Clinical and Social Factors of Compulsory Psychiatric Treatment in Moscow

1. Clinical and Social Factors of Compulsory Psychiatric Treatment in Moscow Prof. Tsygankov Boris, MD, PhD Chief Psychiatrist of Moscow City, Head of the Department of Psychiatry, Addiction and Psychotherapy, Moscow State Universityof Medicine and Dentistry Dr. SavelievDmitri, MD, PhD Department of Psychiatry, Station of Ambulance and Emergency Medical Service named after A.S. Puchkov, Moscow, Russia & Dr. Yaltonskaya A., MD, PhD

2. Prevalence of mental disorders in Moscow

3. Mental Health Care System in Moscow • Outpatient service – Psychiatric Dispensaries • Inpatient service – Psychiatric Hospitals • Emergency service - Station of Ambulance and Emergency Medical Servicenamed after Puchkov • Number of psychiatrists working in Moscow: 1466 –total amount offull time positions 1198 –number of occupied positions

4. Number of beds in mental hospitals (1981-2014) Total: 1981 – 16 565 2009 - 13 857 2013 - 12 309 2014 - 10 499

5. Reform in Mental Health Care System in Moscow since 2012 • Main purpose is to develop better connection between outpatient and inpatient psychiatric services • Focus on providing more help out-patiently through the active work of dispensaries (Day/Night Hospital, House Calls) • Focus on inclusion families into help (through education and increasing the level of legal responsibilities)

6. Preliminary results of the reform • Local Emergency Psychiatric Service in each dispensary was organized. • Main purpose –to provide help to patients with relapses of psychotic disorders at evening/night time • Includes: House Calls, Day/Night Hospitals, Local Intensive Care/Emergency Services with further referral to a local psychiatrist • As a result significant decrease the amount of calls into Emergency Psychiatric Services (after first 2 moths) that allowed to decrease the amount of beds into psychiatric hospitals by 40%.

7. Emergency Psychiatric Service • Part of General Emergency Service provided by Station of Ambulance and Emergency Medical Service named after Puchkov • 24 hours • Receiving and reacting to a phone calls • Service provided by psychiatrists.They make decision about necessary actions and provide consultations to a) staff from hospitals and other medical settings, b) ambulances c) people

8. Emergency Psychiatric Service (2) • 24 emergency psychiatric medical teams (1 psychiatrist + 2 psychiatricparamedics) • 12 emergency psychiatricparamedical teams (for transporting psychiatric patients) (2 psychiatric paramedics) • 8 stations located in the different areas of Moscow Each team uses fully equipped modern ambulance car (Mercedes) with GPS navigation, on-line connection with the head office, medical equipment necessary for providing intensive care.

9. Territory

10. Location of stationsin different areas of Moscow

11. Steps after arrival of psychiatric team to a patient Upon arrival psychiatrist makes a decision about the necessity to provide psychiatric examination (art. 23, 24 «Psychiatric Assistance and Civil Rights Act») Sometimes in difficult cases Emergency Nursing Teams provide transportation of psychiatric patients (for example, to Intensive Care Department of General Hospitals). Reasons for psychiatric examination EXIST (voluntary or non-voluntary examination) Reasons for psychiatric examination DO NOT EXIST • Hospitalization in Psychiatric Clinic (voluntary or non-voluntary art. 28, 29) • Hospitalization in General Hospital (Psychosomatic ward) • Provide medical help • Provide consultation • Refer to a local psychiatrist (active referral to a dispensary)

12. Main indicators of performance 39% - receives help during 20 minutes 68% - during 30 minutes 95% - during 60 minutes

13. Number of attendances and hospitalizations

14. Conclusion • Reform of mental care system has a positive effect: • Decrease loading on psychiatric hospitals and Emergency Psychiatric Service • Increase in number of staff and material well-being • Problems: - Poorly developed connection of outpatient and inpatient service