Učestalost prisile u različitim modelima mentalnog zdravlja: Iskustva iz RECOVER-E projekta u Crnoj Gori
Sažetak
U 2018. godini pokrenute su projektne aktivnosti RECOVER-E u Crnoj Gori, u okviru programa HORIZON 2020. Nakon detaljne analize situacije i okolnosti liječenja pacijenata sa teškim mentalnim oboljenjima, formiran je Tim za mentalno zdravlje u zajednici (CMHT) u okviru Specijalne bolnice za psihijatriju Kotor. Ovaj tim je bio zadužen za vođenje tretmana grupe korisnika sa teškim mentalnim bolestima, na osnovu principa „Fleksibilnog asertivnog tretmana u zajednici (FACT – holandski model). Osnovni cilj ovog istraživanja bio je da se utvrdi da li postoje značajne razlike u primjeni mjera prisile tokom bolničkih readmisija u grupi pacijenata liječenih u CMHT, u odnosu na uobičajenu zaštitu mentalnog zdravlja u Crnoj Gori.
Materijali i metode: Formiran je uzorak od 202 korisnika usluga mentalnog zdravlja iz Kotora i okolnih opština. Pacijenti su randomizovani u dvije grupe slične veličine – interventnu, čiji tretman je vodio multidisciplinarni CMHT, i kontrolnu grupu u kojoj je nastavljeno uobičajeno liječenje. Za procenu i praćenje učestalosti primjene mjera prisile korišćena je bolnička dokumentacija. Nakon završetka studije korišćen je Upitnik o iskustvu prijema Mekartura (McArthur) da se istraži individualni nivo percipirane prisile tokom ponovnih prijema u bolnicu.
Rezultati: Pacijenti u interventnoj grupi imali su statistički značajno manje prisilnih intervencija (kao što su mehaničko sputavanje i prisilno davanje lijekova) tokom studije. Nije bilo drugih značajnih razlika između dvije grupe u pogledu ukupnog broja readmisija i dužine bolničkog liječenja.
Zaključak: Ova studija je pokazala da CMHT tretman može da smanji neke od prisilnih mjera tokom liječenja teških mentalnih bolesti, što dovodi do doživljaja kvalitetnije zdravstvene njege i veće terapijske adherencije.
Ključne reči: FACT, CMHT, mentalno, bolest, ponovni prijem
Reference
Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bull World Health Organ. 2004;82:858–66. doi:/S0042-96862004001100011.
Vos T. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. www.thelancet.com Lancetthelancet.com. 2016;388:1545–602.
Anthony WA. Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosoc Rehabil J. 1993;16:11–23. doi:10.1037/h0095655.
Westen KH, van Vugt MD, Bähler M, Mulder CL, Delespaul PH, Kroon H. FACT als onderdeel van wijkgerichte zorg in het (zorg)netwerk [Flexible assertive community treatment (FACT) as part of a community (health) network]. Tijdschr Psychiatr. 2020;62(4):298-303. Dutch. PMID: 32388852.
Caldas Almeida J, Mateus P, Tomé G, Katschnig H, Hinkov H, Sooniste I, et al. Joint Action on Mental Health and Well-being, Towards Community- Based and Socially Inclusive Mental Health Care, Situation Analysis and Recommendations for Action. 2016. http://www.mentalhealthandwellbeing.eu/assets/docs/publications/WP5 Final-20151203075843.pdf.
Braun P, Kochansky G, Shapiro R, Greenberg S, Gudeman JE, Johnson S, et al. Overview: Deinstitutionalization of psychiatric patients, a critical review of outcome studies. Am J Psychiatry. 1981;138:736–49.
Conway M, et al. A companion to purchasing mental health services. Cambridge Angl Oxford Reg Heal Auth. 1994.
Bond GR, Drake RE, Mueser KT, Latimer E. Assertive Community Treatment for People with Severe Mental Illness. Dis Manag Heal Outcomes. 2001;9:141–59. http://link.springer.com/10.2165/00115677-200109030-00003. Accessed 23 Jan 2016.
Trieman N, Leff J, Glover G. Outcome of long stay psychiatric patients resettled in the community: prospective cohort study. BMJ. 1999;319:13–6. doi:10.1136/bmj.319.7201.13.
Toyama M, Castillo H, Galea JT, Brandt LR, Mendoza M, Herrera V, et al. Peruvian Mental Health Reform: A Framework for Scaling-up Mental Health Services. doi:10.15171/ijhpm.2017.07.
Caldas de Almeida J, Killaspy H. Long Term Mental Health Care for People with Severe Mental Disorders. 2011. http://ec.europa.eu/health/mental_health/docs/healthcare_mental_disorders_en.pdf.
Leff J, Dayson D, Gooch C, Thornicroft G, Wills W. Quality of life of long-stay patients discharged from two psychiatric institutions. Psychiatr Serv. 1996;47:62–7.
Leff J, Trieman N. Long-stay patients discharged from psychiatric hospitals: Social and clinical outcomes after five years in the community. The TAPS Project 46. Br J Psychiatry. 2000;176 MAR.:217–23.
Lund C, Tomlinson M, De Silva M, Fekadu A, Shidhaye R, Jordans M, et al. PRIME: A Programme to Reduce the Treatment Gap for Mental Disorders in Five Low- and Middle-Income Countries. PLoS Med. 2012;9:e1001359. doi:10.1371/journal.pmed.1001359.
Nicaise P, Dubois V, Lorant V. Mental health care delivery system reform in Belgium: The challenge of achieving deinstitutionalisation whilst addressing fragmentation of care at the same time. Health Policy (New York). 2014;115:120–7. doi:10.1016/j.healthpol.2014.02.007.
Steinert T, Lepping P, Bernhardsgrütter R, Conca A, Hatling T, Janssen W, Keski-Valkama A, Mayoral F, Whittington R (2010) Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends. Soc Psy- chiatry Psychiatr Epidemiol 45:889–897. https://doi.org/10. 1007/s00127-009-0132-3
Lepping P, Masood B, Flammer E, Noorthoorn EO (2016) Com- parison of restraint data from four countries. Soc Psychiatry Psychiatr Epidemiol 51:1301–1309. https://doi.org/10.1007/ s00127-016-1203-x
Pelto-Piri V, Kjellin L, Hylén U, Valenti E, Priebe S (2019) Different forms of informal coercion in psychiatry: a qualitative study. BMC Res Notes 12:787. https://doi.org/10.1186/ s13104-019-4823-x
Adorjan K, Steinert T, Flammer E, Deister A, Koller M, Zinkler M et al (2017) Coercive measures in German hospitals for psychiatry and psychotherapy: a pilot study by the DGPPN to evaluate a uniform assessment instrument. Nervenarzt 88:802–810. https:// doi.org/10.1007/s00115-016-0261-3
Aagaard J, Tuszewski B, Kølbæk P. Does Assertive Community Treatment Reduce the Use of Compulsory Admissions? Arch Psychiatr Nurs. 2017 Dec;31(6):641-646. doi: 10.1016/j.apnu.2017.07.008. Epub 2017 Aug 10. PMID: 29179833.
Nielsen CM, Hjorthøj C, Killaspy H, Nordentoft M. The effect of flexible assertive community treatment in Denmark: a quasi-experimental controlled study. Lancet Psychiatry. 2021 Jan;8(1):27-35. doi: 10.1016/S2215-0366(20)30424-7. Epub 2020 Oct 19. PMID: 33091344.
Huber M, Stanciole A, Wahlbec K, Tamsma N, Torres F, Jelfs E, et al. Quality in and Equality of Access to Healthcare Services. 2008.
Shields-Zeeman L, Petrea I, Smit F, Walters BH, Dedovic J, Kuzman MR, Nakov V, Nica R, Novotni A, Roth C, Tomcuk A, Wijnen BFM, Wensing M. Towards community-based and recovery-oriented care for severe mental disorders in Southern and Eastern Europe: aims and design of a multi-country implementation and evaluation study (RECOVER-E). Int J Ment Health Syst. 2020 Apr 22;14:30. doi: 10.1186/s13033-020-00361-y. PMID: 32336984; PMCID: PMC7178587.
Wijnen BFM, Smit F, Uhernik AI, Istvanovic A, Dedovic J, Dinolova R, Nica R, Velickovski R, Wensing M, Petrea I, Shields-Zeeman L. Sustainability of Community-Based Specialized Mental Health Services in Five European Countries: Protocol for Five Randomized Controlled Trial-Based Health-Economic Evaluations Embedded in the RECOVER-E Program. JMIR Res Protoc. 2020 Jun 1;9(6):e17454. doi: 10.2196/17454. PMID: 32476658; PMCID: PMC7296406.
Đedović J, Tomčuk A, Miladinović D, Vlahović S, Ðurišić T. Multidisciplinarni timovi mentalnog zdravlja u zajednici u tretmanu teških duševnih oboljenja u Crnoj Gori - RECOVER-E projekat. Engrami. 2019;41(1):101-13. doi: 10.5937/engrami1901102Q
Gardner W, Hoge SK, Bennett N, Roth LH, Lidz CW, Monahan J, Mulvey EP. Two scales for measuring patients' perceptions for coercion during mental hospital admission. Behav Sci Law. 1993 Summer;11(3):307-21. doi: 10.1002/bsl.2370110308. PMID: 10150233.
Trajanović NN, Đurić V, Latas M, Milovanović S, Jovanović AA, Đurić D. Srpski prevod torontske skale aleksitimije sa 20 pitanja - psihometrijske karakteristike i novi metodološki pristup u prevođenju upitnika. Srpski arhiv za celokupno lekarstvo. 2013;141(5-6):366-70. doi: 10.2298/SARH1306366T
Steinert T, Birk M, Flammer E, Bergk J. Subjective distress after seclusion or mechanical restraint: one-year follow-up of a randomized controlled study. Psychiatr Serv. 2013 Oct;64(10):1012-7. doi: 10.1176/appi.ps.201200315. PMID: 23771400.
Hotzy F, Jaeger M. Clinical Relevance of Informal Coercion in Psychiatric Treatment-A Systematic Review. Front Psychiatry. 2016 Dec 12;7:197. doi: 10.3389/fpsyt.2016.00197. PMID: 28018248; PMCID: PMC5149520.