Elena Posth & Romina Männl from Pfalzklinikum walk us through exactly how the company has entered into a new and exciting era of treating people with mental illness by charting their ‘Innovative psychiatry for the 21st century – Close to domicile. Competent. Human’ project
Mental health is a major issue in Rhineland-Palatinate, a state of Germany. 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 of its sites. Since the beginning of 2020, 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 eight years as the basis of this pilot project.
With the help of outreach multi-professional teams, the pilot project aims at organising the treatment of patients differently and especially more flexibly in their own social environment. Therefore, the number of patients having to be admitted as inpatients, as well as the length of their stay and the number of compulsory admissions will be reduced. Pfalzklinikum assumes that, therefore, 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 the economical use of the available resources.
What does this look like in practice?
In the 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 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 about which targets will be reached and what kind of treatment at which place is the most appropriate at a given time, 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 programme will be extended to seven days a week. In addition, not only will services in the strictly inpatient or outpatient only area will be offered, but also such that are 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 is 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 severe psychosis. Again and again, he has severe crises (psychotic phases), in which he needs intensive care and treatment. In such a crisis, he would simply have been hospitalised 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 besides an inpatient admission. An outpatient or day-clinic or mixed treatment in different settings are also possible in alternation and without further approvals.
In the agreement concerning 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 at the times when he is not in a severe psychotic phase, he determines with the persons treating him and with this reference, 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 24/7 by a multi-professional 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. At times where there are no severe episodes, he can also get outpatient treatment. That way, he can stay in his familiar environment, and his relatives know that he will, nevertheless, be well taken care of.
Not a matter of treating different patients, but 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. The last word goes to Dr Andres Fernandez, Chief Physician of the Rockenhausen Clinic for Psychiatry, Psychosomatics and Psychotherapy who views the project as a marvellous 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.e. with families, employers and friends, are recognised 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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