Innovative. Close to domicile. Human.

by Elena Posth & Romina Männl

Mental health is a major issue in Rhineland-Palatinate. For years, Pfalzklinikum, as a service provider for mental health, has been trying to make treatment and care more innovative. This year, Pfalzklinikum was able to start into a new era of treatment at all its sites. Since the beginning of the year, Pfalzklinikum has been implementing Germany’s largest pilot project under the title “Innovative psychiatry for the 21st century – Close to domicile. Competent. Human.“ Together with representatives of all health insurances located in Rhineland-Palatinate the responsible Pfalzklinikum managers concluded a contract for an initial period of 8 years as the basis of this pilot project.

With the help of outreaching multiprofessional teams, the pilot project aims at organizing the treatment of patients differently and especially more flexibly in their own social environment. Thereby the number of patients having to be admitted as inpatients as well as the length of their stay and the number of compulsory admissions shall be reduced. Pfalzklinikum assumes that, thus, the number of treatments broken off can be lowered and the support of those concerned can be improved in different situations so that their participation in social life can be enhanced and their satisfaction with the treatment increases. This goes hand in hand with an economic use of the available resources.

How does this look like in practice?
In future, a team of reference persons will accompany the patients during the whole recovery process – from the inpatient stay and the treatment in a day clinic to the outpatient therapy, whatever is useful and desired. Thus, Pfalzklinikum can respond better to the needs of those concerned – simply because the reference persons get to know their reference patients better over time. Together they can talk at eye level which targets shall be reached and which kind of treatment at which place is the most appropriate at the time given since problems occurring in the living environment of the persons concerned can be best solved there. Furthermore, outpatient services for coping crises will be expanded and the day-clinic treatment program will be extended to 7 days a week. In addition, not only services in the strictly inpatient or outpatient area will be offered, but also such lying in-between, depending on the need of those concerned. As a consequence, the setting boundaries existing up to now will be changed.

What is new about this model?
Up to now, Pfalzklinikum has been obliged to apply to the health insurances for every single treatment method planned for their patients and have them approved, especially if a change between inpatient and day-care or outpatient treatment was planned. This allocation is due to Germany’s multi-payer health and welfare system according to Bismarck. For this procedure, the treatment team has needed much time and effort which could have been better invested in accompanying the patients. With the new regulation based on a so-called regional budget, Pfalzklinikum receives a kind of lump sum from the health insurances. This money can be used, without further single approvals, to put together a treatment that, from a professional view, suits best the individual needs.


How patient Mr X could be accompanied in a severe psychosis

Patient Mr X suffers from a severe psychosis. Again and again, he has severe crises (psychotic phases), in which he needs intense care and treatment. In such a crisis, he would simply have been hospitalized prior to the pilot project. There would not have been an alternative.
The pilot project brings about the following changes: The treatment and care of patients during a crisis is exactly determined in advance with the patients and their respective environment. Furthermore, there are other options beside an inpatient admission. An outpatient or day-clinic or mixed treatment in different settings is also possible in alternation and without further approvals.
In the agreement on the treatment, the patient’s opinion on what he/she believes to be the most appropriate for him/her in this case in consideration of his/her social environment is given greater consideration. For Mr X this means that in times when he is not in a severe psychotic phase, he determines with the persons treating him and with this reference persons how he wants to be treated in case of a crisis. For him treatment at home is important. In the case of a crisis, he could, thus, be treated and looked after at home twenty-four-seven by a multiprofessional team and in consultation with the persons having treated him so far. Alternatively, he could have drawn on a day-clinic service or an inpatient admission. In times without severe episodes, he can also get out-patient treatment. That way, he can stay in his familiar environment and his relatives know that he is nevertheless well taken care of.

It is not a matter of treating different patients but of treating patients differently
Pfalzklinikum is implementing the treatment concept of this pilot project for mentally ill adults, children, adolescents and persons aged 65 years and older. Dr. Andres Fernandez, chief physician of the Rockenhausen Clinic for Psychiatry, Psychosomatics and Psychotherapy views the project as an opportunity: „In this pilot project we can interact more intensely with the patients’ environment, the registered doctors and other parties involved. By doing so, problems in the patients’ social environment, i.d. with families, employers, and friends, are recognized and, if possible, solved. We will not treat different patients, but we will treat patients differently. What is more, the regions, in which we take care of persons with mental disorders remain unchanged. Thus, our treatment shall become more appealing for those concerned and working with us shall become more attractive for our employees. “

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