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Applying a General Systems Theory Framework in Mental Health

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Applying a General Systems Theory Framework in Mental Health Katrakazas et al. Int J Ment Health Syst (2020) 14:67 https://doi.org/10.1186/s13033-020-00398-z International Journal of Mental Health Systems RESEARCH Open Access Applying a general systems theory framework in mental health treatment pathways: the case of the Hellenic Center of Mental Health and Research Panagiotis Katrakazas1* , Aliki Grigoriadou2 and Dimitrios Koutsouris1 Abstract Language, socio-emotional and cognitive development in children and adolescents with mental health issues is getting increased attention over the last years. Establishing communication patterns and addressing behavioural diversities among this population should be of priority, along with a better understanding in a large variety of patient characteristics within the operational framework of mental healthcare centers. Therefore, the relationships between provided services and operational capability should become more evident. As integrated systems’ approaches are still missing to predict the efciency of treatment services in a macroscopic scale, a General Systems Theory framework is hereby proposed. This framework is applied and tested against the operational framework of the Hellenic Center of Mental Health and Research, in order to identify the need of such an approach and the strong cooperation between medical and population interactions. Using such frameworks as a prerequisite to identify important factors afecting population states can lead to evaluating their impact on the treatment outcome and depict the complexity of path- ways potentially related to the children’s development. Keywords: Mental health, Operational framework, General systems theory, Systems approach, Children population Highlights Background According to World Health Organization (WHO),1 child- • Sensitive groups of children population require a hood and adolescence are considered to be critical stages multidisciplinary approach for the development of skills in self-control, social inter- • Operational frameworks in mental health could action and learning. Tis can afect the mental health improve through a systemic approach and well-being of children and adolescents, whereas • A general systems theory framework is proposed and exposure to risk factors (e.g. bullying at school) can nega- applied to a Greek mental health research center tively afect them in the long-term. As the rates of men- • Mental health care and research can beneft from a tal health and behavioural problems at the population state and time-perspective data basis level are high and continue to increase, healthcare sys- tems could beneft from employing additional tools and methodologies. *Correspondence: [email protected] 1 Biomedical Engineering Laboratory, Athens, Greece 1 Full list of author information is available at the end of the article https ://www.who.int/menta l_healt h/mater nal-child /child _adole scent /en/ © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/publi cdoma in/ zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Katrakazas et al. Int J Ment Health Syst (2020) 14:67 Page 2 of 8 Fig. 1 Municipal Communities of Athens, Greece (https ://modmo v.ellet .gr/maps/) Two of the objectives identifed in the WHO’s com- mental healthcare provision center allows the observa- prehensive mental health plan [1] refer to (a) the pro- tion and identifcation of a correspondence between vision of comprehensive and integrated mental health social, economic and operational indicators. A descrip- and social care services and (b) the strengthening of tion of these parameters are provided hereinafter, based evidence-based information systems. In order to ana- on semi-structured interviews with the staf of the Hel- lyse and assess the functionality and operational capa- lenic Center of Mental Health and Research and online bility of mental healthcare services, identifcation of material provided by their website (https ://www.ekeps correlations and relationships within such systems ye.gr/). would provide a better insight related to the services provided. Such an approach would then easily provide Description of the operational framework an evidence-base for the consequences of a high socio- within the Hellenic Center of Mental Health and Research economic burden of mental diseases, apart from the (HCMHR) medical and emotional one, not only on the micro- (e.g. Te Hellenic Center of Mental Health and Research individuals and their families) level, but on the meso- (HCMHR) is a Mental Health Unit of the broader Public (e.g. school population) and macro- (e.g. nation) level Sector and it is under the jurisdiction and fnancial sup- as well. port of the Greek Ministry of Health, which has eight It is the aim of the current paper to suggest an inte- Mental Health Units in total nationwide. Te specifc grated system’s approach based on General Systems unit is located in the center of Athens and serves three Teory to show that the application and exploitation of the seven municipal communities of the Municipality of such frameworks in a very specialized and focused of Athens (Fig. 1). More specifcally it serves the fourth, attempt can help to defne the individual and popula- ffth and sixth municipal districts, with the following tion relationships, characteristics and interactions inside characteristics: and outside a system. Moreover, the assessment of the efciency and operational capability within an existing Katrakazas et al. Int J Ment Health Syst (2020) 14:67 Page 3 of 8 1. 4th Municipal Community (D4): It includes the Te usual procedure followed by HCMHR with the western districts (Kolonos, Platonos Academy, introduction of a new case (along with the relevant time- Kolokynthos, Prophet Daniel, Sepolia, Nirvana). Its plans) is as follows: population according to the 2011 census is 85,629 (compared to 2001: 92,310). 1. Introduction (of a new case) stage: families (in some 2. 5th Municipal Community (D5): It includes the cases even children or adolescents on their own) northwestern districts from Kato Patisia to Probona contact and arrange the booking of an appointment (Agios Eleftherios, Patisia, Rizoupoli, Probona). Its to meet with a specialist at HCMHR (usually there is population according to 2011 census is 98,665 (com- a duration of one to three weeks until the meeting). pared to 2001: 105,539). 2. Assessment stage: At this stage, learning and devel- 3. 6th Municipal Community (D6): It includes the cen- opmental difculties, anxiety and behavioral prob- tral districts (America Square, Attica Square, Kipseli, lems among others are assessed. It is also decided Nea Kipseli, Ano Kipseli). Its population according whether the child or adolescent will proceed with a to 2011 census list is 130,582 (compared to 2001: treatment plan. Tere is a two to fve percent (2–5%) 162,366) dropout rate, where the child may not continue or is referred to an external service. At this stage, other In addition, HCMHR serves the Municipality of specialists may be included for additional sessions. Galatsi, but the same geographical area is also served by 3. Treatment stage: depending on each case, psycho- the Community Center for Mental Health of Children therapy, counseling, or speech therapy sessions may and Adolescents of the General Hospital Sotiria (located be held. Tese sessions are held on a weekly basis (as in Attica Square). Tis means that according to the 2011 far as the pediatric psychiatrists are concerned) and census, a total of 314,876 residents are served by just one once every 15 days with a counseling expert, for a center in population level. In 2019, the HCMHR staf one year period. Tere is also the possibility of a sup- consists of 13 persons in total (two administrative clerks, portive medication plan (if deemed necessary). Tese three pediatric psychiatrists, fve psychologists, two sessions last 45 min and take place on a weekly basis social workers and one speech therapist), which is con- with an average of 40 sessions per week (this num- sidered adequate in accordance with the current operat- ber refers to sessions held by all HCMHR specialists), ing framework. without taking into account the time needed for the Te services provided by the HCMHR are particularly consultation. important as they are ofered to children and adolescents 4. Re-evaluation stage: at the end of treatment, the con- with mental and developmental disorders and psycho- dition is reviewed and the case is considered ’closed’. social functioning difculties (such as dyslexia, autism Usually 45–50% of cases have completed their cycle spectrum disorders, anxiety or behavioral problems). by the end of the year. Tese services include (a) diagnostic evaluation (and pos- sibly evaluation related to cognitive and developmental An indicative example of a new case at HCMHR skills) that could be communicated to school or other could be described as such: relevant stakeholders (e.g. cases of learning disabilities or when there are families applying for an insurance fund, 1. Parents concerned about their children communicate when there are indications of special treatment plans) by telephone with the HCMHR. An appointment and (b) treatment.
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