Whole System-Whole Life approach in the First Episode Psychosis: the experience in Trieste
Roberto Mezzina1, Chiara Luchetta, Antonio Luchetti, Daniela Vidoni, Giovanni Berna, Alan Rosen; 1Dipartimento di Salute Mentale, WHO Collaborating Centre, AAS n.1, Trieste, Italy, 2Dipartimento di Salute Mentale, ULSS n. 1, Belluno, Italy, 3Dipartimento di Salute Mentale, WHO Collaborating Centre, AAS n.1, Trieste, Italy, 4SC Bambini e Adolescenti, Distretto n.2, AAS n.1, Trieste, Italy, 5Dipartimento di Salute Mentale, WHO Collaborating Centre, AAS n.1, Trieste, Italy, 6University of Wollongong, NSW, Australia
The development of the experience in the Trieste MH Dept (with 24 hrs CMH Centres, a small GH Unit, a system of social co-operatives, supported housing, personal budgets and social inclusion programmes) as well as the implementation of an integrated community system of healthcare based on district teams and services, allowed to experiment on early detection and interention of psyshoses and severe mh disorders of adolescent and young people in an open-door no restraint whole system of care. The project that started ten years ago, incorporating the contribution of many International – e.g. Australian, but not only - best programmes and practices in the field, is based on building up a de-stigmatised pathway of care, facilitating the first contact and the subsequent treatment and rehabilitation. It is based on a service network approach where at any entry the whole system is activated with a number of responses, including mental health promotion and prevention and NGOs. Innovative programmes include group intersubjective approaches. The programme has been evaluated through routine epidemiological data monitoring and a focussed surveys. (1) A small sample of young clients (19 subjects, average 21 y.o.) at first episode of psychosis showed good early recovery outcomes (PANSS and DAS) after 2 years and an average DUP less than 6 months. Data about the need for overnight admissions showed a constant decrease. (2) 33 subjects, 18-30 y.o., with early psychosis (less than 3 years): the experimental group with interpersonal therapies: narrative and literacy group + participation to the young people’s group activities (group therapies, SST sessions, social events and holiday experiences in supported group with peers) showed better clinical outcomes (PANSS and DAS) than the control group. The innovative recovery house, that started in 2015, is in course of evaluation by independent researchers. Instead of running just a specialist point in a caotic hospital-based / traditional outpatient system, with restraint and poor coverage of psychosis in general, we advocate instead for a comprehensive, “whole life whole system whole community approach”, whose characteristcs are the following: 1. Comprehensive and specialised approach at the same time: a functional team built up by operators from CMH Centres, adolescent healthcare district teams, drug addiction services, welfare services, prevention dept. (Developmental issues addressed by the healthcare district team). 2. Mainstreaming / destigmatisation, thorugh healthcare district teams, youth social centres, youth associations involved; 3. Early detection (at risk M states) and early intervention, through a number of ‘receptors’ toward a single personalised pathway of care; 4. Human & social capital activated: service network matching social network, involving family and significant others from the beginning (now trained in the Open Dialogue); family group approach for early orientation and support; 5. 24 hrs ‘hospitality’ (respite) in the open-door CMHC, instead of the usual hospitalization in a crisis, intended also as a life experience of social learning, and further on the opportunity of experiencing a recovery house for those who are in a delayed recovery process; 6. Normal life (normalisation) and wellbeing: whole life needs addressed, a map for navigation & experiencing through a group approach, social actvities, life skills training, psychoeducation, job opportunities (social coops), social participation (associations), a healthy lifestyles and wellbeing programme that is part of the HeAL movement (Aurisina Cave 9); 7. Community involved (schools) through campaigning, dedicated website, social media, and service availability on-the-spot; 8. Peer support, provided through the young people’s group, also after hours and in the weekends. “Something has changed” is the name of the programme, and it is based on the idea of moving from exclusion to inclusion, from dependency to emancipation and participation, where the service catalyses an individual and social process of recovery.
Topic Area: Service System Development and Reform