Transcript Good Practices in Mental Health Care in Norway

Good Practices in Mental Health Care in
Norway – connecting health and social
services.
A glimpse from inside
Arne Repål
I wasn’t that interested in those early
years
The early years
• No District Psychiatric Centres or other kinds
of systematic after care
• The average stay in hospital in 1950 was 3
year
• Hospitals was overcrowded
• They were the home for many patients, not a
place for psychiatric treatment. The patients
were taken care of, given medical support and
kept.
Neevengården psychiatric hospital
1910
Sandviken hospital 2012
White Paper on health policy
• In 1975 the government published a White
Paper on the health policy partly as a
response to the growing costs of health
institutions.
• The Paper outlined that health services should
be based on well-developed primary care
services and that treatment should be
provided at the lowest effective level.
District Psychiatric Centre
In 1991 I moved to Vestfold County and was
involved in building up a new DPC there.
Vestfold is a geographically small county with
230 000 inhabitants. It had been decided to
build up four DPCs beside the psychiatric
hospital.
The District Psychiatric Centre
Central tasks:
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Outpatient clinics/ambulant services
Daytime treatment
Short-time inpatient treatment
Long term treatment and rehabilitation
Consultation, supervision and support for staff
in primary care services
• Acute services and crisis intervention
• Education
The psychiatric hospital
• Urgent psychiatric care where hospitalisation
is needed
• Treatment for patients needed to be held in
closed sections
• Patients with complicated psychiatric illness
Organization
• In the National Mental Health Program the
District Psychiatric Centres was described as
autonomous with their own leadership. This
was wrong I think.
• It made it difficult to establish a good
relationship with the acute ward in the
psychiatric hospital. There was no continuity
when patients were discharged from the
hospital.
A
Akuttilbudet:
Primary Care Services
• The local councils are responsible for social
support and primary health services. The local
community are often small and differs in the
way they have organized the primary care
services. Most of the health personnel are
psychiatric nurses or social workers Patients
also have their local doctor.
Improving Access to Psychological
Therapies project in Norway
• The main focus here are patients with depression and
anxiety. They represent a large number of people; the
mental health problem placing a significant burden on their
wellbeing, their families, the health cervices and the wider
economy.
• 12 communities are involved. Health personnel are given
education within the Cognitive Therapy model. They shall
be able to offer guided self-help, educational groups for
anxiety and depression and individual treatment.
• People can attend without referral.
• The project is to be evaluated and if the results are good
the model will be implemented in the rest of Norway.
Legal aspects
• During the last decade there have been increased
emphasis on patients ´ own view and
preferences both on the individual level and on
the on the organisational level.
• Patients are also given a legal right to receive
treatment within a given time. This is positive,
but it must be right to say that this not always
have been followed by the same concern about
the treatment itself.
• The authorities has focused on reducing the
compulsory mental health care.
National Guidelines for Treatment
• There are National guidelines for treatment of the
most common diagnosis. These guidelines are meant
to be evidence-based.
• There have been some discussion on this topic, and the
level of evidence for choosing one specific treatment
method varies.
• All in all I think the introduction of guidelines are
positive as far as they are used in a sober way. They can
help the leaders adopt programs for strategic
competence development. These guidelines should
also be a central part of the education of health
personnel.
Advices (1)
• Thinking of the patient as part of the local
society as well as an individual is important.
This means that both the specialised services;
the primary services and the patient have to
cooperate. Often the relatives also are
important co-operators.
Advices (2)
• The great challenge is maybe how to get most
out of the recourses available. Keeping
patients in hospitals are expensive, and often
unnecessary. It’s cheaper, and often better for
the patient, to give outpatient treatment of
some kind. How to do this depends on local
conditions.
Advices (3)
• De-institutionalisation means building up an
alternative. Only reducing number of beds in
the psychiatric hospital will not be a good
solution. This can be a serious problem
because it requires a period were you have to
increase the resources spent on health
services before you see the effect.
Advices (4)
• I think we in many cases have moved from
thinking we should cure the patient’s
condition to making it able for him or her to
live with it. Accepting deviant behaviour and
experiences is part of this and involves the
whole society.
Advices (5)
• In choosing what treatment to offer I would
recommend you to consider the scalability of
the method. It is better to chose a method
that relatively easy can be learned by many,
have elements of guided self-help, not require
to many consultations and does not require to
much time spent on maintenance.
Advices (6)
• Coordinate the resources. Don't quarrel about
who are going to do what
• If resources are limited, decide what should be
the priority.
• For those with serious problems like psychosis
you could consider giving education to health
personnel across levels. In Norway this have been
done on a large scale, enhancing the cooperation
between the DPC and the primary health care.
Advices (7)
• Ambulant services are important for patients
who are not able to receive other kinds of
outpatient treatment.
Advices (8)
• Consider the possibility of self-help in various forms for
mild to moderate depression and anxiety. Especially
guided self-help witch combines the use of self-help
materials and a few consultations have shown to have
effect.
• Self-help materials can consist of books or Internet
based programs. This can be part of a stepped care
program.
• If assisted self-help does not help, the person can be
offered participation in self-help groups witch focuses
on psychoeducation. The third level is individual
therapy.