The Day CenterEPAPSY

Dr. Konstantinos Papakonstantinou,

Psychiatrist, psychoanalyst

Scientific manager of Day Center

Day Center

Founded in 2004 5th Psychiatric Sector (200.000 population approx.) Offers complete psychosocial interventions for

psychotic patients The main focus is to prevent them from relapsing,

help reduce hospitalisation and also working towards recovery and reintegration

The aim is to facilitate the recovery process and improve users’ quality of life

35 users have attended the program

Multi-disciplinary team

Psychiatrist / Scientific manager of the D.C Psychologists Social worker Occupational therapist Psychiatric nurse Administrator Assistant/cook Participation of university students and junior professionals

offering volunteer work

Users’ Entry Criteria

a/. Psychopathology (psychotic disorders) b/. Age (18-45yrs.), c/.Users should be followed by an external

collaborating Psychiatrist who will be overseeing their treatment and medication plan

d/. User’s relation with their family (which takes part in the whole process of the user’s rehabilitation)

e/. Users’ strong motivation to attend the program f/. Users with dual diagnosis are excluded

Levels of intervention

A/. Individual levelTherapeutic interventions Individual and group activities (Psychotherapeutic, educational, entertaining)

inside and outside the D.C) individualized case management Active participation of the users (Percorsi di Cura Condivisi, Co-ordination of

group activities)

B/. Social levelFamily interventions Families : individual and group support (narrow target group) SOFPSY: psycho-education and support (broader community)

C/ .Community level Creation of a community-based support network Social club Creation of KoiSPE (Social Cooperative) Creation of SOFPSY (Users’ family & friends association) Anti-stigma interventions in the community

Assessment

Users’ assessment is carried out in two levels Quantitative (scales) Qualitative (group activities, clinical meetings)

Staff assessment Staff development and assessment program

currently running Internal and External Clinical supervision Regular team meetings

Qualitative outcomesPsychodynamic approach

Psychodynamic understanding of the patient, family and dynamics.

It is also used in the professionals’ education program

External psychodynamic supervision

PSCYCHOANALYTIC TEQUNIQES ARE NOT BEEN USED FOR INDIVIDUAL OR GROUP PSYCHOTHERAPY OFFERED IN THE D.C

Qualitative outcomesImportant aspects of group activities

1. The material is been recorded and evaluated as a group and also individually over an extended period of time. Changes in users are evaluated in clinical meetings and are used to inform and adjust the individual care plan (ICP). Consideration to use material as raw data for conducting qualitative research.

2. These activities offer users alternative pathways of expressing or narrating their story and are been worked through. More subtle changes of users can be assessed.

3. Furthermore, they facilitate and reflect users’ inclinations and talents, which contributes in the users’ self integration and improves users’ thought process.

The example of Painting groups A volunteer professional of Fine Arts, after offering a basic

training on drawing and colors’ usage, s/he collaborates with the users and they all conclude on what is important and valuable to be further used in certain circumstances.

The evolution of users’ techniques is particularly interesting . However, the most significant aspect is the evolution of the users’ expressiveness and the ability to express emotions over time.

The users, though initially reluctant about the whole process, as a consequence of the group’s framing, they come to embrace being exposed and exhibiting their work.

Pictures exhibited in the Conference: Psychiatry and Art, May 2010, Chania-Crete

Painting 1

Painting 2

Qualitative OutcomesVocational Rehabilitation- KoiSPE (Social Cooperative) “Iliotropio”

Part of the Social Economy and Solidarity movement in Europe Covers the 5th Psychiatric sector (partial absence of mental health

services/units in this sector) Management of KoiSPE from Day Center staff

Present activities1/. Cleaning Services: Co-operation with School Committees 9 users have worked in the project, (October 2010)2/. Cleaning services: Collaboration with the Ministry of Labour and

Social Security (6 users), March 2011

Future activities Plan of establishing a new business (coffee shop)

Important note: Users’ training, preparation and support for the job tasks

Percorsi di Cura Condivisi Programs’ experts: -Barbara D’Avanzo (Institution Mario Negri, Milan, Program supervisor) -Renzo De Stefani (Responsible of Mental Health Service, Trento)-Pierluigi Morosini (Research Director of Insituto Superiore di Sanita, Rome)

Training in vivo, (Trento) Training of Greek professionals (psychiatrists, mental health professionals,

families, volunteers)

8 Day Center users have already joined the program and have completed the 1st verification. 7 more have also been recently introduced.

Program Outline: The user, a family member, the key-person, the psychiatrist and a guarantor have regular joint meetings every 6 months, and assess as a group the user’s progress in the following areas:

a)Psychopathology, b)Functioning, c) Social skillsAnd set goals to be met until the next verification meeting as a part of their

follow up)Users: -active participation in the therapeutic process (empowerment)-Acknowledgement for their need for help,-More effective management of symptoms during relapse ( realization of the

psychotic dimension of their omnipotence during a psychotic relapse-Reality testing & healthy aspect of self vs. Psychotic omnipotence

Quantitative AssessmentAssessment tools

Tests are administered to users a month after signing in the therapeutic program

PANSS (1/year psychiatrist) COTE (1/6months, Occupational Therapist) WHO-QuoL(1/year, self-administered) Family practices (1/year, facilitator&user) Family burden (1/year, administered to the

family)

Results-PANSS Year 1: 22 Valid (Mean 94,18) Year 2: 14 Valid (Mean 87,64) Year 3: 10 Valid (Mean 85,30) Year 4 : 7 Valid (Mean 74,86),

1 2 3 40

10

20

30

40

50

60

70

80

90

100

Table1.Mean PANSS score per year

PANSS- Results

0

10

20

30

40

50

60

70

80

90

100

Year 1Year 2Year3Year4

Positive Negative

General Psychopathology

Aggression

Total Score

Table 2. PANSS Mean scores in 3 sub-scales& total score

Results- COTE

1st semester Ν=152nd semester Ν=153rd semester Ν=154th semester Ν=115th semester Ν=96th semester Ν=57th semester Ν=48th semester Ν=39th semester Ν=1

Table 3. COTE Means of Interpersonal Relationships and total score

0= no difficulty, 1= little difficulty, 2= some difficulty, 3= serious difficulty, 4= very serious difficulty

1 2 3 4 5 6 70

10

20

30

40

50

60

Interpersonal relations

Total score

Results-Family Burden Scale

1 2 3 4 5

10

20

30

Mean sum of family burden

Mean sum of aggressive behaviour

Year 1&2 N=17, Year 3 N=13, Year 4 N= 6 , Year 5 N=3

Table 4. Family Burden Scale Means of total FB score and Means of aggressive behaviour

Results- Family Practices Scale

Year 1 N=20, Year 2 N=18, Year 3 N=11,

Year 4 N=8, Year 5 N=4, Year 6 N=4

1 2 3 4 5 623

24

25

26

27

28

29

Total Family practices score

Table 6. Mean Scores of Family Practices Scale

Implications…concerning the users

Because of the fragmented continuity of care, users typically stay longer in the Day Center. Although this extended stay causes difficulties, such as institutionalisation phenomena and prolonging new user intake, there is evidence (both qualitative and quantitative) that the existing users continue to benefit from the program for more than the average 2-3 years. Efforts are made to assure extended care pathways, by developing a post- Day Center program and the Social Co-operative. DiscussionIs it good practice to extend the therapeutic contract with the DC(?) and extend the users’ dependence on services(?) narrowing their autonomy (?)

Implications… concerning the staffThe Day Center staff operate in many levels

(different roles, goals). This happens due to the lack of established care pathways. However, there needs to be an effort to concentrate on more specific and strategic priorities in the near future.

Subject for discussion

Is this enriching the Day Center’s services or distract the staff from their role (?) and cause confusion and burn out (?)

Which priorities(?)