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Stepped care as a model for the integration of primary and specialty mental health care

12 October 2006. 2. We need to make difference again between general and specialized mental health care. 12 October 2006. 3. Current problems in Dutch mental health care. Large mental health institutesBureaucraticPrimary care physicians lose controlContinuing increasing patient inflowLong wait

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Stepped care as a model for the integration of primary and specialty mental health care

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    1. 12 October 2006 1 Stepped care as a model for the integration of primary and specialty mental health care Bea Tiemens, Giel Hutschemaekers Gelderse Roos Institute for Professionalisation

    2. 12 October 2006 2 We need to make difference again between general and specialized mental health care

    3. 12 October 2006 3 Current problems in Dutch mental health care Large mental health institutes Bureaucratic Primary care physicians lose control Continuing increasing patient inflow Long waiting lists Primary care physicians lose control Negative image Image of low quality care Too many psychiatric patients in the street And the care by the primary care physician?

    4. 12 October 2006 4 Short history Treatment of mental health problems by primary care physicians Fifties, sixties, seventies: move away from the medical model more emphasis on context Eighties and nineties: criticism from psychiatry: underdetection and undertreatment back to the medical model context on the background general approach disappears

    5. 12 October 2006 5 Example Current treatment of depression and anxiety by the primary care physician NIVEL 2004: 78 % of the patients with the diagnosis depression receive psychofarmaca 82 % of the patients with the diagnosis anxiety disorder receive psychofarmaca Where is the generalist?

    6. 12 October 2006 6 Solutions for the mental health care problems in te last decade Strengthening primary care by Training primary care physicians Consultation and collaboration projects Psychiatric nurses in primary care practices

    7. 12 October 2006 7 The problems of the solutions Many local solutions are organizational or administrative, replacing care Role of psychiatric nurses often is not clear We brought specialist interventions into general practice which: Are primarily focused on symptom reduction Neglect the context Increase the risk of medicalization Do not fit to the generalists specialism: being a generalist 3. The primary problems are not solved

    8. 12 October 2006 8 Direction of new solutions Evaluation by NIVEL (2004), recommendations: Regions need a shared vision on mental health care Responsibilities need to be clear: who is the problem owner? But how?

    9. 12 October 2006 9 Stepped care models as solutions Model I Diagnosis specific Starts with least invasive intervention Focus and goal of treatment is symptom reduction

    10. 12 October 2006 10

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