Marek Páv

Psychiatric Hospital Bohnice, Prague

CZ11 NF-CZ11-PDP-1-002-2014

Supported by grant from Norway

Project S.U.P.R.: The creation of the comprehensive

rehabilitation system for the mentally ill and its

implementation in the Inpatient Facilities Číslo projektu: NF-CZ11-PDP-1-002-2014

Programme Operators Meeting 3. 12. 2015

Czech systém of Psychiatric care

Structural similarity to other countries

• Large hospitals

• Community care is limited

• Psychiatric care reform strategy 2013

HDP per capita in USD

Participating institutions

• Recruitment of all major psychiatric hospitals from Czech republic- major providers of

rehabilitation care 8 000beds

• Cooperation with Norwegian partner- DPS Nydalen (Oslo university hospital)

• Czech National institute of menthal Health and Psychiatric clinic 1st. MF Charles university

Project overview

• Analyze current situation in participating hospitals in the field of psychiatric

rehab.

• Suggest improvements in rehabilitation field, develop a working methodology

• Implement the changes, train the people

• Support implementation (literature, bilateral visits)

• Measure outcomes, correct working methodology

• Develop a final methodology, establish a standard of rehabilitation care

Project harmonogram

2014 2015

2016

9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11

Preparatory phase Implementation phase Final phase

Contracting X X x

Analysis x x x x Analysis in particular fields X X X

Choice of evaluation tools, therapeutic procedures X X X X

translations X X X X X X X X X X X

Adaptation X X X X X X X X X X X X X X X X X X X

Pilot study X X X X X X X X X X X X

Implementation X X X X X X X X X X X X X X X X X X Training in rehabilitation x x x x x x x x x x

Publication outputs x x x x x x x x x x

Conferences x x x x x

Working visits X X X

Preventive activities x x x x x x x x x x

Analysis

• Relatively rich therapeutic regimes across hospitals

• Lack of therapeutic planning

• No individual Rehabilitation planning

• No crisis plan

• Lack of cognitive training and diagnostics

• Lack of personnel trained in psychiatric Rehabilitation

• No supervision

• Weak connection with care outside the hospital

0

10

20

30

40

50

60

70

Therapeutic environment

Treatment and interventions

Self management and authonomy Social inclusion

Human rights

Recovery oriented practice

13 departments N=462 patients (age20-50, průměr 35)

QuIRc (Quality Indicator for Rehabilitative Care) (www.quirc.eu, Killaspy et al, PLoS One, 2012)

Built environment

Initial analysis

Selected priorities

• Support individual Rehabilitation planning by modifying hospital information

system (all but one hospitals use the same NIS)

• Rehabilitation training- CARe (Comprehensive Approach to Rehabilitation)

http://thecareeurope.com/ 32 trainers (at least 2 from each hospital)

• Cognitive training (computer kiosks and cognitive training), MATRICS testing

• Support supervision on participating departments

• Translations:

• Preventive activities: workshops, information materials

Pilot study

Treatment procedure according to the working methodology (SUPR short methodic)

Instruments:

SUPR sociodemographic characteristic

SKPS (CSRI CZ In) – economy and service use

EQ-5D – QALY (self-report)

GAF – overall functioning

CAN – analysis on needs

BPRS - psychopathology

CAT – satisfaction with treatment (self-report)

MANSA – quality of life(self-report)

SSMIS – self stigmatization (self-report)

Recruitment of 150 patients, length of treatment 90 days

Role of project partner

• Veronica Vaage-Kowalzik MD, Chief psychiatrist of Inpatient Unit-main partner

• Grete Larsen MD MHA, Psychiatrist Head of the psychosis outpatient unit

Nydalen DPS

• Wenche Andreassen, Head of Ward Treatment Section

• Jeanette Engeset, Head of Unit Nydalen DPS

• Visits 11/2013 Bohnice, Psychiatric clinic CUNI, 11/2014 in Bohnice, Dobřany,

Horní Beřkovice, 11/2015 Jihlava, Havlíčkův Brod

• familiarity with our system of care

• study materials

• Comment information system changes

• 2 visits to Oslo (11 czech experts)

Working visist to Oslo

Specific solution

Title

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Working visist to Oslo

Lessons learned from Cooperation

• Funding is crucial, much more personnel in Norway

• Structure of teams, cooperation, horizontal not vertical Information transfer

• Individualized approach to each patient

• Not preparing patients in the hospital, training „in situ“

• Regional responsibility for each patient

• In many aspects psychiatry is the same

• Both sides would welcome more predictability in project terms

• Sometimes different approach to formalization

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