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Assignment 2 Advocacy for integration of mental health care into primary care and the development of psychiatric rehabilitation services and programs The development of integration of mental health care in primary care is crucial for diverse reasons which include the fact that: – Mental diseases are frequent and create substantial social, professional and economical loss to society, namely in Portugal 1 in each 5 people has a mental disorder, numbers that go highly above European statistics.

– The coexistence of physical disorders and mental disorders is usual and integrating mental health care into primary care provides for a global and inclusive approach to any individual – There is a great disparity between the frequency of mental illness and the amount of individuals receiving treatment, since there are little resources for specialized treatment to attend to all the needs in mental health care – Access to mental health care is easier when it is a part of primary health care, since it is located closer to patients’ homes and it improves community integration and monitoring.

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– Stigma is lessened and human rights violations are inexistent – It is less expensive and more cost-effective than psychiatric hospitals and it also diminishes indirect costs with long distance dislocations – Outcomes are favorable and intervention is effective, especially when there is a connection with community services.

– The primary health care team is in contact with a broad range of the population and can therefore identify particular symptoms and signs early in the evolution of disease, providing for timely intervention and a better outcome – Consumers prefer being attended at a primary health care setting than a psychiatric service – The relationship that settles between a primary health care professional and his/her patient attains comfort to the disabled patient and favors communication; on the other hand

the primary health care team has a holistic vision of the subject and namely has deep knowledge on the individual’s background, which improves understanding of the patient’s difficulties and hardships – Health education, prevention and intervention is possible on a more often basis in a primary health care setting.

The development of psychiatric rehabilitation services makes possible for the patients to become functional and integrated into society, improving their ability to work and be economically productive, create Assignment 2 Mental Health Policy and Plans and maintain interpersonal relationships; it strengthens individuals’ self esteem and sense of accomplishment, providing for faster and better recoveries.

Strategies for developing integration of mental health care in primary health care Since Portugal is a country with a high prevalence of mental disorders a reorganization of services is in order. Psychiatric services are unable to handle every case of mental disorder and the lack of contact with general population increases the sub diagnostic frequency of this diseases.

This problem can only be solved by focusing mental health care in a community setting, creating services linked to primary care. The two most frequent disorders are anxiety (16,5%) and depression (7,9%). Interventions should be legislated by mental health policy and plans formalizing the government’s commitment towards integration. Mental health coordinators should be assigned to direct these strategies. The main goals of integration are: 1.

Goal: Development of community based mental health services and psychiatry units at general hospital Strategy: The country should be divided into sociodemographic areas of care including 4 main directions: o Integrated Program of Care for Severe Mental Disorders which provides for Assertive Community Treatment for these patients o Program for interaction with general practice professionals, directed towards common mental diseases o Program for prevention of anxiety disorders o Program for prevention of depressive disorders and suicide.

These Programs should be based on psychiatry departments located in general hospitals, with progressive closing of psychiatric hospitals, and a connection to community services, namely General Practice Services, should be promoted. No service should be closed before the establishment of a replacement 2.

Goal: Integration of mental health services in primary care Strategy: It should be based on the principle that areas of intervention should be clearly settled in order to improved effectiveness of general practice professionals; common mental disorders should be diagnosed, treated and followed by general practice professionals, with supervision and training by mental Assignment 2 Mental Health Policy and Plans health teams located in general hospitals through Programs of connection to community practice and severe mental illness should be diagnosed and treated in psychiatry services.

3. Goal: Equitable access to appropriate assessment and treatment of physical health conditions Strategy: This is only possible if there is a general practice approach to mental disorders, since general practice also deals with physical conditions and knows the patient as a whole 4. Goal:

Training of mental health staff Strategy: In and pre service training is a part of the integration process; community mental health teams should supervise and train general practice professionals regularly and psychiatry residents should have community mental health services included in their training program. Referrals should be clear and clinical information provided by mental health teams should be as specific as possible in order to be able to do a reasonable triage before mental health consults 5. Goal:

Participation of service users and careers in all aspects of care Strategy: Evaluation of patients’ and families’ satisfaction can be a useful tool to improve services further on 6. Goal: Promotion of research Strategy: Monitoring through statistical analysis the most prevalent disorders in order to implement more adequate policies and plans directed to those diseases 7.

Goal: Establishment of robust systems to monitor the quality of care delivered Strategy: Deploy statistical analysis and inquiries about users’ and families’ satisfaction Additional concerns Psychotropic medication should be available at primary care facilities and prescription legislation should allow for primary care professionals to provide for psychotropic medication.

A mental health budget increase is needed since training has to be paid for as well as additional staff hiring. Although psychiatric diseases’ prevalence is 22,9% in Portugal only 3% of the state budget is allocated to mental health so an increase to 10% is in order. Assignment 2 Mental Health Policy and Plans.

Strategies to develop psychiatric rehabilitation services and programs to improve care provided to people with severe mental disorders Rehabilitation services have become progressively more relevant since recent approaches to mental disorders consider that they are a disability grading rather than an illness itself. The goal is to achieve the base of the WHO service organization pyramid for an optimal mix of services for mental health, which is self-care. Therefore community living and integration for these patients is largely valued.

The goals for psychosocial rehabilitation program implementation are: 1. Goal: Development of the psychosocial network Strategy: Promote the following lines of action o Supported housing and independent housing, with services dependent on the individual’s demands o Socio-occupational units based mainly on supported employment in which patients are placed in competitive work environments with background support maintained indefinitely; other services include transitional employments to get a vocational skill basis and sheltered workshops;

Modules on building and maintaining relationships and family intervention programs are also beneficial for improving self esteem and motivation o Assertive community treatment teams to provide for treatment, support and rehabilitation services among the community living These domains have to be managed in accordance with housing departments and employment organizations. 2.

Goal: Development of specialized institutional services for those with more complex needs Strategy: Plan for residential units or admissions to other specialized services and assertive community care once the patient is able to live in community settings 3. Goal: Fighting against stigma and social exclusion Strategy: Sensitize employment organizations and firms towards hiring mentally disordered individuals through campaigns against stigma and discrimination, presenting recent data on the employment rates of these subjects and financial incentives such as reduction in tax contribution 4. Goal: Support to families Assignment.

2 Mental Health Policy and Plans Strategy: Mental disease often represents a great burden to families, accentuated by the degradation of economic conditions, on the onset of the financial crisis, and the urbanization process, which triggered a gap within family members. Support must be addressed through family intervention programs 5. Goal: Improvement of quality of care in psychiatric hospitals and deinstitutionalization Strategy:

Reinforcement of human rights legislation and implementation of rehabilitation programs that may facilitate community living Additional concerns Informal community care, such as NGO’s, teachers, police, users and family associations is important for prevention of relapse and it represents accessible and acceptable service.

Expected difficulties There are several hardships in integration and implementing psychiatric rehabilitation programs such as: – Poor coordination between health services and employment and housing departments: this requires joint management and funding – Financial constraints may make it hard for a mental health budget increase – Mental health professionals may not be willing to accept a shift in paradigm towards a community approach versus a psychiatric hospital approach – Stigma and discrimination in work environments and even in villages and society level are hard to overcome – Absence of promotion and prevention in schools, workplaces and villages.

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