Module Thirteen PSYCHIATRIC SERVICES

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Module Thirteen PSYCHIATRIC SERVICES

• Lesson 1 Psychiatric reformation (2 training
  hours)
• Lesson 2 the role of psychiatric services
• 
  (3 training
  hours)
• TOTAL TIME 5 TRAINING HOURS OF 45 MINUTES

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Lesson 1

• PSYCHIATRIC REFORMATION
• TIME
• 90 minutes (2 training hours of 45 minutes) 

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Step 1 Introduction (10?)

• Transferring the care for people with psychiatric
  problems from a big psychiatric institution to
  the community requires the development of
  supporting structures that can offer prevention,
  diagnosis, therapy and psychiatric
  rehabilitation.
• International experience has proved that the
  organization of these services for the first time
  is a difficult issue and can be achieved only
  when
• There is politic determination,
• The society supports the effort,
• There is secure funding,
• the appropriate organisms can be found.

4
Step 2 Discussion (15?)

• Where are psychiatric services offered in Greece?
  
• When did the function of community services
  begin?
• What do you know about the Psychiatric
  reformation and its context ?

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Step 3 Theory presentation (20?)

• The dominant situation before the Reformation
• In Greece, until the middle 80s, the only public
  offer of psychiatric care was done in asylums
  (Psychiatric clinics).
• Asylums usually hosted people with severe
  psychoses or antisocial behaviour and the
  hospitalization aimed firstly to discharge the
  community from a person with undesirable
  behaviour and secondly offer treatment to the
  person.

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Step 3 (continued)

• The conditions in the asylums were miserable
• Tenths of patients were rushed in large wards
  which had no other furniture apart from beds.
• The hygiene rooms were unacceptable.
• The personnel (included the doctors) was small in
  number and not trained.
• People of all ages lives together.
• People with Mental Retardation and other Organic
  Mental Disorders lived with psychotic patients.
• Any sense of personality, decency, personal
  choice was reduced to a state Of rigid hierarchy,
  uniformity and flattening.      

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Step 3 (continued)

• The duration of stay in the asylum was always
  long with undefined end.
• There were no service of psychiatric care for
  people with milder disorders or problems.

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Step 3 (continued)

• The period of Reformation
• On 1981, Greece became the 10th member of the
  European Economic Community (EEC).
• It was acknowledged that the sector of Mental
  Health among others needed upgrade.
• After the submission of a concrete proposal an
  important financial support was approved for the
  reformation of psychiatric health based on the
  principles of Communitys Psychiatric Health
  (standards)
• This proposal after its approval constituted the
  regulation 815/84 of EEC and the same year was
  legislated in Hellenic Republic (law N.1397/84)
  in the context of application and National Health
  System.

9
Step 3 (continued)

• The context of the Reformation
• There were four basic targets
• ?. The development of complete networks of
  psychiatric services throughout the country.
• This required the separation of the country in
  Psychiatric Sectors.
• Each Sector was responsible to offer all
  psychiatric services required in a determined
  geographic department.
• This should have necessarily service of first aid
  mental care (Mental Health Center),
  hospitalization service (psychiatric department
  of central Hospital) and services of psychiatric
  rehabilitation (work and residence).
• Appropriate services for children and adolescents
  should had to be developed.

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Step 3 (continued)

• ??. Minimize the number of Asylums.
• This would be achieved by
• Minimizing of hospitalization, as the services
  would be offered to the community and to the
  specific area.
• The reintegration of people and groups of
  patients from asylums to new rehabilitation units
  in the area of their origin.

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Step 3 (continued)

• ???. Ameliorate the conditions in asylums.
• With the creation of modern hotel structure.
• With better personnel.
• The separation of persons with Mental Retardation
  and Organic Mental Disorders.
• The separation of elders.

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Step 3 (continued)

• IV. Give the opportunities of training and
  further specialized studying, for suitable staff
  for all psychiatric services to exist

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Step 4 Discussion (15?)

• In what degree do you think that the targets of
  Psychiatric Reformation are achieved?
• What were the reasons in your opinions for the
  delayed application ?
• What do you think are the difficulties for its
  completion?

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Step 5 Theory presentation (20?)

• The progress of the Reformation
• The initial schedule for the completion of the
  reformation was set to five years.
• During its application there were serious delays
  and serious problems occurred. (f ex Leros
  issue).
• Several extensions were given and the validity of
  the regulation 815/ 84 over passed the decade.
• Unfortunately during this period it the
  application of Psychiatric Sections was not
  achieved .

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Step 5 (continued)

• Random psychiatric community services were
  developed in several regions where the conditions
  permitted and there were well trained and
  experienced personnel, but mainly will and
  determination.
• A new law for Mental Health came into force, the
  law N 2071 / 92, which simply determined the
  legal frame for the function of these services
  naming them Units of Mental Health.
• The asylums even if they improved their
  structure, the conditions of hospitalization and
  their general function, they were not
  substantially decongested and continued to
  receive the majority of patients.

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Step 5 (continued)

• The few existent psychiatric departments of
  general hospitals functioned but not as
  effectively as to keep the persons for
  hospitalization in their place of origin.
• The next law for Mental Health, law N. 2716/99
  gave again priority to the organization and
  function of Psychiatric Sections. Its application
  is promising, as well as the application of the
  program PSYCHARGOS, through which the
  psychosocial rehabilitation of many persons that
  live in psychiatric clinics is intended again.

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Step 6 Questions and comments (5?)

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Step 7 Lessons evaluation (5?)

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Lesson 2

• THE ROLE OF PSYCHIATRIC SERVICES
• TIME
• 135 minutes (3 training hours of 45 minutes) 

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Step 1 Introduction (5?)

• Every minute about 1 out of 6 suffer from a
  mental disorder.
• Not all of them are severe.
• Despite their rate of incidence and the important
  consequences in peoples life, only recently was
  emphasized the development of services for their
  efficient treatment.

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Step 2 Slide projection and discussion (20?)

• Slide 13.2.1 The role of Mental Health Services
   
• Te services of Mental Health must
• Offer high quality treatment and care to the
  society.
• Satisfy the needs of people who use them and not
  to discriminate them.
• Be easily accessed and offer services wherever
  there are needed.
• Offer opportunities that promote independence

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Step 2 (continued)

• Offer continuous care and treatment.
• Offer support to he families of the persons who
  use them.
• Collaborate and keep good coordination with other
  services.
• Offer training and experience and contribute to
  the training of skillful staff.
• Support their personnel and secure its rights.
• Be held responsible to society.

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Step 3 Exercise (20?)

• Leaflet 13.2.1 Functions of various Mental
  Health Services
• Complete the table of the leaflet with or -
  in each square according to the offer or not of
  the function from a service.

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Step 4 Slide projection (35?)

• Slide 13.2.2 Communal Psychiatric Services
  Centre of Mental Health 
• Prevention
• in schools, work places, neighborhoods etc.
• in their families, new parents, couples and
  people that are liable to mental disorders
• in sensitive population groups, (f ex
  immigrants, patients of physical diseases)
• Evaluation and diagnosis
• Therapeutical treatment
• Medication
• Psychotherapy
• Social interventions
• After hospitalization observation
• Cooperation with other Mental Services.
• Training of all the sectors of professional in
  mental health.

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Step 4 (continued)

• Slide 13.2.3 Community Psychiatric Services
  Psychiatric department of General Hospital  
• Intervention in social stigma
• Offer of short hospitalization
• Treatment of emergency psychiatric problems
• Diagnostic and therapeutical service
• Cooperation with other Psychiatric Services
• Training of all the sectors of professionals in
  mental health

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Step 4 (continued)

• Slide 13.2.4 Community Psychiatric Services
  rehabilitation services  
• Evaluation of social needs, problems, inabilities
  and abilities of the patients
• Planning , organization and observation of
  residence Units
• Planning , organization and observation of
  Working Units
• Creation of new communication means with other
  social and working organizations
• Collaboration with other Psychiatric Services
• Training of all professionals in mental health

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Step 4 (continued)

• Slide 13.2.5 Community Psychiatric Services
  units of Partial Hospitalization
• Day Hospital
• Offer of all services of any psychiatric
  department for people that require
  hospitalization but their state does not demand
  24 hour stay in the hospital and have supportive
  family environment
• Diagnostic and therapeutical services
• Development of group activities
• Promotion of the stay in the community for the
  person and involvement of the family in the
  problem.
• Help to eliminate the stigma

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Step 4 (continued)

• Day Care Centre???t?? ?µ??a?
• Support service additional to the rehabilitation
  services
• Offer of training in social skills
• Organization of programs of pre-professional and
  professional training
• Offer of creative occupation and entertainment to
  the persons that are not able to work
• Development of group activities
• Cooperation with other Psychiatric Services
• Training of all professionals in mental health

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Step 5 Discussion (10?)

• Make a brief discussion regarding your work on
  Step 3 and the information from Step 4.

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Step 6 Brainstorming (10?)

• The functions of various Services of Mental
  Health can possibly overlap and the choice of the
  most appropriate one is not always obvious. Think
  of examples.

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Step 7 Exercise (25?)

• Leaflet 13.2.2 Exercise
• Complete for every case the most adequate
  Psychiatric Service.

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Step 8Questions and comments (5?)

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Step 9 Lessons evaluation (5?)