clinical and social factors of compulsory psychiatric treatment in moscow
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Clinical and Social Factors of Compulsory Psychiatric Treatment in Moscow. Prof. Tsygankov Boris, MD, PhD Chief Psychiatrist of Moscow City, Head of the Department of Psychiatry, Addiction and Psychotherapy, Moscow State University of Medicine and Dentistry - PowerPoint PPT PresentationTRANSCRIPT
Clinical and Social Factors of Compulsory Psychiatric Treatment in MoscowProf. Tsygankov Boris, MD, PhD
Chief Psychiatrist of Moscow City, Head of the Department of Psychiatry, Addiction and Psychotherapy, Moscow State University of Medicine
and DentistryDr. Saveliev Dmitri, MD, PhD
Department of Psychiatry, Station of Ambulance and Emergency Medical Service named after A.S. Puchkov, Moscow, Russia
& Dr. Yaltonskaya A., MD, PhD
Prevalence of mental disorders in Moscow
Показатель 2010 2011
Trend
Prevalence of mental disorders (per 100 thousands people)
455,3 455,3 0%
Incidence of mental disorders (per 100 thousands people)
Including children (0-14 years old)
9,9
2,3
11,6
2,7
Increased by 17,1%
Increased by 17,4%
Number of cases schizophrenia
Number of cases of disability due to mental disorders (schizophrenia)
47105
33626
47152
34036
Increased by 0,01%
Increased by 1,2%
Prevalence of hospitalizations due to schizophrenia (per 100 thousands people)
232,2 232,3 Increased by 0,4%
Mean number of days spent in-patiently due to schizophrenia
79,4 90,3 Increased by 13,7%
Re-hospitalizations (% from a total number of hospitalizations)
29,3 32,5 Increased by 10,9%
Mental Health Care System in MoscowOutpatient service – Psychiatric DispensariesInpatient service – Psychiatric HospitalsEmergency service - Station of Ambulance
and Emergency Medical Service named after Puchkov
Number of psychiatrists working in Moscow:1466 – total amount of full time positions1198 – number of occupied positions
Number of beds in mental hospitals (1981-2014)
1981 1992 1995 2006 2009 2013 20140
500
1000
1500
2000
2500
3000
ПКБ № 1 им. Н.А. Алексеева ПБ № 3 им. В.А. Гиляровского ПБ № 4 им. П.Б. Ганнушкина ПБ 15
Total:1981 – 16 5652009 - 13 857 2013 - 12 309 2014 - 10 499
Reform in Mental Health Care System in Moscow since 2012
Main purpose is to develop better connection between outpatient and inpatient psychiatric services
Focus on providing more help out-patiently through the active work of dispensaries (Day/Night Hospital, House Calls)
Focus on inclusion families into help (through education and increasing the level of legal responsibilities)
Preliminary results of the reformLocal Emergency Psychiatric Service in each dispensary
was organized.
- Main purpose – to provide help to patients with relapses of psychotic disorders at evening/night time
- Includes: House Calls, Day/Night Hospitals, Local Intensive Care/Emergency Services with further referral to a local psychiatrist
As a result significant decrease the amount of calls into Emergency Psychiatric Services (after first 2 moths) that allowed to decrease the amount of beds into psychiatric hospitals by 40%.
Emergency Psychiatric Service
Part of General Emergency Service provided by Station of Ambulance and Emergency Medical Service named after Puchkov
24 hoursReceiving and reacting to a phone
callsService provided by psychiatrists.
They make decision about necessary actions and provide consultations to a) staff from hospitals and other medical settings, b) ambulances c) people
Emergency Psychiatric Service (2)
24 emergency psychiatric medical teams (1 psychiatrist + 2 psychiatric paramedics)
12 emergency psychiatric paramedical teams (for transporting psychiatric patients) (2 psychiatric paramedics)
8 stations located in the different areas of MoscowEach team uses fully equipped modern ambulance car (Mercedes) with GPS navigation, on-line connection with the head office, medical equipment necessary for providing intensive care.
Territory
Location of
stations in
different areas of Moscow
Steps after arrival of psychiatric team to a patient
Sometimes in difficult cases Emergency Nursing Teams provide transportation of psychiatric patients (for example, to Intensive Care
Department of General Hospitals).
Upon arrival psychiatrist makes a decision about the necessity to provide psychiatric examination (art. 23, 24 «Psychiatric Assistance
and Civil Rights Act»)
Reasons for psychiatric examination EXIST (voluntary or
non-voluntary examination)
Reasons for psychiatric examination DO NOT
EXIST
- Hospitalization in Psychiatric Clinic (voluntary or non-voluntary art. 28, 29)- Hospitalization in General Hospital (Psychosomatic ward)
• Provide medical help• Provide consultation • Refer to a local psychiatrist
(active referral to a dispensary)
Main indicators of performance2010 2011 2012
2013(11
month)
Calls 101 102 103 563 106 987 103 235
On- sites visits 57 469 62 700 70 611 65 830
Consultations 43 633 40 863 36 376 37 405
39% - receives help during 20 minutes
68% - during 30 minutes95% - during 60 minutes
Number of attendances and hospitalizations
Number of attendance emergency
psychiatric team
Number of hospitalization %
2010 37685 21617 58%
2011 41900 25841 62%
2012 47418 29535 62%
ConclusionReform of mental care system has a positive effect:
- Decrease loading on psychiatric hospitals and Emergency Psychiatric Service
- Increase in number of staff and material well-being
Problems:
- Poorly developed connection of outpatient and inpatient service