Psychosocial Rehabilitation model in Šiauliai District Mental Hospital

The public institution Šiauliai District The public institution Šiauliai District Mental HospitalMental Hospital

Eugenijus MikaliūnasEugenijus MikaliūnasTartu International ConferenceTartu International Conference

2007 10 312007 10 31

Hospital recourse 2006-12-31d.

Number of beds – 200Number of beds – 200Daytime Inpatient Department – 41 placesDaytime Inpatient Department – 41 placesMedical staff – 120 establishmentsMedical staff – 120 establishmentsServices provided for – 400 000 peopleServices provided for – 400 000 peopleIncome per annum – 8,5 million Lt.Income per annum – 8,5 million Lt.

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The public institution Šiauliai District Mental Hospitals’ report on the activities of Year 2006

Patients treated – 2864Patients treated – 2864

Bed-days – 61228Bed-days – 61228

Average time of patient treatment – 21,4 daysAverage time of patient treatment – 21,4 days

Bed functioning – 306Bed functioning – 306

Bed turnover – 14,32Bed turnover – 14,32E. Mikaliūnas E. Mikaliūnas

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Partners

Family doctors

Mental health care centres

Public institution Šiauliai District Hospital

Department of Psychotherapy

Psychiatric department of children and

adolescent.Public

institution ŠDMH

Šiauliai public institution Center for Addictive

Disorders

Primary health care level Secondary health care level

Šiauliai public institution Nursing Hospital, Psycho

geriatric subdivision

Public institution Šaukėnai

Mental Hospital E. Mikaliūnas E. Mikaliūnas

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Schema of Provided Services

THE RECEPTION AND CONSULTATIVE DEPARTMENT

Department of Psychiatric Crises

services

Departments of General Psychiatry

services

Department of Daytime

Psychiatric services

Department of Psychosocial Rehabilitation services

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Departments of Provided Services

• Reception• Planned and urgent consultations• Consultations in general medicine hospitals

• Consultation in Reception and Consultative Department (psychiatrist, mental health nurse, social worker)• 100 beds Inpatient Department

100 beds Inpatient Department

41 places, 16 of them - seasonal

THE RECEPTION AND CONSULTATIVE DEPARTMENT

CRISIS DEPARTMENT

DEPARTMENT OF GENERAL PSYCHIATRY

DEPARTMENT OF PSYCHOSOCIAL

REHABILITATION

DAYTIME IMPATIENT DEPARTMENT E. Mikaliūnas E. Mikaliūnas

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Medicine Staff Recourses in Treatment Department

Salary Fund

60%

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Psychiatrists – 17 Nurses – 44 :

Reception and Consultative Dep. – 6

Emergency State Dep. – 18 General Psychiatry Dep. – 15 Care administrators – 5

Nurse assistants – 41 : Emergency State Dep.– 28 General Psychiatry Dep.– 13

In total: 102

Staff Recourses of Psychosocial Rehabilitation Department

Salary fund

20%

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Head of the department Administrator Psychiatrist Social worker Medicine psychologist Specialist of psychosocial rehabilitation Mental state nurse (for occupation) Occupational therapist (ergo therapist) Art therapist Occupational therapist for physical preparation Music therapist Physical medicine and rehabilitation nurse Occupational nurses

In total: 30

Department of Psychosocial Rehabilitation

Aims of Psychosocial Rehabilitation Department

Establish a multidisciplinary team, that applies Establish a multidisciplinary team, that applies methods, alternative to pharmacological treatment methods, alternative to pharmacological treatment for the inpatients in the hospital and Day for the inpatients in the hospital and Day Department.Department.

Help people with severe and long-lasting mental Help people with severe and long-lasting mental disturbances to improve life quality.disturbances to improve life quality.

Help to adjust successfully to the environment and Help to adjust successfully to the environment and feel life satisfaction with the minimal specialists' feel life satisfaction with the minimal specialists' supervision.supervision.

Help to restore and maintain lost skills and acquire Help to restore and maintain lost skills and acquire new one's.new one's.

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Team of the Psychosocial Rehabilitation Department:

Psychiatrist (1)Psychiatrist (1) Psychologist - psychotherapist (1)Psychologist - psychotherapist (1) Medical psychologists (3)Medical psychologists (3) Social workers (5)Social workers (5) Mental health nurses for occupation (5)Mental health nurses for occupation (5) Occupational therapists (3)Occupational therapists (3)

SERVICES PROVIDED IN THE PSYCHOSOCIAL

REHABILITATION DEPARTMENT

SERVICES:

Long-term psycho pharmacological treatmentLong-term psycho pharmacological treatment Psychotherapy (group and individual)Psychotherapy (group and individual) Psychosocial rehabilitation:Psychosocial rehabilitation:

Restoration and teaching of domestic skills:Restoration and teaching of domestic skills: Personal budget planningPersonal budget planning Individual food preparationIndividual food preparation Food preparation in a groupFood preparation in a group Buying, composing menuBuying, composing menu Ware washing and careWare washing and care Knitting, sewingKnitting, sewing Drawing, clay modellingDrawing, clay modelling

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SERVICES: Hygiene skills restorationHygiene skills restoration Social skills trainingSocial skills training Developing leisure time spending skills and Developing leisure time spending skills and

integrated living in a community skills:integrated living in a community skills: Swimming poolSwimming pool Social services centreSocial services centre ExhibitionsExhibitions TheatreTheatre Computer skills trainingComputer skills training Discussions about ethicsDiscussions about ethics

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CommunityCommunity – as a roof, where we hide – as a roof, where we hide during slasher rain, as a fireplace where we during slasher rain, as a fireplace where we get warm in a cold winter day.get warm in a cold winter day.

Z. BaumanZ. Bauman

Social thinkerSocial thinker

E. Mikaliūnas E. Mikaliūnas 2007.10.31 Tartu International Conference2007.10.31 Tartu International Conference

MODELS of Psychosocial Rehabilitation

CONSERVATIVE MODELCONSERVATIVE MODEL Treatment supplement applying special Treatment supplement applying special

interventions with the aim to prevent handicap. E.g. interventions with the aim to prevent handicap. E.g. Psychological programme for the client and his Psychological programme for the client and his family, occupational therapy, leisure time therapy.family, occupational therapy, leisure time therapy.

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MODELS of Psychosocial Rehabilitation

CLIENTS' CHOSEN GOAL MODELCLIENTS' CHOSEN GOAL MODEL

Highly specialized treatment, when a client has a need Highly specialized treatment, when a client has a need to develop specific skills and specialists formulate to develop specific skills and specialists formulate tasks an interventions to reach this goal. E.g.: social tasks an interventions to reach this goal. E.g.: social skills training.skills training.

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MODELS of Psychosocial Rehabilitation

INTEGRATIVE MODEL OF SERVICES AND INTEGRATIVE MODEL OF SERVICES AND INTERVENTIONS:INTERVENTIONS:

Long term support after treatment. Integration of Long term support after treatment. Integration of services and interventions. Specialists evaluate client's services and interventions. Specialists evaluate client's needs and help is assigned according to the conditions needs and help is assigned according to the conditions and demands. E.g.: long-termed and thorough and demands. E.g.: long-termed and thorough community treatment.community treatment.

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Psychosocial rehabilitation of patients with schizophrenia

Rehabilitation

Community based methods of treatment

Self-help group

Individual psychotherapy

Methods of psychosocialrehabilitation

Family therapy

Group therapy

Maurizio Pompili et. allWorld J Biol Psychiatry, (2004) 5,201-210

E. Mikaliūnas E. Mikaliūnas 2007.10.31 Tartu International Conference2007.10.31 Tartu International Conference

Psychosocial interventions for patients with schizophrenia

Social skills training

Psychosocial interventions

Occupational rehabilitation

Individual therapy

Family therapy

Supportedemployment

Assertive communitytreatment

Self-help groups

Crisis centers

Hospitalisation

Group therapy

Social therapy

Psychotherapy

Community-based methods of treatment

Problem solving strategies

Maurizio Pompili et. allWorld J Biol Psychiatry, (2004) 5,201-210

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The end

THANK YOU FOR THANK YOU FOR YOUR ATTENTION!YOUR ATTENTION!