Trastornos mentales y tratamiento

Euro Mental Health 2019: System therapeutic principles in working with psychosis- Davy Dries- Ghent University Hospital

Abstract

Davy Dries

Introduction

The theoretical framework The driving force behind this research idea are the current funding cuts within mental health services instigated by municipal councils in Belgium and in the Netherlands that have an effect on the availability of day activity services, raising the possible question if the lack of services has an effect on the recovery process of people with a serious mental illness. Another underlying reason and concern behind the need for this investigation are the recent figures that show an increase of forced admissions in Psychiatric Hospitals. This has been attributed to a decline in supportive strategies and admission possibilities that assist in the recovery process. Clinical and community relevance in regard to day activities has been a long-time supporting strategy in caring for people with a serious mental illness, either in a hospital or community setting. These services have been around since the dawn of psychiatric care. In large psychiatric hospitals activities were and are organised as part of the treatment and nursing processes. These days participating in activities outside the confines of home can stimulate community participation, create an exchange mechanism between service users and promote a more positive self-esteem. Furthermore, the possible therapeutic benefits of reducing relapses of psychiatric symptoms, community acceptance and participation have been documented

Methods:  There is a substantial amount of literature dealing with the issue of activities and the issues related to the recovery process. The principal researcher has found articles that touched on the subject in the database PubMed, Google Scholar, and the International Journal of Mental Health Nursing, Community Mental Health Journal, International Journal of Mental Health, International Journal of Mental Health Systems and Quality of Life Research. For example, key articles by Happell et al. and Borg et al. were used. The databases PubMed and Cochrane Library were considered for multiple searches using various combinations of key words as: day activity, recovery, ACT (Assertive Community Treatment), serious mental illness, schizophrenia, psychosis, psychiatric hospital admission, service users, local community and Ghent.

Ethical issues in the planned data collection Ethics approval will be sought from the Ethics Committee of the Ghent University Hospital, to start interviewing patients in the day activity center in Ghent. Participants will be provided with information of the study and asked to sign a consent form. Identifying information will be removed from any reported material. De-identification of participant’s names and their socio-demographics will occur, with a pseudonym allocated to each participant to preserve their confidentiality. The recordings of interviews will only be heard by the principal researcher, the transcribing in Dutch will be completed by the principal researcher to increase his experience of familiarity with the data. The recordings will not be used for any other purpose.

Results:  The literature defines day activities as all activities that participants are involved in to fill in her or his day. Therefore, the first aim of these activities is to be occupied. These activities vary from active employment to hobbies and anything in-between. The literature shows, by entering keywords in the databases, that day activities have an important role in recovery. By using the search engines, the following concepts have been identified by the principal researcher:

• Relaxation is a model identified by the literature. Within this concept the participant is involved in activities that will relax them, like listening to music.

 • Feeling fit is also a component. It serves the feeling of wellbeing and energy. It can assist to gain physical health after a period of i.e. illicit drug use.

 • Self-expression are all the activities that can fall under the concept of creativity. Examples are acting, drawing, painting and photography.

• Self-development. This entails all activities that are aimed at the process of recovery. The fourth item can be marked as the umbrella of the concepts that have been identified. The literature shows a variety of definitions of recovery. Aside from the official Macquarie dictionary (online) definition: “Repair, reinstate, salvage and salvation”.

 • Something that is broken that needs to be mended

• Conscious thought and less occupied with problems

 • Cured from drugs and

• Being part of the community again.

Discussion:  In order to understand the full scoop of the issue at hand, one will have to realise that the fairly recent introduction of the Mobile Teams and FACT (Flexible Assertive Community Treatment) model changed the care for people with a serious mental illness significantly, thus needing new parameters to evaluate this care. Extended admission to a psychiatric hospital is now replaced by active social psychiatry. Their strength is that they work with the local partners in their subsequent municipal council. These partners also include the organised day activities delivery of care. The core business is recovery and focusses on recovery supporting care and methodology.

Strength of this pilot study is the qualitative approach. Qualitative approaches offer flexibility. Qualitative research is “multi-method in focus, involving an interpretive, naturalistic approach to its subject matter”. This means that qualitative researchers study issues in their natural settings, attempting to make sense of, or interpret, phenomena in terms of the meanings people bring to them.

Note: This work is partly presented at 2^nd International Congress on Mental Health on June 13-15, 2019 held in Amsterdam, Netherlands