Population expected versus population in care in one year At least one trouble at % of people with at the MINI in general least one trouble at the population MINI in care in one year Depressive episodes 11.7% 1.39% 13 Données SMPG Data from MHGP and RIMP Develop Health Democracy Integration in the territory organisation for health, mental health and citizenship Participation of service users Means offer high quality cares Communal Council for Health, Mental Health and Citizenship (MH local council) An organisation (NGO) gathering 6 towns’ mayors, citizens users or not, families, artists, cultural services, Low Income Housing services, curators, social services, sanitary services, MH services. Local elected official as the NGO President A health thinking vision on the territory Communal Council for Health, Mental Health and Citizenship (MH local council) 1- A health thinking and vision on the territory 2- A functional NGO for supportive housing and insertion of people in MH « handicap » situations 3- Actions of prevention, MH promotion, information: - « Well being workshops »: co chair users – carers/professionals aim to raising awareness, forster destigmatisation and mutual support - Training for suicidal crisis management 4- Coordination of partners in the territory: - Group of complex situation analysis - Local Health Contracts Develop health democracy means support users and carers participations Mutual support groups “Amitié Partage” “ les Ch’tis Bonheur” - Etoile Bipolaire, Bipolar Star - Alcoolique Anonyme, narcotique anonyme ... - Le Réseau Entendeurs de Voix (REV) Hearing Voicers - Aftoc... (OCD French NGO) UNAFAM (Family and Carers National NGO) Involve service users in the policy of the mental health service – Users forum – Elected users spokesman – Working groups for services organisation – Activity Sharing : training, information to the population – Awareness an destigmatization actions... Health democraty Forster a co-design process of the MH services: users participation and involvement (Empowerment) * Users forums – Elected users spokesman * Development of participative gathering « Parole aux usagers » with peer support workers (médiateurs de santé) * Data collection and analysis of service users inputs, users participation to events analysis and resolution proposals, restitution of users opinions and proposals * Involvement of elected users spokesman in decision making bodies (general steering comitee, task forces) 3. Acceptable care providing for the population : EARLY, CONTINUING, COMMUNITY BASED CARE MH Services oriented by and for Recovery Actions and services are based on : 1- une dynamique optimiste (positive, réactive avec des propositions multiples) 2- « l’éducation thérapeutique » : mobilise les connaissances des théories de l’éducation pour aider les personnes à développer des connaissances ou des savoirs-faire qu'ils jugent utiles 3- la responsabilité personnelle – l’auto-gestion (boite à outils « bien être », plan de crise) 4- le soutien au développement d’un réseau de soutien durable * Copeland (1997) Wellness Recovery Action Plan, Broché, Paris MH Services oriented by and for RECOVERY Recovery as a basis of action . Role of « peer health mediators » ( peer support worker) from 2 to 5 persons . Partnership with self help groups and supportive peer networks – Encourage access to peer supporting and mutual help . Staff training by « expert of experience » users (from users NGOs) – Themes : « what does help / what doesn't help), care pathways... Well being works shops (Ateliers mieux être) co- animation users / professionnals Valorisation of users experiences and expertises - Among professionnals – Role of the peer support workers : « peer health mediators» – Training sessions run by users representatives (Self Help NGO etc) - MH promotion, prevention, information – Ateliers mieux être - Well being workshops – Training for suicidal risk management -In care and self help – Partnership with self help and supportive networks - In the local policy and health democracy in the territory – Participation of local users and carers NGO - Participation of users in the services organisation – Users forum (2012) in the city : qualitative assessment, quality process assesment – User Spokesmen election (2015) – Spokesmen elected participation (2016) in organisationnal meetings and working groups * Davidson et al (2009) Handbook of service user involvement in mental health research (pp. 87-98). Chichester: Wiley-Blackwell. 76% of MH professionnals in ambulatory care Psychiatrists, Psychologists, Nurses, Social Workers, Body Therapists, Peer Support Workers, Artists, Sports Instructors, Occupational Therapists, Health Managers, Social Managers, Cultural Managers... Mobility of all professionnals trough the territory and the services HUMAN RESOURCES – 01 2016 76% of MH professionnals in ambulatory care New care demands Systematic letter from the user General Practionner Early reception less than 48 hours in 90% Evaluation : free and structurated interwiews and questionnaires (MINI +/ - MMS), suicidal risk assessment If crisis or emergency: immediate assessment by a doctor (medical service on call 24h) Multidisciplinary evaluation (twice a week) Systematic mail of response to the user GP =) 1084 new care demands in 2015 New demands increasing evidence of access to care facilitation New demands 1200 1099 1093 1094 1100 1081 992 1000 900 816 826 800 721 724 700 600 500 2007 2008 2009 2010 2011 2012 2013 2014 2015 Consultations