Task Force on Health Promoting Psychiatric Services
Progress Report
Hartmut Berger
Table of contents
The task force as part of the HPH Network 1
Basic principles of mental health promotion 2
Basic principles of mental health promotion in psychiatric services 2
Structure of the task force 3
Core Areas
· Implementation and evaluation of models of good practice 3
· Exchange of informations within the network 4
· Scientific activities 5
· Development and design of guidelines for mental health promotion 6
in psychiatric services
· Disseminating the concept of mental health promotion 6
Future development 6
List of references 7
The task force as part of the HPH Network
The task force on health promoting psychiatric services is part of the HPH, a network founded by WHO in 1993. This network is encompassing up to now approximately 600 hospitals in Europe as well as in other parts of the world like Canada and Taiwan. The network is based on the Budapest-Declaration which was formulated by the WHO in 1991. Following this declaration health promoting hospitals should implement
1. healthy work place conditions including strategies of active participation
2. healthy conditions for patients including strategies of empowerment
3. strategies and measures of close cooperation with other health services in the field
Basic principles of mental health promotion
Mental health promotion is based on
A holistic view of health and illness
A holistic view of patients within their psychosocial framework
Advocating active participation, empowerment and responsibility for the own health of patients, relatives and employees of mental health services
Supporting the given resources
Supporting healthy work place conditions
Close cooperation and networking with other mental health and general health services in the field
A learning organization referring to total quality management
Basic principles of mental health promotion in psychiatric services
Basic principles of mental health promotion in psychiatric service are
The orientation to a holistic concept of mental health
The commitment to the principles of salutogenesis including the promotion of empowerment, resilience, sense of coherence, self efficacy and recovery
The respect of human dignity, equality and the free will with special regard to the specific needs resulting from different cultures
The commitment to adequate information of patients and their relatives
The commitment to the well being of patients and employees
The provision of resource-orientated services
The organization of community based services with easy access and high responsiveness
Structure of the task force
The task force on health promoting psychiatric services was founded in 1998 enfolding a working group of varying members from different countries mainly from Ireland, Scotland, Norway, Lithuania, Denmark, Germany, Poland and Italy. The task force is managed by a working group of Vitos Philippshospital, a clinic for psychiatry and psychotherapy seated in D-64560 Riedstadt Germany. The task force is partially supported by the stakeholder but there is no funding by the government or other institutions. Therefore the task force is not able to recruit and administer a continuously acting network of psychiatric institutions, which was intended in the beginning. But it was possible to implement working groups for special themes as well as a close and continuous scientific cooperation with the universities of Darmstadt, Frankfurt and the psychoanalytic institute in Mainz.
Implementation and evaluation of models of good practice
At Vitos Philippshospital the following projects could be realized:
At the patients level
Design and development of psychoeducative family intervention, a multiyfamilyintervention for patients with schizophrenic disorders and their relatives
Deployment of integrated treatment planning
Suicide prevention together with the alliance against depression in our catchment area
Reorganization of the acute admission wards according to the Soteria-concept
The implementation of an independent ombudsman
The implementation of an independent user organization
The implementation of an independent visiting commission
Yearly questionnaires for patients asking for patient satisfaction
Implementation of a smokefree hospital
At the level of workplace
Continuous training in techniques to prevent violent behavior
Continuous supervison in all teams
Yearly questionnaires for workplace satisfaction
Deployment of standards for psychiatric nursing
Implementation of a smokefree hospital
Development of guidelines for the treatment with psychopharmaca
Implementation of a staff unit for health promotion and prevention at the workplace
Implementation of a balanced scorecard for health promotion at the workplace
At the institutional level
Implementation of quality management referring to DIN EN ISO 9001 including the commitment of mental health promotion and prevention on the levels of workplace and patients
Reorganisation of the hospital to need adapted and a resource orientated services including evidence based psychiatric and psychotherapeutic interventions at all levels
Implementation of a visiting service to physicians in the catchment area
Launching three new day hospitals for elderly patients and addicts in the catchment area
Relocation of a psychiatric ward to a general hospital in Rüsselsheim for crisis intervention
At the level of cooperation with other services
Implementation of a continuous conference to coordinate the offers of the different services at the level of the needs of patients
Supporting the development of new services including a psychiatric department in a general hospital and by this cutting the catchment area and the size of the hospital by half
Building an alliance against depression in the catchment area
Exchange of informations within the network
The task force organized since 1998 in the course of the HPH conferences a total of 11 workshops and three conferences. The first conference was held 1998 in Darmstadt. At this HPH conference the network of pilot hospitals presented the results of the implementation and evaluation of health promoting strategies. The next two conferences were dedicated to the health promoting work of psychiatric services in the course of the HPH conferences in Dublin 2005 and Vienna in 2007. The next preconference will be held in Gothenburg May 22nd 2013. All in all 187 lectures, poster presentations and discussions showed a wide variety of inspiring good mental health promoting practice for example early interventions in high risk families, implementation of self help groups to cope with becoming old, self help groups for people with chronic mental disorders, education programs for GP’s, early intervention after self-harming und much more. It’s intended to publish this broadly based expertise in the final report to give an overview about specific activities in the field and to provide suggestions for a good practice of mental health promotion.
Scientific activities
Dealing with mental health promotion you’ll find two major obstacles. First there is no sharp definition, what mental health promotion is, what to do in realizing it, how it works and what is the outcome. Second there is not so much evidence based expertise in the field. Thus one of our main points of interest was to develop studies which could show measurable effects on the short and long run under the conditions of all day psychiatric practice. Furthermore the studies had to be done without appreciable financial support due to the above mentioned lack of funding. In spite of that barriers it was possible to realize a bundle of studies with the aim to show, what is working and if so, how mental health promotion should be done leading to reliable und sustainable effects. In the following all studies which are realized and planned will be presented in a short form.
The first study looked on how staff empowerment could be realized. Kilian, Paul and Berger showed in a study published 1996, that the wellbeing at the workplace is strongly dependent to active participation and self-determination. Thus occupational health promotion needs staff empowerment.
In another study Friedrich, Gunia and Berger examined the effects of psychoeducative familyintervention (2004) and could show a significant reduction of relapse rates and an amelioration of the familial communication.
Decristan performed a study on the effects of suicide prevention in our catchment area (2007) which showed a reduction of suicide attempts. But due to a limited number of patients the results were not significant.
Together with the Zentralinstitut für seelische Gesundheit Mannheim the hospital attended a multicenter study to evaluate the effects of assertive community treatment. The study is finished but not published yet.
A study about the implementation of a model for integrated care to prevent relapse in schizophrenic disorders together with a network of GP‘s, which is financed by an insurance company (BKK Hessen).
The development of a questionnaire about emotion regulation as an instrument for detection and early intervention for impulse control disorders was finished by Brandi in 2010.
Ongoing are four studies:
An intervention for patients with chronic schizophrenic disorders and metabolic syndrome to gain weight loss, self control and quality of life as well as self esteem.
The evaluation of a self- assessment- tool for mental health promotion in psychiatric settings, which was developed by a working group of the task force.
The design and deployment of a balanced score card for health promotion of employees in mental health settings.
The implementation and evaluation of home-treatment and early crisis intervention for patients with severe mental disorders commissioned by an insurance company
Development and design of guidelines for mental health promotion in psychiatric services
After finishing the above named studies it’s planned to bring the results of the research, the analysis of the given models of good practice and the self -assessment-tool as well as the balanced score card for mental health promotion together into a manual which comprehends guidelines for mental health promotion in psychiatric services.
Disseminating the concept of mental health promotion
Beside the depicted activities the task force is engaged in disseminating the concept of mental health promotion by 22 publications in scientific journals and by 161 invited lectures as well as 31 invited workshops since 1998 in the course of conferences and invitations to hospitals throughout Europe. Furthermore the task force was member of two projects for implementation of mental health promoting strategies called IMPHA and EMIP, which both were sponsored by the Commission of the European Union. The task force was also member of the working group, which elaborated the green paper on behalf of the European Commission which was the basis for the declaration of Helsinki. This was the first time that European Health Ministers emphasized the importance of mental health promotion. The task force was furthermore member of two working groups, which were initiated by the Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Neurologie with the appointment to develop evidence based guidelines for the treatment of depression and for the treatment of people with severe mental illness by psychosocial interventions. The task force is as well founding member of the Aktionsbündnis für seelische Gesundheit, a NGO which intends to promote mental health at all levels. Last but not least the task force keeps a close cooperation with the Bundesdirektorenkonferenz, an association of all medical directors of psychiatric hospitals in Germany and with the German-Polish Society of Mental Health. Moreover the task force is counseling the regional government of the Oblast Donezk/Ukraine in developing new structures in mental health settings.
Future development
On the basis of the given experience it seems to be time for a report about what mental health promotion could be and how to be realized in all day practice in psychiatric settings. Therefore it’s planned to fashion the knowledge in a manual and guidelines for mental health promotion in psychiatric services after finishing the above mentioned and ongoing studies. This should be done by a final report for the general assembly of the HPH network presumably in the year 2014. With that report the work of the task force on health promoting psychiatric services could be finalized.
List of references
1. Berger, H., H. Gunia, K. Nürnberger, A. Teschner (1997) Psychoedukative Gruppen für Familien. Erste Erfahrungen. In: Dittmar V. (Hrsg.): Die Behandlung schizophrener Menschen. Roderer Regensburg
2. Berger, H., R. Paul, H. Gunia (1999) Gesundheitsförderung als Beratungsform: Psychoedukative Gruppen in der Behandlung schizophrener Patienten. In: Pelikan, J.M., Wolff, S. (Hrsg.): Das gesundheitsfördernde Krankenhaus als Projekt. Juventa, Weinheim.
3. Kilian, R., R. Paul, H. Berger, M.C. Angermeyer (1997) Empowerment und Gesundheitsförderndes Krankenhaus. In: Grundböck, A., P. Nowak, J.M. Pelikan (Hrsg.): Gesundheitsförderung - eine Strategie für Krankenhäuser im Umbruch. Facultas, Wien. 137 - 142-
4. Berger, H., H. Gunia, R. Paul (1998) Health Promotion as a forum of counselling - Psychoeducative patient and family groups. In: Pelikan J.M., H. Lobnig, K. Krajic (Hrsg.): Feasibility, Effectiveness, Quality and Sustainability of Health Promoting Hospital Projects. Conrad, Gamburg 1998. 65-69
5. Berger, H., R. Paul (1999) Das psychiatrische Krankenhaus Philippshospital. Was ist der Unterschied zu anderen gesundheitsfördernden Krankenhäusern. In: Wege zum gesundheitsfördernden Krankenhaus. Conrad, Gamberg 1999
6. Berger, H., R. Paul (1999) The Health Promoting Psychiatric Hospital - What is the difference? Experiences from the Philippshospital Pilot Hospital Project in Riedstadt. In: Pelikan J.M, M. Garcia-Barbero, H. Lobnig, K. Krajic (Hrsg.): Pathways to a Health Promoting Hospital. Conrad, Gamburg. 71 – 94
7. Berger, H., K. Krajic, R. Paul (Hrsg.) (1999) Health Promoting Hospitals: Healthy Workplace, Clini cal Centre of Excellence, Partner for Comprehensive Care, Ally for Public Health - Health Promoting
Hospitals. Proceedings of the 6th International Conference on Health Promoting Hospitals. Conrad, Gamburg 1999
8. Kilian, R., R. Paul,H. Berger (1998) The role of staff empowerment in the prevention of patient aggression and staff burnout at psychiatric hospitals. In: Pelikan, J.M., H. Lobnig, K. Krajic (Hrsg.): Feasibility,Effectiveness, Quality and Sustainability of Health Promoting Hospital Projects. Conrad, Gamburg 1998. 110 – 116
9. Paul, R., H. Berger, R. Kilian (1996) Health Promotion in a Psychiatric Healthcare Institution. In: Newsletter Health Promotion Hospitals 8, 4 - 59.
10. Berger, H. (1999) Health Promotion - A Change in the Paradigms of Psychiatry. In: Berger, H., K. Krajic, R. Paul (Hrsg.): Health Promoting Hospitals in Practice: Developing Projects and Networks. Conrad, Gamburg
11. Berger, H., R. Paul (1999) The Vision of the Health Promoting Hospital. In: Berger, H., K. Krajic, R. Paul (Hrsg.): Health Promoting Hospitals in Practice: Developing Projects and Networks. Conrad, Gamburg