Care from a Hospital Setting
integrated prevention, rehabilitation/remobilisation/reintegration programmes
Keywords: Psychiatric (health) care, social services, integrated care, mental health
Integrated psychiatric care in a hospital setting
Summary
The new Slovak Social Services Act, in force since January 2009, introduced a legal basis to integrate social care services into the hospital setting. The Psychiatric Hospital Samuel Blum Plešivec, established in 1898, is the oldest psychiatric residential facility in Slovakia. After receiving independence in January 1992, it was turned into a supra-regional health care facility for patients with serious mental health disorders and increased needs for psychiatric care. In September 2004 the hospital became a model for ‘integrated mental health care’ for this client group, by incorporating a social- health department into the hospital structure, starting with 16 clients. Currently there are 45 clients, 7 of whom are above 65 years of age. The department was established as a response of the Slovak government to the findings and recommendations of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), with the aim of improving the quality of living conditions in residential care for adult patients/clients with increased needs for psychiatric care who have only limited chances to live in their own homes. Based on this project, the hospital is presently registered under the social services legislation as a social service provider. It is funded via a regional government subsidy to cover expenditure of social care services (nursing care, ADLs, occupational therapy, leisure activities), clients’s fees and compulsory health insurance (to cover health care services).
What is the main benefit for people in need of care and/or carers?
The main benefit for older people in need is providing them with integrated psychiatric care under a single organisational structure (integrated care from one place).
What is the main message for practice and/or policy in relation to this sub-theme?
The main message for practice and policy is that administrative burdens in other hospital facilities can be overcome by following this example on integrated psychiatric care.
Warum wurde diese Initiative implementiert?
In Slovakia, there are some historically grounded gaps in providing integrated health and social care services for patients/clients in residential facilities. Despite the responsive legislation that came into force in January 2009, currently only 10 hospitals follow the concept of integrated care by offering social services in a hospital setting (Ministry of Labour, Social Affairs and Family of the Slovak republic, information from the Central register, on request). One of them is the Psychiatric Hospital Samuel Blum Plešivec that, established in 1898, represents the oldest psychiatric residential facility in Slovakia.
In 2004 the hospital launched a project to implement integrated mental health care for clients with severe mental health problems and increased needs for psychiatric care who were not treated appropriately in residential social care facilities. To organise and ensure integrated care, the social-health department (zdravotno - sociálne oddelenie; hereafter “SHD”) was established within the hospital´s organisational structure. The SHD is part of the in-patient hospital department of which the total capacity is for 240 patients/clients, but only 45 places (beds) are for those with complete social-health needs being treated within the SHD.
The SHD started its real operation in 2005 with 16 patients. At present it has 45 clients, the majority of them aged between 41-65 years. Seven clients (4 men and 3 women) are above the age of 65 years.
Beschreibung
In January 1992 the Psychiatric Hospital Samuel Blum Plešivec became a supra-regional health care facility for patients with serious mental health disorders and increased needs for psychiatric care.
In 2004, the hospital launched a project with the aim of relocating patients with increased demand for psychiatric care from residential social care to the residential health care sector to ensure comprehensive psychiatric care, including ADL/IADL care. State subsidy to prepare conditions for establishing the SHD and launching its activities amounted in 2001-2002 to SKK 10 million (about €330,000), plus SKK 80,000 (about €2,600) for basic equipment.
To organise integrated mental health care for older clients the dynamic theory of ageing is applied (Džodla, 2010). Daily activities are divided into three blocks: (1) group memory training; (2) stimulation of soft motor and visual motor abilities, exercising relaxation techniques; (3) leisure time activities, supportive therapies, evening activation programmes. Care and support measures are based on developing daily routines by following regular regimes. The SHD employs nurses, medical helpers, special educationalist and social workers. The proportion of the non-medical professionals is higher in comparison to that of the inpatients’ department and common psychiatric medicine in the hospital.
Funding of integrated care is sector-mixed. The majority of "social" expenditure is covered by the regional government’s subsidy (in 2009 it amounted to about €232,000) and clients’ fees that amounted in 2009 to about €125,000 (Výročná správa, 2010). Health care costs are covered from the health insurance fund. To be subsidized by public money for social services (nursing care, ADL/IADLs, occupational therapy) the hospital is registered with the Ministry of Labour, Social Affairs and Family of the Slovak Republic as a provider of social services.
Welche Effekte wurden erzielt?
There is no official report on the evaluation of the SHD and its activities. Concerning clients’ assessments, the hospital management points out that the target group is problematic and, due to the mental conditions of the clients, cooperation with them is limited. Feedback based on a customer satisfaction survey (questionnaire) can thus only be collected from a small sample of clients, and findings are very weak: in 2010, only 8 out of 44 clients filled in the questionnaires. However, the director highlights some positive aspects of their work from different perspectives:
- Client’s perspective: Complex and highly skilled care is provided according to the clients’ needs, i.e. psychiatric care, nursing care, support with activities of daily living, social rehabilitation, occupational therapy and leisure time programmes. All clients are divided into six working groups to provide help with household chores, gardening or other activities.
- Clients’ relatives provide positive feedback on the opportunity of providing their dependent family members with integrated care when the possibility to care for them at home is limited (they report a lack of ability and capacity to provide the necessary treatment due to severe health status of their family members).
- Community based perspective: Cooperation with civil society organisations in the Plešivec region led to an integration of clients who now participate in cultural or sporting events at local, regional or national levels.
- System perspective: The practice of the hospital was turned into a model of good practice that was transferred also to other psychiatric hospitals, e.g. the hospital in Michalovce.
Worin bestehen die Stärken und Schwächen der Initiative?
Strengths
- The project of integrated social care in a hospital setting served as a pilot project for implementation of the new legislation valid from 2009.
- The project thus served to prevent start-up problems and non-intended effects in hospitals that followed the example of Plešivec hospital.
Weaknesses
- The hospital’s capacity for providing integrated care does not match demand for integrated psychiatric care. The original capacity was planned for 35 clients, presently there are 10 more places, while ministerial permission allows for a maximum of 50 places.
- Resources for social care services are insufficient.
- Cultural and professional barriers for inclusion of social services into health care settings are still prevalent, in particular considering the lower professional status of social care workers (Džodla, 2010; NEP meeting, 2010).
Opportunities
- The transferability of the experience to other psychiatric hospitals.
- The establishment of a regular legal and financial framework.
- The implementation of new quality management procedures to overcome some reservations and prejudices of health care professionals (mainly medical doctors) to cooperate with other care specialists (e.g. with social workers).
Threats
- Lack of budget for more demanding social support and services.
Impressum
Autor: Kvetoslava RepkovaReviewer 1: Georg Ruppe
Reviewer 2: Satu Meriläinen
Verified by: Mr. Pavol Džodla, Director of the hospital Plešivec
Externe Links und Literatur
- Džodla, P. (2010) Basic paper prepared on request.
- Plešivec Ministry of Health (2006) Koncepcia zdravotnej starostlivosti v odbore geriatria (The Conception of Health Care Services in Geriatrics). Bratislava: Ministry of Health of the Slovak Republic.
- Ministry of Labour, Social Affairs and Family (2009) Národné priority rozvoja sociálnych služieb. (National priorities on social services development). Bratislava: MLSAF of the Slovak Republic.
- NEP meeting of the Slovak Interlinks team. Bratislava: IVPR, 26.10.2010
- Výročná správa Psychiatrickej liečebne Samuela Bluma Plešivec za rok 2009 (Annual report on 2009).
- Zákon č. 448/2008 Z.z. o sociálnych službách (Act No. 448/2008 Coll. on social services).