Roland van de Sande

1. The EU Mental Health Pact, implications for nurses Roland van de Sande

2. Brief introduction Clinicalpractice Research Education

3. Content • From green papers towards EU Mental Health Pact • Implications present EU policymakingprocess for psychiatric nurses • Futurechallenges for Horatio in the Mental Health Pact process

4. Focus EU green paper Nursing implications ? • Youth; improvement of parenting and eduction • Workforce; identifyunhealthypsychosocialaspects • Elderly; support socialnetworks • Vulnerablegroups; counseling and coaching • Prevention of depression and suicide • Combatstigmatization and socialexclusion • Improvement of community mental health care • Prevention of loss of humancapital • Earlyrecognition of mentallyillindividuals in workforce

6. Participation of nursing organizations in the EU mental health pact process Largestworkforce in healthcare (6,5 million nurses in Europe)

7. Not invited Otherinviteddelegates in the EU mental health pact process • Non governmental mental health associations • Service-user and carerorganizations in mental healthcare • Research and education centers • Delegates of the Ministries of Health of memberstates

8. Preparatory meetings conducted by the DG SANCO Luxembourg (February 2008). High level EU mental health conference in Brussels (June 2008) • 1. Youth and education • 2. Older people • 3. Depression and suicide • 4. Workplace settings • 5.Combating stigma and exclusion

9. EU Core missions mental healthpolicy Early detection of mental suffering and to prevent the critical delay of adequate treatment and to avoid the loss of human capital To combat stigma, deprivation, health and social service inequalities in the EU countries Promoting adequate stress and safety management for carers and professionals

10. EU generalobjectives in healthcare • Promotion of efficienthealthinformation • Combatinghealthtreats • Monitoringhealthdeterments • Promotion of integratedhealth care • Tacklinginequalities • Encouraging international co-operation

11. Mental Health Expenditure in European countries (% of total health expenditure), source: MHEEN 2004

12. WHO completed suicide rates

14. Involuntary admissions Prevalence (%) of involuntary admissions per 100,000 population by country in 1998, 1999 or 2000; Source: Salize, Dressing, Peitz Involuntary Placement and Treatment of Mentally Ill - Legislation and Practice in European Union Member States (2002)

15. Affective loss of control(Kaplan & Wheeler, 1983) Recovery Climax arousal Crisis Provocative stimuli High arousal Loss of control Arousal reduction. Risk Reduction Incident evaluation SOAS-R Hostile attitude Physical aggression Verbal threaths crisisplan ? close observation ?

16. Risk of false positive and false negative jugdments contextual implications Accepted risk Watchfull waiting Defendable risk Tailormade interventions Unacceptable risk Safety first Autonomy versus close observation

17. Number of qualified psychiatric nurses (Source WHO,2001)

18. Inequalities in nursing training (Nolan & Brimlecombe,2004) • Variety in length and content in psychiatric training • Nurse qualificationfor all educationstaff is required • Howeverdiscrepancies in acadamiclevels of staff • International collaboration in actionlearningprojects

19. Mental health care infrastructure, globalperspective(Thornicroft & Maining, 2002) • Mental health disease management programs in 45% of the countries • Most countries have mental health laws available for decision-making (74%) • In contrast with most countries in South Eastern Asia (17%) • Worldwide mental health laws tend to be older than 40 years (85%) • About 20% of the global population have no access to psychiatric medication. • Whereas adequate medication can reduce suffering significantly.

20. Gaps in mental health care • Recognition of the severity and compound of psychiatric symptoms in vulnerable European citizen • Lack of adequate aftercare in cases of self harming and severe neglecting • Appropriate medication management • Lack of therapeutic alliances with carers • More dynamic risk management required • Collaboration with carers and service users

21. Implications for nurses • Nurses are often frontline officers and play a key role in early detection of mental distress and the provision of continuity of care the crisis, stabilization and recovery phase. • Our mission is to share expert knowledge and taking responsibility for influencing 7x24 hour mental health practice by international dissemination of relevant evidence informed practices.

22. Earlydetection of mental distress • Recognition of behavioralproblems and/orpsychiatricsymptoms • Burden of carers • Level of arousal in healthcare professionals

25. Advances in monitoring and care planning • Frequent use of rating scales and feedback onoutcomes • Evidenceinformed care pathways • Consultation to serve other professionals • Post incident evaluationswith services users and carers • Clinicalsupervisionprovidedbypsychiatric nurse specialists • Involvement of recoveryperspectives as much as possible in the journey to recovery (crisis, stabilization and rehabilitation)

27. 20_X_ 35 35_X_ 35 Score sheet Kennedy-Axis V short version (daily use) 1. Psychological functioning 2. Social skills 3. Violence 4. ADL-occupational functioning Danger level = 35

28. Improvements in patientsafety • Qualitycontrolon split seconddecisions • International reflectiononlocalpractices • Quantitativedatacollectionimprovesawareness • Learningfromqualitative research findings • Non blaming incident analysis • Research based training (multi-centerapproach) • Reflectivepractice EU FP7 framework funding?

29. Risk of unsupervised restraints

33. THANK YOU info@horatio-web.eu