The Organization of Mental Health Services in Ulss – 9 Treviso
description
Transcript of The Organization of Mental Health Services in Ulss – 9 Treviso
![Page 1: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/1.jpg)
The The OrganizationOrganization of Mental Health of Mental Health Services in Ulss – 9 TrevisoServices in Ulss – 9 Treviso
![Page 2: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/2.jpg)
The Organization ofLocal Health Areas in Veneto
• We call them: Az. Ulss• Az = Azienda (Company: It is public company but
it has a management like a private company)• U = Unità (Unit)• L = Locale (Local)• S = Socio (Social: Municipalities have given Lhas
the management of some social services)• S = Sanitaria (Health)
• In other Regions: LHAs are not also “social” but only “health”
![Page 3: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/3.jpg)
Az.Ulss in Veneto Region
![Page 4: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/4.jpg)
Az.Ulss in Veneto Region
![Page 5: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/5.jpg)
The Organization of LHAs : the Districts
![Page 6: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/6.jpg)
The Organization ofMental Health Services in LHA
• There is one Mental Health Department for each of 21 Veneto Region LHAs
• Every Mental Health Department has one or more Mental Health Units
• In Az.Ulss 9 every District has one Mental Health Unit (4 Districts = 4 MHU)
• Every Mental Health Unit organizes many facilities
![Page 7: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/7.jpg)
Mental Health Department
• In Italian language: DSM (Dipartimento/Department – Salute/Health – Mentale/Mental)
• Responsible for planning and coordinating all mental health services in a specific area
• Run by a Director, supported by a Board of Directors (of the units), a Broad Committee, and an Assembly
![Page 8: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/8.jpg)
Mental Health Department
• It plans and work in cooperation with NPOs, Patients and Families Associations
• DSM coordinates the “Mental Health Area” that agree with Municipalities the “Piano di Zona” (Zone Planning Act)
• The Zone Planning Act describes the social activities shared by Municipalities and DSM, the way of building them, the financial resources
![Page 9: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/9.jpg)
The Organization:Mental Health Unit
• Hospital Services • National Planning: 1 bed per 10.000 population
– In Az. Ulss 9:• 1 Hospital Unit in Treviso General Hospital• 1 Hospital Unit in Oderzo General Hospital• We need 1 more Hospital Unit in Treviso General
Hospital (2012?)– Now: 1 bed /17.000 inhabitants
• Community-based services
![Page 10: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/10.jpg)
Community-based services
– 1 CSM (Mental Health Center) : the core for activities• It is out of hospital• Psychiatric and Psychological activities for
outpatients• Psychoeducational activities• Group Therapy• Home support• Social support
![Page 11: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/11.jpg)
Community-based services• Partial Time treatments = Day Patients
Patients live in their houses and come to facilities for 4-6 hours of treatment
– Centro Diurno (Day Rehabilitation Service): • Psycho education activities• Group Therapy • Occupational activities
– Day Hospital (Day Treatment Service)• Group Therapy• Psychopharmacological Therapy
![Page 12: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/12.jpg)
Community-based services• Full Time treatments: patients live in community
– Residential Facilities• CTRP (Sheltered therapeutic Rehabilitation
Community)• CA (Sheltered House community)• GAP (Sheltered group house)
– Selection is based on: illness severity / disability / needs for intensive treatment / day care time
– A way from high disability and severe disease to better health and skills
![Page 13: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/13.jpg)
Sheltered Residential Facilities• CTRP (Sheltered therapeutic Rehabilitation Community)
– 8 – 14 inpatients– Highest intensity of treatment– Lowest social skills – Staff: 24/24 hours
• CA (Sheltered house community)– 6 – 8 inpatients– Medium intensity of treatment– Better social skills– Staff: 12/24 hours
• GAP (Sheltered house)– 4 inpatients– Low intensity of treatment– Low disability– Staff: 4 hours/day
![Page 14: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/14.jpg)
Community based Facilities• In Az. Ulss 9 we are modifying and completing the
network of facilities– Modifying: some facility were organized for patients discharged 30
years ago from Psychiatric Hospitals. Their needs are changed – Completing: we need facilities more suitable for young people and
early psychosis
• We now manage directly some facilities, and indirectly some others, managed directly by NPOs
– Italian Financial Laws limit the engagement of new staff– LHAs must buy services from private organizations– NGOs are the best reference, owing to costs and the possibility of
creating a good collaboration
• In Az.Ulss 9 the new planning will spend more than 10 million euro / year for sheltered residential facilities managed by NPOs
![Page 15: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/15.jpg)
What we know: the Data• In Az. Ulss 9 we have two flows of data
– Hospital Discharging data: » patient (sex, date of birth, where he lives, job, … )» admission (planned, emergency, compulsory)» disease (diagnosis, therapy)» length of hospital stay
– Outpatients data » patient (sex, date of birth, where he lives, job, ….)» how the patient arrived to services» disease (diagnosis)» what we do (psychiatric or psychological examination,
psychotherapy, rehabilitation activities, admission to residential or day/residential facilities, and so on)
• In Veneto Region we have the same two flows for all LHAs
![Page 16: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/16.jpg)
Veneto Data Base: Hospital
![Page 17: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/17.jpg)
Veneto Data Base: Mental Health Communiy based Services
![Page 18: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/18.jpg)
DSM Computerized Medical Folder
![Page 19: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/19.jpg)
Mental HealthYear
Report
VenetoRegion
![Page 20: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/20.jpg)
How many patients? Rate per 1000 population - 2008
![Page 21: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/21.jpg)
Admissions of psychiatric patients(all hospital units) – Public vs private unit
![Page 22: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/22.jpg)
Admission of psychiatric patients(all hospital units)
![Page 23: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/23.jpg)
Admissions of psychiatric patients(all hospital units) rate per thousand population 2008
![Page 24: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/24.jpg)
Admissions to Public Psychiatric units in Veneto Rate per thousand population 2008
![Page 25: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/25.jpg)
Admissions to Private Psychiatric units in Veneto per thousand population 2008
![Page 26: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/26.jpg)
Compulsory Admissions to Psychiatric Public units
![Page 27: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/27.jpg)
Compulsory Admissions to Psychiatric Public units - Rate per thousand population 2008
![Page 28: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/28.jpg)
Community Based Services DSM 9 vs RegioneIncidence – Prevalence - 2011
18562
5044
1698
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
All Patients Active Patients New Patients
![Page 29: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/29.jpg)
Prevalence rate per 1000 population 2012 by Unit
0,00
2,00
4,00
6,00
8,00
10,00
12,00
14,00
16,00
18,00
040091 040092 040093 040094
![Page 30: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/30.jpg)
Incidence rate per 1000 population 2012 by Unit
0,00
1,00
2,00
3,00
4,00
5,00
6,00
040091 040092 040093 040094
![Page 31: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/31.jpg)
Prevalence by age and sex 2009
![Page 32: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/32.jpg)
Prevalence per 1000 population by age Males 2009 – Az.Ulss 9 / vs Veneto
![Page 33: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/33.jpg)
Prevalence per 1000 population by age Females 2009 – Az.Ulss 9 / vs Veneto
![Page 34: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/34.jpg)
Prevalence by diagnosis - 2012
0
200
400
600
800
1000
1200
1400
Alim
enta
zion
e, s
onno
et a
l
Ans
ia, a
datta
men
to,
nevr
osi
Dem
enza
e d
istu
rbi
orga
nici
Dis
turb
i da
sost
anze
Dis
turb
i evo
lutiv
ico
gniti
vi
Dis
turb
i evo
lutiv
ico
mpo
rtam
enta
li
Dis
turb
i um
ore
Per
sona
lita'
ed
iden
tità
sess
uale
Pro
blem
a no
ndi
agno
si
Rita
rdo
men
tale
Sch
izof
reni
a e
altr
eps
icos
i
![Page 35: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/35.jpg)
Incidence by diagnosis - 2012
0
100
200
300
400
500
600
700
Alim
enta
zio
ne,
sonno e
t al
Ansia
,
adattam
ento
,
nevro
si
Dem
enza e
dis
turb
i org
anic
i
Dis
turb
i da
sosta
nze
Dis
turb
i evolu
tivi
com
port
am
enta
li
Dis
turb
i um
ore
Pers
onalit
a' e
d
identit
à s
essuale
Pro
ble
ma n
on
dia
gnosi
Rita
rdo m
enta
le
Schiz
ofr
enia
e
altr
e p
sic
osi
![Page 36: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/36.jpg)
Incidence by diagnosis - rate per 10000 population 2008 – Ulss 9 vs Veneto
![Page 37: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/37.jpg)
Activities 2012
020004000
60008000
100001200014000
160001800020000
Vis
ite P
sic
hia
tric
he
Vis
ite P
sic
olo
gic
he
Esam
e T
estis
tico
Psic
ote
rapie
Collo
quio
info
rmativ
o o
di s
oste
gno
Incontr
i Opera
tivi M
ulti
pro
fessio
nali
Inte
rvento
di P
sic
oeducazio
ne F
am
iliare
Inte
rvento
tera
peutic
o R
iabilita
tivo
Str
uttura
to
Rela
zio
ne C
linic
a
Riu
nio
ne d
i Equip
e o
tra
Opera
tori
Segre
tariato
Socia
le
Som
ato
tera
pia
Psic
hia
tric
a
![Page 38: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/38.jpg)
Social therapeutic and rehabilitation activitiesSocial therapeutic and rehabilitation activities
Employment Sheltered jobs (together with “Provincia”)
Law “68”: companies have to employ some people from a list of patients with disabilities
SIL (Service for job integration): training employment (a few hours, little earnings)
No profit work companiesWe are now starting Supported Employment
Individual placement and support of people without training in competitive jobs
Help for House
Agreement Acts with Municipalities for houses for psychiatric people
![Page 39: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/39.jpg)
Mental Health PromotionMental Health Promotion
A specific staff that promote groups to explain mental health organization and to inform about mental health diseasesIn schools In Municipalities
Every year there is the “mental health day”, to encounter population
![Page 40: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/40.jpg)
Residential activities
• Patients admitted 2012 = 140– Patients discarged from psychiatric hospital = 61– Patients without history of psychiatric hospital = 79
• Facilities = 18
![Page 41: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/41.jpg)
Staff
Employed Consultant NPOs Sum Real Staff
Psychiatrists 26 2 0 28 27,39
Psychologists 5 4 4 13 7,97
Nurses 109 0 7 116 105,66
Social Workers 6 0 0 6 6
Education Staff 11 0 11 22 15,84
Care Technical Staff 41 0 88 129 97,57
Administrative Staff 6 0 0 6 5,67
Others 5 6 13 24 13,04
SUM 209 12 123 344 279,14
Staff/population: 1,2 per 1000 population
![Page 42: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/42.jpg)
Staff by facilities UOA 1
Profilo professionale CSM Ctrp CD SPDC
Psychiatrists 6 2
Psychologists 2 1
Nurses 16 6 7 15
Social Workers 1
Education Staff 11 1 3
Care Technical Staff 2 6 7 6
Administrative Staff 1
![Page 43: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/43.jpg)
How much does it cost (2010)?
Totale
Community Based
Services Hospital
Buying Assets 1.276.012,82 1.230.012,81 46.000,01
Staff 9.449.987,77 7.475.855,22 1.974.132,55
Administration 297.702,10 289.117,75 8.584,35
Not Sanitary Services 1.599.544,37 1.413.441,43 186.102,94
Other Sanitary Services 196937,29 136094,16 60843,13
Buying Services 6.689.884,60 6.689.884,60 0,00
OVERALL COST 19.510.068,95 17.234.405,97 2.275.662,98
Financial Resourcesof Az.Ulss 9 € 552.650.811,00 € 283.210.811,00 € 239.118.000,00
% 3,53 6,09 0,95
![Page 44: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/44.jpg)
A few data on the implementation of the Mental Health Reform in the Veneto Region
• 805 beds for acute psychiatric emergencies in 40 general hospitals
• 337 community-based services, 111 of which are residential
• ¾ of community-based services are run by LHA’s• 3.000 staff (80% work for LHA’s): 47% nurses, 24%
care givers, 13% psychiatrists, 6% educators, 3% psychologists, 3% social workers (ie. 1 : 1500 inhabitants)
![Page 45: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/45.jpg)
• 64.700 (16,3 per 1.000 inhabitants) mentally ill people treated in 2007, of whom 11.680 (3,0/000) admitted to general hospitals and 59.800 (15,1/000) in community-based services
• Note: estimated prevalence of mental illness in Italian population: 8%
→ 368.000 in Veneto region (ie. most treated by G.P.’s)
• Overall costs: € 250 million (ie. 3,5% of LHA’s budget)Note: the objective is 5%
![Page 46: The Organization of Mental Health Services in Ulss – 9 Treviso](https://reader035.fdocuments.us/reader035/viewer/2022070410/56814539550346895db202d8/html5/thumbnails/46.jpg)
Admissions to Public Psychiatric Unit by diagnosis – rate per 10.000 population – AzUlss 9 vs Veneto