Psychiatria środowiskowa między romantyzmem a pozytywizmem — próba integracji podejść

This paper will attempt to address the following question: What should modern community psychiatry entail? I will try to discuss key issues, of which the most basic and important can be summed up as: What is mental illness? Is it a permanent change in the brain with all its social consequences, or a way in which we define “others”? Should we build a system of care “for life” or only plan for a crisis? Are the problems associated with “mental illness” within the bounds of the medical system/social assistance, or rather in the area of human rights? Is it possible to integrate these seemingly contradictory attitudes? These basic problems of community psychiatry are discussed in the areas of diagnoses, treatment, forced treatment, housing, work, and patients’ organizations. The challenge ahead now becomes not the deinstutunalisation of hospitals but a complete change of view of what constitutes “mentally ill”.Autorka niniejszej pracy próbuje zmierzyć się z pytaniem: jaka ma być współczesna psychiatria środowiskowa? Próbuje omówić podstawowe kwestie, w których prześwituje w tle dyskusja podstawowa: czym jest choroba psychiczna; czy jest trwałą zmianą mózgu z wszystkimi tego społecznymi konsekwencjami; czy sposobem w jaki określamy „innych”; czy należy budować system opieki „na całe życie” czy tylko na wypadek kryzysu; czy problemy związane z „chorobą psychiczną” mieszczą się w obszarze system medyczny/pomoc społeczna czy raczej w obszarze praw człowieka; czy jest możliwa integracja tych, wydawałoby się, sprzecznych postaw? Te podstawowe problemy psychiatrii środowiskowej omówione są w obszarze — diagnoza, leczenie, stosowanie przymusu leczenia, mieszkanie, praca, organizacje pacjentów. Aktualnym wyzwaniem psychiatrii środowiskowej staje się nie deinstytucjonaliza, ale całkowita zmiany widzenia „chorego psychicznie”

Rationale, component description and pilot evaluation of a physical health promotion measure for people with mental disorders across Europe

Introduction: The HELPS project aimed at developing a toolkit for the promotion of physical health in people with mental disorders to reduce the substantial excess morbidity and mortality in the target group. Methods: The HELPS toolkit was developed by means of national and international literature reviews, Delphi rounds with mental health experts and focus groups with mental health experts and patients/ residents in 14 European countries. The toolkit was translated into the languages of all participating countries, and usability of toolkit modules was tested. Results: The toolkit consists of several modules addressing diverse somatic health problems, lifestyle, environment issues, patient goals and motivation for health-promotion measures. It aims at empowering people with mental illness and staff to identify physical health risks in their specific contexts and to select the most appropriate modules from a range of health promotion tools. Discussion: The HELPS project used an integrative approach to the development of simple tools for the target population and is available online in 14 European languages. Preliminary evidence suggests that the toolkit can be used in routine care settings and should be put to test in controlled trials to reveal its potential impact

European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS): background, aims and methods

Background: People with mental disorders have a higher prevalence of physical illnesses and reduced life expectancy as compared with the general population. However, there is a lack of knowledge across Europe concerning interventions that aim at reducing somatic morbidity and excess mortality by promoting behaviour-based and/or environment-based interventions. Methods and design: HELPS is an interdisciplinary European network that aims at (i) gathering relevant knowledge on physical illness in people with mental illness, (ii) identifying health promotion initiatives in European countries that meet country-specific needs, and (iii) at identifying best practice across Europe. Criteria for best practice will include evidence on the efficacy of physical health interventions and of their effectiveness in routine care, cost implications and feasibility for adaptation and implementation of interventions across different settings in Europe. HELPS will develop and implement a "physical health promotion toolkit". The toolkit will provide information to empower residents and staff to identify the most relevant risk factors in their specific context and to select the most appropriate action out of a range of defined health promoting interventions. The key methods are (a) stakeholder analysis, (b) international literature reviews, (c) Delphi rounds with experts from participating centres, and (d) focus groups with staff and residents of mental health care facilities. Meanwhile a multi-disciplinary network consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well as to hold resonance for community dwelling people with mental health problems. Discussion: A general strategy on health promotion for people with mental disorders must take into account behavioural, environmental and iatrogenic health risks. A European health promotion toolkit needs to consider heterogeneity of mental disorders, the multitude of physical health problems, health-relevant behaviour, health-related attitudes, health-relevant living conditions, and resource levels in mental health and social care facilities