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Dr. Iris Hauth Medical Director Regional Managing Director President of the DGPPN

Welcome to the Alexianer – St. Joseph Krankenhaus, Berlin Weißensee Autumn meeting of the Union européene des medicins spécialistes – Section of psychiatry 15. October 2015. Dr. Iris Hauth Medical Director Regional Managing Director President of the DGPPN. Reform of Psychiatry

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Dr. Iris Hauth Medical Director Regional Managing Director President of the DGPPN

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  1. Welcome to the Alexianer – St. Joseph Krankenhaus, Berlin WeißenseeAutumn meeting of the Union européene des medicins spécialistes – Section of psychiatry15. October 2015 Dr. Iris Hauth Medical Director Regional Managing Director President of the DGPPN

  2. Reform of Psychiatry • Prevalence mental disorders • Current health care structures • Innovative forms of health care

  3. PSYCHIATRY-ENQUETE • After the Second World War, thepsychiatry in Germany, especially in the large care clinics, was in a terrible state. • 1975 thefederalgovernmenthasbeeninformed in thecontextofthepsychiatryenqueteaboutthesituation – out ofitthe large reformofpsychiatry was developed. • The large regional hospitalswereclosedandsmalldepartments at generalhospitalswereopened. • In 1990, throughthe so-calledPsychiatry-PersonnelOrdinancesufficientqualifiedpersonnelcameintothehospital. • From 1992 - implementationofpsychotherapy in clinicsforpsychiatry. • The specialist was renamed in specialistforPsychiatryandPsychotherapy.

  4. REFORMOBJECTIVES OF THE PSYCHIATRY-ENQUETE (1875) • Whathasbeenimplemented • Dehospitalisationoflong-term patients • Development andexpansionofoutpatientservicesandpsychiatricdepartments in generalhospitals • Community-basedoutpatientandpre-admission providers • Demand-oriented care of all mentallyillpeople • Equalitybetweenmentallyandsomaticallyillpeople • Continuityoftreatmentandrehabilitation • The reformofpsychiatryisstagnating

  5. Reform of Psychiatry • Prevalence mental disorders • Current health care structures • Innovative forms of health care

  6. FIRST RESULTS OF THE DEGS MENTAL HEALTH Computerbased interviews with 5.318 persons aged 18 to 79 – representative for the German residential population. Anorexia Nervosa Physicalcausedpsychologicaldisorders Drug abuse Post-traumaticdisorders Psychoticdisorders Bipolar disorders Somatoform disorders Obsessive-compulsivedisorders Unipolar depressions Alcoholdisorders Anxietydisorders Every year 33,3% (95% KI:31,8-34,8) of the population suffer from at least one disorder. 12-Months- prevalence (%) Reference: RKI, Degs Symposium 14.6.2012. Online Ressource: http://www.rki.de/DE/Content/Gesundheitsmonitoring/Studien/ Degs/degs_w1/Symposium/Symposium_inhalt.html?nn=2766148

  7. TREATMENT-RATE by AGE AND GENDER What percentage of the affected people were in contact to the health care system due to their complaints? % oftheaffectedpersonswith a 12-months diagnosis 37,5% Total Men (2540) Women (2778) High treatmentrates Drug addiction (59,3%) MDD (recurring: 61,2%) Generalisedanxiety (64,0%) Post-traumaticdisorder (66,6%) Bipolar disorder (88,1%) Low treatmentrates Socialphobia (53,5%) Specificphobias (45,6%) Alcoholdependency (46,6%) Obsessive-compulsivedisorder (42,5%) Nicotineaddiction (35,6%) Alcoholabuse (25,8%) Age group Reference: RKI, Degs Symposium 14.6.2012. Online Ressource: http://www.rki.de/DE/Content/Gesundheitsmonitoring/Studien/Degs/degs_w1/ Symposium/Symposium_inhalt.html?nn=2766148

  8. DO MENTAL DISORDERS INCREASE WITHIN THE GERMAN GENERAL POPULATION? (18-65 years) Results of the German health surveys 1998,2010 Total prevalence (12 Months) all mental disorders 31,1% 29,6% 1998 2010 No significant change

  9. Reform of psychiatry • Prevalence mental disorders • Current health care structures • Innovative forms of health care

  10. OUTPATIENT HEALTH CARE STRUCTURES Where do mentally ill people get treatment? Onlystationarytreatment Stationaryandambulatorytreatment Neurologist Psychological Psychotherapists Medical Psychotherapist Psychiatric/psychotherapeuticambulance Only General practitioner Others N= 565 treated persons Reference: Bundesgesundheitssurvey 1998, Wittchen und Jakobi 2001

  11. OUTPATIENT HEALTH CARE STRUCTURES Professional groups participating in contract-medical psychiatric psychotherapeutic care (without general practitioners) 13.500 Psychological Psychotherapists 5.000 Medical Psychotherapists 3.000 Psychiatrists 2.200 Neurologists 3.000 Psychosomatic 2.300 other specialists with the designation Psychotherapy/Psychoanalysis Σ = 29 000 actors

  12. OUTPATIENT HEALTH CARE STRUCTURES Outpatient care – Increasing demands due to mental disorders Psychotherapist Neurologist, Psychiatrist

  13. DEVELOPMENT OF THE NUMBERS OF HOSPITAL BEDS FOR PSYCHIATRY AND PSYCHOTHERAPY 1976 - 2006 About 420 specialized hospitals and departments in general hospitals Decrease of beds about 53 % Reference: Statistisches Bundesamt

  14. PERFORMANCE DATA OF INPATIENT TREATMENTS IN THE DEPARTEMENTS OF PSYCHIATRY AND PSYCHOTHERAPY 1990 - 2011 Capacity compression

  15. PSYCHOSOMATIC Hospitals Day clinics Reference: Statistisches Jahrbuch 2011

  16. CURRENT CAPACITIES IN PSYCHIATRIC CARE

  17. PSYCHIATRIC CARE: EXPENDITURE ON THE TEST-STAND (Melchinger et al. 2003/2006) Total expenditure by health insurances and social welfare per 100.000 inhabitants = 12,7 Mio. Euro/year 1,4 Mio € Long-term care institutions Temporary institutions Assisted Living Other institutions (Workshops, day centre) PIAs Outpatient psychiatric psychotherapeutic care Psychiatric-psychotherapeutic hospital care 0,6 Mio € Socialwelfare 0,7 Mio € 1,3 Mio € 3,3 Mio € GKV 5 Mio €

  18. HOW DO PATIENTS EXPERIENCE THE PROVISION OF CARE? Resident Psychiatrist – SGB V AmbulatorySocialtherapy – SGBV employment,day-care centres Assisted Living General practitioner – SGB V Day clinic – SGB V Information centres Rehabilitation clinic SGB VI Psychological Psychotherapist Professionals Ambulatory Rehabilitation – SGB V & VI Social-psychiatricservices Psychiatrichospital – SGB V Medical Psychotherapist Ambulatory care – SGB V Institutionaloutpatient´sdepartment – SGB V Occupationalrehabilitation SGB IX Integration assistance SGB XII Bild: Shutterstock (Anatoly Maslennikov)

  19. HOW DO PATIENTS EXPERIENCE THE PROVISION OF CARE? Completely fragmented funding system Assisted Living AmbulatorySocialtherapy – SGBV employment, day-care centres General practitioner – SGB V Day clinic – SGB V Information centres Rehabilitation clinic SGB VI Resident Psychiatrist – SGB V Psychological Psychotherapist Professionals Ambulatory Rehabilitation – SGB V & VI Social-psychiatricservices Bild: Shutterstock (Anatoly Maslennikov) Psychiatrichospital – SGB V Medical Psychotherapist Ambulatory care – SGB V Occupationalrehabilitation SGB IX Integration assistance SGB XII Institutionaloutpatient´sdepartment – SGB V • High grade health care system, but different health care providersandinstitutions, whichabsorbthecosts.

  20. Reform of the psychiatry • Prevalence mental disorders • Current health care structures • Innovative forms of health care

  21. In many cases the seclusion of sectors causes an inefficient service provision. Communal psychiatric association Isolatedinformation Isolatedinformation Isolatedinformation Estimated saving volume by interlocking the service providers 10-15% of the “costs for health“ Reference: Oberender & Partner; Mummert & Partner: Studie Krankenversicherung 11/2000

  22. REFORMOBJECTIVES OF THE PSYCHIATRY-ENQUETE (1875) • Whathasbeenimplemented • Dehospitalisationoflong-term patients • Development andexpansionofoutpatientservicesandpsychiatricdepartments in generalhospitals • Community-basedoutpatientandpre-admission providers • Demand-oriented care of all mentallyillpeople • Equalitybetweenmentallyandsomaticallyillpeople • Continuityoftreatmentandrehabilitation • The reformofpsychiatryisstagnating

  23. INNOVATIVE FORMS OF HEALTH CARE Instruments of legislation

  24. INTEGRATED CARE • Hamburger Modell - §140 SGB V • Hamburg Eppendorf Universitätsklinik • Running time since 2007 • Healthinsurence: AOK-RhHH, DAK, HEK, IKK classic • VP: UKE (Lambert, Bock) • Payment: annual lump sum incl. KH • Indication: Psychoticdisorder (F1-F3) • Evaluation: detailed, hospital-prevention, objectiveandsubjectiveprocess-improvement • Control byhospital

  25. INTEGRATED CARE • Hamburger Modell - §140 SGB V • Managed Care Model PsychosisSpecialistoutpatientclinic at UKE (SPA) Psychosis Specialist infirmary and acute care infirmary at UKE (PS II & PS EG) Therapeutic model of Assertive Community Treatment (ACT) 20 resident neurologistsandpsychiatrists Day clinic, crisisdayclinicandoccupationaltherapy at UKE Reference: Integrierte Versorgung von Psychose: das Hamburger Modell; Prof. Lambert et al.

  26. COMPULSORY ADMISSION Compulsory admission lifetime Compulsory admission during the last 2 years Compulsory admission (integrated Care) within 3.7 years Compulsory admission (for 2 years in the integrated care) All patients (N=246)

  27. INTEGRATED CARE • NWpGNetzWerk psychische Gesundheit • Berlin, Bremen, Bayern, NRW, SH, Hamburg, Sachsen, Niedersachsen • Running time since 2009 • Healthinsurances: TK, KKH Allianz • VP: Provider ofthe Dachverband Gemeindepsychiatrie (BAG IV), Pinel, Brücke SH (Faulbaum-Decke), GAPSY Bremen, UKE, GPG (Greve) • Payment: annual lump sum (300 – 5.000) fortheproviders incl. Hospital costs, different paymentfortheproviderofservices • Inclusion: F2- F6, pre-hospital treatment • Evaluation: Hospital prevention (0,5 vs. 15 d / Jahr) • Control bypsychosocialprovider

  28. INTEGRATED CARE NWpG NetzWerk psychische Gesundheit Reference: DGVT-Kongress; Dipl.-Psych. Klüsener

  29. AIM: CLINICAL PATHWAY SGB V lower need high need high complex need Panel physicians/ Psychotherapists Panel physicians/ Psychotherapists Panel physicians/ Psychotherapists Panel physicians/ Psychotherapists PIA Etc. Ambulatory care/ Sociotherapy day clinic Etc. crisis intervention Etc. Etc. Etc. In-patient care outpatient services communal psychiatric services IV-contracts, §64 models clinic services • common therapeutic targets • coordinated modular services • treatment pathways • quality assurance

  30. REQUIREMENTS OF THE DGPPN 1.) The reform of psychiatry is stagnating. 2.) Lack of effective coordination in the system of advisory, mentoring and therapeutic offers. 3.) A comprehensive, integrated and individualized local care system, overarching sector and setting, oriented at the individual and changing needs of patients. 4.) Further development of the fragmented care system by integrated care contracts and § 64 projects. 5.) Clear defined clinical pathways with modular structure, depending on the individual patients´needs. 6.) Clear defined cooperation of the local service providers. 7.) Reform of the outpatient and inpatient health care system. 8.) Normative standards in the regulatory framework.

  31. Zentrum für Neurologie, Psychiatrie, Psychotherapie und Psychosomatik

  32. At a glance Institutions: 232 in 5 states Hospitals: 20 with 3.638 beds Psychiatry: 1.970 / Somatic: 1.526 / Rehab: 142 95.010 inpatients, 176.000 outpatients Nursing schools: 6 with 401 trainees Medical centre: 7 with 44 surgeries Senior institutions: 27 with 1.667 places 138 places in living community Integration assistance: work: 3.477 places living: 2.065 places Child and youth welfare: 147 places Service society: 8 Patient and billing days: 3.060.404 Employees: 12.968 Balance sheet 2013: 842 Mio.€ Turnover 2013: 656 Mio.€

  33. Care ofapproximately 25 % of Berlin residentsbythe Alexianer Pankow 380.000 Reinicken-dorf Lichten- berg Spandau Mitte 317.000 Marzahn Wilmersdorf Kreuzberg Tempel-hof Zehlendorf Köpenick 233.000 Neukölln

  34. Historyof St. Joseph-KrankenhausOld part: sights 1893 1993 1888 2004 2006

  35. New part: sights - since 1999 TK Prenzlauer Berg TK Pankow Galerie im St. Alexius Gebäude St. Joseph-Krankenhaus Berlin- Weißensee Gartenstr 1 13088 Berlin

  36. St. Joseph-Krankenhaus Weißensee Psychiatry, Psychotherapy, Psychosomatic Addiction medicine, Rehabilitation Clinic for Psychotherapy and behavioral medicine 4 day clinics • At St. Joseph-Krankenhaus • Prenzlauer Berg • Pankow Outpatient clinic/ medical centre Therapeutic living communities Special centres: Post-traumatic disorders, Psychic disorders before and after birth, early identification of psychosis, memory clinic Neurology • 347 beds incl. 90 places in day clinic • Medical director, chief physician, Bmanaging director: Dr. med. Hauth • Chief physician Prof. PD Dr. med. Godemann • Chief physician Prof. Dr. Thomas Müller

  37. Currentstructure Total: 347 full-/partstationarybeds/places ClinicforPsychiatry, Psychotherapy und Psychosomatic: 101 beds + 66 places in dayclinic Clinic for Psychotherapy and behavioral medicine : 82 beds + 6 places in dayclinic Clinicforaddictionmedicine: 26 beds 20 rehabilitation-beds + 6 fulldayoutpatientrehabilitationplaces ClinicforNeurology: 40 beds

  38. The St. Joseph-Krankenhaus in numbers (2014) • Psychiatry: stationarytreatmentsabout 3900 • Psychiatry: partial inpatientabout 1170 • Neurology: stationarytreatmentsabout 1200 • Outpatient clinicabout 6800 cases • Average lengthofstay: Psychiatry 20,3 days, Neurology 10,5 days • Occupancy rate in thePsychiatry: stationary 107 %, partstationary 116 %

  39. Clinic for Neurology (Prof. Dr. Thomas Müller) • 2 Hospital wards • outpatient consultation, MS-outpatient clinic §116 • outpatient Physiotherapy • neurodegenerative diseases, Parkinson, dementia, Multiple Sclerosis, complex pain therapy • 3 years training authorisation • Rotation physician position for psychiatric colleagues, Rotation in the hospitals for Neurology in Berlin-Neukölln and Potsdam

  40. 3 acute wards Disorder-specific with integrated day clinic Clinic for Psychiatry, Psychotherapy and Psychosomatic (Chief physician Dr. med. I. Hauth) Psychotherapy (Mother-Child-treatment Posttraumatic disorders) 4 day clinics, disorder-specific PIA Special consultations Outpatient occupational therapy Counselling services (in 10 hospitals) Cooperation GPV

  41. 1 acute ward with integrated day clinic Clinic for Psychotherapy and behavioral medicine (PD chief physician Prof. Dr. med. Godemann) 2 Hospital wards Gerontopsychiatry Special wardsAnxiety and compulsive disorders Memory-outpatient clinic/day clinic Outpatient clinic Network for Ageing

  42. Clinic for addiction medicine (Chief physician Dr. I. Hauth, senior physician Dr. U. Keller) Qualified withdrawal with integrated day clinic Rehab-withdrawal ward with integrated day clinic Outpatient-Consulation 34 places assisted living Expansionproject addiction network Pankow

  43. Obligatory care/ community psychiatry • Schizophrenic Psychosis, Depressions, addiction, gerontopsychiatry, chronic sick people • People from the district Pankow in cooperation with physicians, therapists and complementary institutions Supraregional special services • Early diagnosis of schizophrenic Psychoses • Posttraumatic disorders • Personality disorders, stress disorder • Memory consultation • Postpartum disorder, women/mother-child-treatment • Anxiety and obsessive-compulsive disorders

  44. Diagnosis andtherapy depth analysis funded Psychotherapy, behavioral therapy Disorder-specific Psychotherapy IPT, DBT modern Pharmacotherapy Training of social skills - Social Skill-Training Outpatient-day clinic Patients Integrated care Psychoeducation Rehabilitation of Cognitive functional deficits Treatment guidelines Trialog, Empowerment occupational, art- and musictherapy Centered nursing

  45. Outpatient clinic at St. Joseph-Krankenhaus Weißensee Special consultations: • Gerontopsychiatry • Memory consultations • Comorbidity addicition and psychiatric disorder • Mental disability • Mother-child-consultation • ADHD - Diagnosis

  46. Medical servicecentre at SJKW 3 specialists for Psychiatry/Psychotherapy Physician for general medicine 3 psychological Psychotherapists 2 specialists for Neurology Clinic for Neurology Clinic for Psychiatry Cooperation with • outpatient ergotherapy • outpatient physiotherapy Clinic for addiction medicine Surgery for Magnetic resonance imaging Senior institutions

  47. Diagnosis at St. Joseph-Krankenhaus • Magnetic resonance imaging • Neurophysiological diagnosis • Computerbased psychiatric and neuropsychological results • Psychological: instrument-based tests and multimodal diagnosis

  48. Biological Therapy • Modern medicationaccordingtoguidelines • Light therapy • Electroconvulsivetherapy

  49. Psychotherapy • Psychodynamic psychotherapy • Behavioral therapy • Disorder-specific psychotherapy (IPT, DBT) • Relaxation techniques • Art- and musictherapy

  50. Social Psychiatry • Cooperation with outpatient, complementary services in the region to speak about different patients • Annual „customer discussions“ together with the medical assistant speaker, police and judges • Presentation of complementary institutions by trainings and excursions • Participation in a Relatives Group and counselling services • Clinic panel

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