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Primary and secondary mental care: equality and complementarity. E.H. (Dineke) Smit European Forum of Primary Care Galatasaray University, Istanbul September 9/10, 2013. Content.
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Primary and secondary mental care: equality and complementarity E.H. (Dineke) Smit European Forum of Primary Care Galatasaray University, Istanbul September 9/10, 2013
Content The first step towards successful cooperation (primary / secondary care) is admitting the differences and see the primary and secondary care as equal. The best of two worlds The next step is to build bridges, clarify the valuable complementarityby co-creation.
Primary and secondary mental health care ScientificParadigm Patients Model of Care Mental Health care Care orientation Good care Care organization
So this what you mean when we talk about ‘an elephant’!? Mental health care Compared with the elephant (where do you look at, head or tail?) you can choose a position in mental health care, using a scale of 1 – 5.
Scientific paradigm “The constellation of beliefs, values and techniques that caregivers have in common as well as the common model from which one thinks and acts” (Kuhn, 2012). Classical science Complexity science
Model of care The way you look at sickness and health. Is a depression associated with brainabnormalities or ‘a bad mix and bad luck’? Bio-medical model Biopsychosocialmodel
Care orientation The amount of knowledge of a specific field / area or in general (concerning health care)? Generalist perspective Specialist perspective
The patients population Differences in patient population, varied or not varied? Only major disorders or minor, major and all in between? Heterogeneouspatientpopulation Homogeneouspatientpopulation
Care organization Community Health care, neighbourhood orientated or hospital Care, disorder orientated? Funded by local government or the national health care? Monodisciplinairor multidisciplinair? Community Health care, neighborhood orientated Hospital Care, disorder orientated
Definition of good care What is dominant: deontologicalethics, virtueethics, consequentialism? Or is anequaldialogbetweenallethicstheoriespossible? Pluralisticethics Monisticethics
Integration or co-creation? Integration means: the intermixing of people / groups who were previously segregated.
Integration or co-creation? Integration means: the intermixing of people who were previously segregated. Co-creation means: the action or process of several people bringing something into existence (what was not there before…)
Primary Care Barbara Starfield, professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, defined primary care as: “ the first point entry to a health care system;the provider of person-focused (not disease-oriented) care over time; the deliverer of care for all but the most uncommon conditions; and the part of the system that integrates or co-ordinates care provided elsewhere or by others “ (Starfield, 1998)
Primary Care I would like to add: Primary care emphasizes complexity science; has a heterogeneous patient population; works from a biopsychosocialmodel; has a generalist perspective and a community health care approach; and it recognizes the different ethical theories as being equal.
Final advise Acknowledge the difference, see primary and secondary as equal, strive for a co-creation between primary and secondary mental health care to aim for better mental health care!
