Report by Jan Pfiefer, Psychiatrist, Czech Republic, 04/05/2020
" ... on a national level a strong discussion is being held about the need to accelerate the process of deinstitutionalisation, both in health care social services as well."
Jan Pfiefer, Psychiatrist, Czech Republic
In connection with the fact that institutional care (large psychiatric hospitals, social institutions) proved to be very risky for the possibility of rapid transmission of the disease, on a national level a strong discussion is being held about the need to accelerate the process of deinstitutionalisation, both in health care social services as well.
Large psychiatric hospitals have been tasked with creating facilities in some of their buildings for the eventual quarantine of their clients with corona virus infections if begin to appear in facilities. For this reason, and in order to reduce the risk by reducing the number of clients, a number of clients began to be discharged quickly from the psychiatric hospital. These were clients in an advanced stage of addiction treatment. There were also geronto psychiatric clients. These were also clients treated for psychotic illness. In previous debates on deinstitutionalisation plans, hospital management has argued that they cannot reduce their beds because all clients hospitalized here need their "treatment." It has suddenly been shown that bed capacity can be reduced by up to one third in one week.
We do not yet have a more accurate record of what is happening to the laid off clients. Most of them went to home care. Most of the discharged patients with psychosis passed into the care of community teams. Many hospitals worked with community teams to plan to release the group, and the release was quite safe.
However, there were cases when this was not the case. Clients could end up in various types of hostels, where community teams had to search for them themselves and find it more difficult to establish cooperation with them.
In some cases (rather sporadically), psychiatric nurses from psychiatric inpatient facilities began working part-time in community teams. This further strengthened the continuity of care for laid off clients.
The reaction of community teams to the current situation is different. Some have reduced their field work and communicate with clients by telephone or visual media. On the contrary, some have strengthened their field work. They replace dysfunctional outpatient clinics of self-employed psychiatrists. In the client's home, they apply depot medications, etc. Teams have also started to use Skype and other similar programs to communicate with each other (team sessions). Some teams are practically not in their hinterland, but are almost 100% of the time in the field.
Mobile media have become much more widely used to communicate with clients. Some clients react badly to this, some respond well, and even prefer this communication to personal contact.
Although unemployment has not risen dramatically yet, some clients report losing their jobs.
Web seminars have been used to a massive extent for therapeutic group sessions as well as for teaching and educational activities. The clients themselves also took part in this and organize a supportive, informative web meeting for members of their organizations or groups.
Many new crisis lines were created and hundreds of volunteers joined their operation. Hundreds of professionals are then available online with advice and supervision.
It turns out that smoldering domestic conflicts have escalated in many cases. It is estimated that domestic violence has increased. Many sectors have been involved in the protection and support of people at risk of domestic violence. A mobile application for people at risk of domestic violence was created. Postmen are trained in recognizing signs of domestic violence (when they get into their homes when delivering mail or parcels). They are trained in the skill of open-ended questions and in supporting potential hugs to ask for help. Other delivery services (companies specializing in the delivery of ready meals or food, etc.) also joined the program.
Consideration is being given to how to re-establish the system of crisis interventions and how to strengthen the overall ability of the system to work with people with post-traumatic syndrome.
The government has decided to put more money into health insurance. At this step, it was also mentioned that the continuation of the reform of care for the mentally ill must be ensured.
In summary:
The spirit of cooperation and belonging has been strengthened throughout society.
Mental health is proving to be an important factor to take care of.
- The current situation has strengthened cooperation between inpatient and community services and thus strengthened mutual trust.
- The advantages of community, mobile teams were shown and they generally gained more respect from other health services as well as from the local government.
- The riskiness of large residential facilities has been shown and arguments to speed up deinstitutionalisation have been strengthened.
- Community resources have been mobilized, which have not yet been used for mental health care.
In general, readiness for virtual communication has increased (even across borders), paradoxically, the availability of educational programs in the field of mental health care has increased (webinars, video recording, etc.)