The Organization of Mental Health Services in Ulss – 9 Treviso

The The OrganizationOrganization of Mental Health of Mental Health Services in Ulss – 9 TrevisoServices in Ulss – 9 Treviso

The Organization ofLocal Health Areas in Veneto

• We call them: Az. Ulss• Az = Azienda (Company: It is public company but

it has a management like a private company)• U = Unità (Unit)• L = Locale (Local)• S = Socio (Social: Municipalities have given Lhas

the management of some social services)• S = Sanitaria (Health)

• In other Regions: LHAs are not also “social” but only “health”

Az.Ulss in Veneto Region

Az.Ulss in Veneto Region

The Organization of LHAs : the Districts

The Organization ofMental Health Services in LHA

• There is one Mental Health Department for each of 21 Veneto Region LHAs

• Every Mental Health Department has one or more Mental Health Units

• In Az.Ulss 9 every District has one Mental Health Unit (4 Districts = 4 MHU)

• Every Mental Health Unit organizes many facilities

Mental Health Department

• In Italian language: DSM (Dipartimento/Department – Salute/Health – Mentale/Mental)

• Responsible for planning and coordinating all mental health services in a specific area

• Run by a Director, supported by a Board of Directors (of the units), a Broad Committee, and an Assembly

Mental Health Department

• It plans and work in cooperation with NPOs, Patients and Families Associations

• DSM coordinates the “Mental Health Area” that agree with Municipalities the “Piano di Zona” (Zone Planning Act)

• The Zone Planning Act describes the social activities shared by Municipalities and DSM, the way of building them, the financial resources

The Organization:Mental Health Unit

• Hospital Services • National Planning: 1 bed per 10.000 population

– In Az. Ulss 9:• 1 Hospital Unit in Treviso General Hospital• 1 Hospital Unit in Oderzo General Hospital• We need 1 more Hospital Unit in Treviso General

Hospital (2012?)– Now: 1 bed /17.000 inhabitants

• Community-based services

Community-based services

– 1 CSM (Mental Health Center) : the core for activities• It is out of hospital• Psychiatric and Psychological activities for

outpatients• Psychoeducational activities• Group Therapy• Home support• Social support

Community-based services• Partial Time treatments = Day Patients

Patients live in their houses and come to facilities for 4-6 hours of treatment

– Centro Diurno (Day Rehabilitation Service): • Psycho education activities• Group Therapy • Occupational activities

– Day Hospital (Day Treatment Service)• Group Therapy• Psychopharmacological Therapy

Community-based services• Full Time treatments: patients live in community

– Residential Facilities• CTRP (Sheltered therapeutic Rehabilitation

Community)• CA (Sheltered House community)• GAP (Sheltered group house)

– Selection is based on: illness severity / disability / needs for intensive treatment / day care time

– A way from high disability and severe disease to better health and skills

Sheltered Residential Facilities• CTRP (Sheltered therapeutic Rehabilitation Community)

– 8 – 14 inpatients– Highest intensity of treatment– Lowest social skills – Staff: 24/24 hours

• CA (Sheltered house community)– 6 – 8 inpatients– Medium intensity of treatment– Better social skills– Staff: 12/24 hours

• GAP (Sheltered house)– 4 inpatients– Low intensity of treatment– Low disability– Staff: 4 hours/day

Community based Facilities• In Az. Ulss 9 we are modifying and completing the

network of facilities– Modifying: some facility were organized for patients discharged 30

years ago from Psychiatric Hospitals. Their needs are changed – Completing: we need facilities more suitable for young people and

early psychosis

• We now manage directly some facilities, and indirectly some others, managed directly by NPOs

– Italian Financial Laws limit the engagement of new staff– LHAs must buy services from private organizations– NGOs are the best reference, owing to costs and the possibility of

creating a good collaboration

• In Az.Ulss 9 the new planning will spend more than 10 million euro / year for sheltered residential facilities managed by NPOs

What we know: the Data• In Az. Ulss 9 we have two flows of data

– Hospital Discharging data: » patient (sex, date of birth, where he lives, job, … )» admission (planned, emergency, compulsory)» disease (diagnosis, therapy)» length of hospital stay

– Outpatients data » patient (sex, date of birth, where he lives, job, ….)» how the patient arrived to services» disease (diagnosis)» what we do (psychiatric or psychological examination,

psychotherapy, rehabilitation activities, admission to residential or day/residential facilities, and so on)

• In Veneto Region we have the same two flows for all LHAs

Veneto Data Base: Hospital

Veneto Data Base: Mental Health Communiy based Services

DSM Computerized Medical Folder

Mental HealthYear

Report

VenetoRegion

How many patients? Rate per 1000 population - 2008

Admissions of psychiatric patients(all hospital units) – Public vs private unit

Admission of psychiatric patients(all hospital units)

Admissions of psychiatric patients(all hospital units) rate per thousand population 2008

Admissions to Public Psychiatric units in Veneto Rate per thousand population 2008

Admissions to Private Psychiatric units in Veneto per thousand population 2008

Compulsory Admissions to Psychiatric Public units

Compulsory Admissions to Psychiatric Public units - Rate per thousand population 2008

Community Based Services DSM 9 vs RegioneIncidence – Prevalence - 2011

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Prevalence by age and sex 2009

Prevalence per 1000 population by age Males 2009 – Az.Ulss 9 / vs Veneto

Prevalence per 1000 population by age Females 2009 – Az.Ulss 9 / vs Veneto

Prevalence by diagnosis - 2012

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Social therapeutic and rehabilitation activitiesSocial therapeutic and rehabilitation activities

Employment Sheltered jobs (together with “Provincia”)

Law “68”: companies have to employ some people from a list of patients with disabilities

SIL (Service for job integration): training employment (a few hours, little earnings)

No profit work companiesWe are now starting Supported Employment

Individual placement and support of people without training in competitive jobs

Help for House

Agreement Acts with Municipalities for houses for psychiatric people

Mental Health PromotionMental Health Promotion

A specific staff that promote groups to explain mental health organization and to inform about mental health diseasesIn schools In Municipalities

Every year there is the “mental health day”, to encounter population

Residential activities

• Patients admitted 2012 = 140– Patients discarged from psychiatric hospital = 61– Patients without history of psychiatric hospital = 79

• Facilities = 18

Staff

Employed Consultant NPOs Sum Real Staff

Psychiatrists 26 2 0 28 27,39

Psychologists 5 4 4 13 7,97

Nurses 109 0 7 116 105,66

Social Workers 6 0 0 6 6

Education Staff 11 0 11 22 15,84

Care Technical Staff 41 0 88 129 97,57

Administrative Staff 6 0 0 6 5,67

Others 5 6 13 24 13,04

SUM 209 12 123 344 279,14

Staff/population: 1,2 per 1000 population

Staff by facilities UOA 1

Profilo professionale CSM Ctrp CD SPDC

Psychiatrists 6 2

Psychologists 2 1

Nurses 16 6 7 15

Social Workers 1

Education Staff 11 1 3

Care Technical Staff 2 6 7 6

Administrative Staff 1

How much does it cost (2010)?

Totale

Community Based

Services Hospital

Buying Assets 1.276.012,82 1.230.012,81 46.000,01

Staff 9.449.987,77 7.475.855,22 1.974.132,55

Administration 297.702,10 289.117,75 8.584,35

Not Sanitary Services 1.599.544,37 1.413.441,43 186.102,94

Other Sanitary Services 196937,29 136094,16 60843,13

Buying Services 6.689.884,60 6.689.884,60 0,00

OVERALL COST 19.510.068,95 17.234.405,97 2.275.662,98

Financial Resourcesof Az.Ulss 9 € 552.650.811,00 € 283.210.811,00 € 239.118.000,00

%  3,53 6,09 0,95

A few data on the implementation of the Mental Health Reform in the Veneto Region

• 805 beds for acute psychiatric emergencies in 40 general hospitals

• 337 community-based services, 111 of which are residential

• ¾ of community-based services are run by LHA’s• 3.000 staff (80% work for LHA’s): 47% nurses, 24%

care givers, 13% psychiatrists, 6% educators, 3% psychologists, 3% social workers (ie. 1 : 1500 inhabitants)

• 64.700 (16,3 per 1.000 inhabitants) mentally ill people treated in 2007, of whom 11.680 (3,0/000) admitted to general hospitals and 59.800 (15,1/000) in community-based services

• Note: estimated prevalence of mental illness in Italian population: 8%

→ 368.000 in Veneto region (ie. most treated by G.P.’s)

• Overall costs: € 250 million (ie. 3,5% of LHA’s budget)Note: the objective is 5%

Admissions to Public Psychiatric Unit by diagnosis – rate per 10.000 population – AzUlss 9 vs Veneto