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Imrovement of identification of patients with first psychotic episodes in primary care and their treatment and social services in Arkhangelsk oblast

Project title Imrovement of identification of patients with first psychotic episodes in primary care and their treatment and social services in Arkhangelsk oblast
Database Data inserted through the NDPHS Project Pipeline
ID in the source database 148
Thematic area
  • Development of Health Systems and Social Services
  • Health Promotion, Education and Information
  • Mental Health
  • Primary Health Care
Topic The project has two interrelated goals: 1. Development of primary health care for patients with psychiatric problems 2. Differentiation and decentralisation of the specialized psychiatric care with a main focus upon patients with first episode psychotic disorders.
Project geographical area Russia
Substate level / administrative units /regions Arkhangelsk Oblast
Lead partner (organisation) Arkhangelsk Region Administration
Lead partner (owner or/and project manager) no data
Partner organisations Arkhangelsk Region Administration
Start date 2010-01-01
End date 2010-12-31
Duration (months) 12
Target audience 1. Psychiatric patients with severe mental disorders and their families as well as multidisiplinary treatment staff in primary health care and specialiced psychiatric services 2. Teachers and researchers at the Northern State Medical University (NMSU) and at the University of Tromsø 3. Leader of Institute of Family medicine, NMSU, Directors of Archangels County Clinical Psychiatric Hospital (ACCMH) and the Psychiatric Clinic at the Psychiatric Dispensary (PD) and the Director of the health Care Department of Archangels Oblast.
Summary Russian mental health services have traditionally mainly been based on in-patient psychiatric services in large hospitals. Patients are often hospitalized for longer periods of time due to stigmatisation of psychiatric patients in the society, limited resources within the patients’ family systems, high unemployment rates among severely ill psychiatric patients, limited treatment resources in the hospitals, a poorly developed primary care, in particular for psychiatric patients, and poor social and economical support systems. The project which is a health care developmental project in psychiatry has the following interrelated objectives: 1. Development of psychiatric competence within primary health care and establishing institutionalized diagnostic and treatment guidelines and educational programs. 2. Promote cooperation between primary and specialiced care for psychiatric patients by training staff members from the primary and specialiced care together in multiprofessional team work and family treatment. Making these educational activities locally sustainable over time. 3. Specific competence building in the specialized care. 4. Differentiation and decentralisation of the specialized psychiatric care with a main focus upon patients with first episode psychotic disorders. The effects of the project related activities will be evaluated.
Background In spite of increasing national wide financial commitment in primary care, the mental health services in the Russian Federation are still in an early stage of decentralisation and deinstitutionalization. This process is taking place in a context of weak national economical support. Russian mental health services have traditionally mainly been based on in-patient psychiatric services in large hospitals in the suburbs of big cities. Patients are often hospitalized for longer periods of time due to stigmatisation of psychiatric patients in the society, limited resources within the patients’ family systems, high unemployment rates among severely ill psychiatric patients, limited treatment resources in the hospitals, a poorly developed primary care, in particular for psychiatric patients, and poor social and economical support systems. The federal standards for postgraduate education of general practitioners (GPs) do not comprise education in psychiatric diagnostic and therapeutic practice, but do include standards concerning following up patients referred from the specialized psychiatric services. According to Russian law, only GPs who have undergone a particular certification procedure are allowed to diagnose and treat less severe mental disorders. Severe mental disorders can only be given a preliminary diagnosis and referred to treatment in the specialized psychiatric services. Most patients who are receiving treatment in the specialized psychiatric services are admitted directly without previous contact with the primary care system. Following up patients who have fulfilled their treatment in the specialized psychiatric services are only to a limited degree taken care of by the primary care system. The federal ambition of decentralisation and deinstitutionalization of mental health care will also depend on a stronger use of the resouces in patients’ families and local networks and to a reduction of stigma. The Russian health care system, both in primary and specialiced care, have weak traditions in user orientation. The current global economical crisis has strongly reduced the hospital budget with reduced capacity for adequate treatment and professional development.
Objectives 1. Development of psychiatric competence within primary health care. Establishing institutionalized guidelines and educational programs 2. Promote cooperation between primary and specialiced care for psychiatric patients 3. Specific competence building in specialiced care and treatment of patients with first episode psychosis. 4. Differentiation and decentralisation of the specialized psychiatric care with a main focus upon patients with first episode psychotic disorders
Specific objectives/indicators 1a. To Evaluate the process of implementing a model for improvement of psychiatric competence on the primary care level. 2a.This will be monitored though a systematic qualitative evaluation of attitudes, knowledge and the practice of the GP’s and nurses in primary care related to their work with psychiatric patients, including first episode psychotic episodes. This will be performed before and during implementation of the psychiatric educational programs for primary care in cooperation between the Faculty of Family Medicine and Institute of Psychiatry, NMSU, and the Norwegian project partners. 1b. Run long term training programs in multiprofessional team work and family treatment for multiprofessional participants from primary and specialized care together. 2b. The quality of the training programs will be continually evaluated among the participants and their leaders. 1c. To compare the effects of two treatment and social support programmes for “first-episode psychotic patients”, one established in the primary health care and one in the specialized psychiatric services in Archangelsk Oblast. 2c. This will be monitored through a prospective two year follow-up study of the treatment results in the two treatment groups. As an intergal part of this evaluation study, the associations between duration of untreated psychosis (DUP) and short- and long-term outcomes for the patients with first-episode psychosis in Archangelsk County will be examined. In addition, factors associated with the decline in the number of patients admitted at Archangels County Clinical Mental Hospital (ACCMH) with first-episode psychosis during the last years will be examined. A project protocol is elaborated.
Results 1. Development of psychiatric competence within primary health care. Establishing institutionalized diagnostic and treatment guidelines and educational programs. 1a. During 2009 a training program in psychiatry for general practitioners (GPs) has been developed in cooperation between the Institute of Family Medicine, NMSU, who has the responsibility for postgraduate education of GPs, and the Russian Assossiation. This program includes teaching in symptoms and signs of all common psychiatric disorders and substance abuse, use of diagnostic instruments, biological and psychosocial treatment methods, rehabilitation and primary and secondary prevention and cooperation between primary and specialized care. For 2010 the Institute has received grants from the Russian Federation to conduct psychiatric competence building in GPs. In september a psychiatrist ved a PhD was employed at the Institute to lead this educational activity. The level of psychiatric competence among staff members at the Institute is poor and training for trainers is necessary. In 2010 the project will contribute to the development of a training program for trainers. Two experienced Lithuanian psychiatrists and psychologists who have been engaged as teachers in the project since 2004, will contribute. For this purpose they will prolong their two yearly trips with two days. The following preliminary mandat is formulated: a) define which professional groups should be included in the program (from a health services point of view it would be an advantage both to include nurses, midviwes and feltshers), b) learnings goals, c) corresponding pedagogical methods, d) structure. 1b.In March 2009, a research group was established with the following goals: To generate ideas and projects that can a) contribute to a better knowledge of the needs in the health service that the progamme intend to meet and b) evaluate the effects of the active elements of the programme (educational aspects, teamtraining and better cooperation between different professionals and levels of health care). More specific goals are: Engage researchers in the research projects that are being developed; contrubute to supervison of the researchers and to the publication of the results; contribute to the development of guidelines for psychiatric practice in primary care. Professor Vladimir Popov from the Institute of Family Medicine was elected leader of the group which also comprises Norwegian partners. During 2009 the Institute of Family Medicine at NMSU (responsible Professor Vladimir Popov and ass. Professor Yulia Khabarova have been conducting a survey among general practitioners (GPs) to test the effects of their postgraduate education at the Institute (Prospective study with pre- and post measurements). Pre-education results show that the level of psychiatric competence is very poor: psychiatric patients are experienced as a “a problem” which they want to get rid of as soon as possible by referring them to the specialized care, that more communication with psychiatric patients and their families “only will create more problems”, they do not have necessary knowledge to identify first-episode psychotic patients and to prescribe psychofarmaca, the relationships and cooperation between the GPs and psychiatrists in the specialized care are poorly developed and characterized by lack of continuity. However, the survey also indicates that if the GPs get the necessary certification for treating psychiatric patients with corresponding payment, they are motivated to take care of this group of patients. These pre-education results will be followed up by post-education measurements. According to cpt. 19 of the Russian law of psychiatric treatment, GPs who have undergone an officially approved education in psychiatry can be certified for diagnosing and treating psychiatric patients. The mentioned eductional program will evaluated for approval in 2010. In 2010 the research group will in cooperation with the Institute of family Medicine, NMSU, elaborate guidelines for diagnostic and therapeutic psychiatric practice in primary care. 2. Promote cooperation between primary and specialiced care for psychiatric patients. In developing psychiatric competance in primary care it is cruical to utilize exisiting resouces in the specialized care and to develop interconnectedness and cooperation between the two lines. Psychiatric competence is to a large degree a function of the quality of the professioanl nettwork. In order to develop personal and professional relationships, staff from primary and specialized care are trained together in multidiciplinary team work and family treatment. 2a. Multiprofessional teamwork training Two two-week seminars have been arranged since the last project application was written, one in November 2008 and one in May 2009. A third seminar is planned in November 2009. The seminars have been conducted by two clinically experienced Lithuanian group analysts who speak Russian fluently. Altogether 40 GPs, psychiatrists, psychologists, social workers and nurses coming from primary care, Archangels psychiatric hospital (ACCMH), Psychiatric Dispenser (PD) and somatic hospitals or policlinics have participated. Participants were divided into 4 supervision groups each consisting of representatives of all professions and regions. The aim is to gain experience from team work and discussions and to share experiences in working with patients with first psychotic episodes and to build working relationship. The schedule consisted of plenary sessions, theory lectures and small supervision groups. The evaluations of participants and leaders are very positive and the seminars will be continued twice in 2010. Project money has also been used to sponsor a more thorough group analytic education for two psychiatrists/psychologists who can take over as future conductors in multiprofessional training. The program in St. Petersburg has been unrolled and applications will be sent to the London Institute of Group Analysis for 2010. 2b. Multiprofessional training in family treatment A two day seminar about identification and treatment of first episode psychotic patients, with special emphasis on psycho educative family treatment took place March 4-5 2009 in Archangels. Lecturers came from Stavanger University Hospital in Stavanger, PsykOpp and Pro-psy in Stavropol. About 60 participants took part: members of multiprofessional teams (psychiatrists, psychologists, social workers, nurses) working with first episode psychotic patients at the Archangelsk regional psychiatric hospital (ACCMH), PD, Karpogory, and GP's and nurses working at the health care centre at the city of Novodvinsk. Topics that were covered: the significance of early identification and intervention of patients with first psychotic episode, diagnostics and evaluation procedures, relevant intervention methods and combinations of different kinds of treatment modalities, psycho educational multi family work; effect studies- principles/methods. Special challenges with implementation of multi family work in Stavropol. Rationale for information service - principles, models and experiences from Stavanger and Stavropol. A 40-hour seminar about multifamily psycho educative work followed by a 2–year supervision period for a multiprofessional group of specialists from Archangelsk has been planned in cooperation between the leaders of ACCMH and PD and representatives from Stavropol and Stavanger University hospital. The seminar will take place in Archangels in week 46 in 2009 with 40 participants from the primary and specialized psychiatric care. Supervision on participants’ own multifamily work will take place en 2010 and 2011. Those who go through the whole education will be certified as supervisors and teachers in future educational activity. 2c. Participation in “Days of schizophrenia” in Stavanger (November, 2009) Seven dedicated and active psychiatrists, psychologists and nurses from teams in the project (two from the psychiatric hospital, two from the dispenser and two from the districts) will participate. They will also have the opportunity to see how they work at the psychiatric departments of Stavanger University Hospital and to experience multifamily psycho educative work in practice and exchange experiences with colleagues from Stavropol. It might be useful to participate in the “Days of schizophrenia” also next year (included in the budget for 2010 also). 2d. Information brochures and literature In 2010 project money will be used for printing information brochures in Archangels about patients’ legal rights and the health care system they are subjected to. Some money will also be used for psychiatric literature for the participants. A lot of relevant literature has been translated to Russian by Pro-psy in Stavropol. 3. Specific competence building. Adequate psychopharmacologic treatment is essensial in the treatment of all psychotic disorders. Due to the financial crisis fewer patients get optimal (more expensive) medicines. To monitor psychopharmacologic treatment, blood analyses are necessary. Most likely, new equipment will be provided at the PD during autumn 2009. This laboratory will have capacity to meet all analysis needs in the oblast (both in the specialized and primary care). For 2010 financial support is needed to teach clinical pharmacologist and a technician in St. Petersburg. In order to keep a continued focus on the quality of milieu therapeutic treatment at ACCMH, the Lithuanian teachers are spending some time for supervision of the clinical work of hospital staff. They also give supervision to a group of leaders for promoting their understanding of the treatment processes in the wards they have responsibility for. 4. Differentiation and decentralisation of the specialized psychiatric care with a main focus upon patients with first episode psychotic disorders. The two treatment models that are going to be developed, one in the primary health care and one in the specialized psychiatric care, will be implemented and studied in a research program. Data collection will be initialized as soon as the geographical areas has been finally determined.
Total foreseen budget EUR 113,526
Total implementation costs
(for completed projects, if available)
no data
Conversion to € was done on
(according to the relevant
exchange rate at
Infoeuro Monthly Files)
no data
Financing agencies / organisations Norwegian Ministry of Health and Care Services
Project's URL / project's website no data
Papers associated with this project no data
Further information no data
Last posted: on 2010-12-02 at 15:54:15

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