EMERGING SERVICE MODELS IN MENTAL HEALTH AND INTELLECTUAL DISABILITY IN THE CITY OF VIENNA

1. EMERGING SERVICE MODELS IN MENTAL HEALTH AND INTELLECTUAL DISABILITYIN THE CITY OF VIENNA Ernst Berger > UNIVERSITY OF VIENNA < > NEUROLOGICAL HOSPITAL ROSENHUEGEL < > COMMUNITY MENTAL HEALTH SERVICES VIENNA < Double Diagnosis /da Vinci / Biomed /VIENNA 2000

2. VIENNACAPITAL OF AUSTRIA 1,6 MIO INHABITANTS1977MORE THAN 2500 IN-PATIENTS IN PSYCHIATRIC HOSPITAL START OF REFORM OF PSYCHIATRIC CARE Double Diagnosis /da Vinci / Biomed /VIENNA 2000

3. TARGET PLAN FOR PSYCHIATRIC CARE 1979 HOUSING PROGRAM FOR DISABLED PEOPLE 1986 DEINSTITUTIONALISATION PROGRAM 1996 Double Diagnosis /da Vinci / Biomed /VIENNA 2000

4. TARGET PLAN for PSYCHIATRIC CARE 1979 DECLARATION:„NORMALISATION OF LIVING CONDITIONS OF DISABLED PEOPLE...“ REALITY:NO CHANGES IN THE NEXT YEARS FOR ABOUT 500 DISABLED PEOPLE IN PSYCHIATRIC HOSPITAL OF VIENNA Double Diagnosis /da Vinci / Biomed /VIENNA 2000

5. FIRST STEPS of CHANGE MODEL PROJECT OF 1984: (COMMUNITY MENTAL HEALTH SERVICES VIENNA) THE FIRST GROUP-HOME FOR DISABLED PEOPLE AFTER LONGTIME HOSPITALISATION • 1984 - 93 • N = 22 (7f / 15m) • Age 16;0 - 30;2 years • (BERGER 1995) Double Diagnosis /da Vinci / Biomed /VIENNA 2000

6. HOUSING PROGRAM FOR DISABLED PEOPLE 1986 1000 NEW LIVING PLACES IN GROUP HOMES OUTSIDE THE HOSPITAL Double Diagnosis /da Vinci / Biomed /VIENNA 2000

7. DEINSTITUTIONALISATION PROJECT 1996 • THE LAST STEPS: GROUP HOMES FOR TWO GROUPS OF SEVERE DISABLED IN-PATIENTS: A) PEOPLE WITH MULTIPLE HANDICAP B) PEOPLE WITH DUAL DIAGNOSIS Double Diagnosis /da Vinci / Biomed /VIENNA 2000

8. DEINSTITUTIONALISATION PROJECT 1996 • INTERIM REPORT JUNE 2000 • RETROSPECTIVE INVESTIGATION ABOUT PERIOD 1986 – 98 • N = 135 CLIENTS Mean age = 40 y (17 - 73 y) Mean hospitalisation period = 23,45 y Double Diagnosis /da Vinci / Biomed /VIENNA 2000

9. DEINSTITUTIONALISATION PROJECT 1996 CLUSTERS OF CLIENTS Double Diagnosis /da Vinci / Biomed /VIENNA 2000

10. CLUSTERS • TYPE 1 .... „SEVERE DISABILITY“ • TYPE 2 .... „HIGH COMPETENCE“ • TYPE 3 .... „DUAL DIAGNOSIS“ Double Diagnosis /da Vinci / Biomed /VIENNA 2000

11. DEINSTITUTIONALISATION PROJECT 1996 PROCESS OF DEINSTITUTIONALISATION and TYPES OF CLIENTS Double Diagnosis /da Vinci / Biomed /VIENNA 2000

12. BASIC CONDITIONS IN ORGANISATION OF PSYCHIATRIC CARE FOR DOUBLE DIAGNOSED PEOPLE IN VIENNA NO MEDICAL SPECIALISATION ON DUAL DIAGNOSIS >SMALL KNOWLEDGE OF PSYCHIATRISTS ABOUT INTELLECTUAL DISABILITY >PREDOMINANCE OF MEDICAL CONCEPTS VERY DIFFERENT LIVING SITUATIONS OF CLIENTS Double Diagnosis /da Vinci / Biomed /VIENNA 2000

13. SOME RELEVANT POINTS IN THE DEINSTITUTIONALISATION PROJECT HIGH RATE (> 50%) OF AGGRESSIVE BEHAVIOUR HIGH RATE ( 45%) OF SEVERE SPEECH DISTURBANCES BUT REMARKABLY BETTER (TWICE) RESSOURCES FOR CARE Double Diagnosis /da Vinci / Biomed /VIENNA 2000

14. SOME ACTUAL PROBLEMS IN THE CARE OF PEOPLE DUAL DIAGNOSED NO CLEAR LEGAL RULES ABOUT THE USE OF COERCION AND FORCE IN THE EVERYDAY CARE OUTSIDE OF HOSPITALS THE RESPONSIBILITY OF PSYCHIATRIC INSTITUTIONS FOR PEOPLE WITH DUAL DIAGNOSIS IS DIMINISHING Double Diagnosis /da Vinci / Biomed /VIENNA 2000

15. MODEL OF PSYCHIATRIC CARE FOR PEOPLE WITH INTELLECTUAL DISABILITY DIFFERENT LEVELS INPATIENT CARE OUTPATIENT CARE AREAS OF DAILY LIFE Double Diagnosis /da Vinci / Biomed /VIENNA 2000

16. LIVING AREAS OF PEOPLE WITH INTELLECTUAL DISABILITY HOUSING PROFESSIONAL CARE WORKING FULLY PARTIALLY PRIVATE CARE FULLY PARTIALLY LEISURE TIME INDEPENDENT Double Diagnosis /da Vinci / Biomed /VIENNA 2000

17. OUTPATIENT CARE FOR PEOPLE WITH INTELLECTUAL DISABILITY COMMUNITY MENTAL HEALTH CARE PRIVATE SECTOR TEAM OF SPECIALISTS FOR DOUBLE DIAGNOSIS GENERAL PSYCHIATRIC OUTPATIENT CARE FACILITIES + EMERGENCY CARE PSYCHIATRISTS IN PRIVATE PRACTICES Double Diagnosis /da Vinci / Biomed /VIENNA 2000

18. OUTPATIENT CARE TEAM OF SPECIALISTS MULTIPROFESSIONAL TEAM SPECIALLY TRAINED PSYCHIATRIST SPECIALLY TRAINEDPSYCHOLOGIST SPECIALLY TRAINEDPSYCHOTHERAPIST SOCIAL WORKER Double Diagnosis /da Vinci / Biomed /VIENNA 2000

19. INPATIENT SERVICES FOR PEOPLE WITH INTELLECTUAL DISABILITY PSYCHIATRIC HOSPITAL UNIT FOR DUAL DIAGNOSIS GENERAL PSYCHIATRIC HOSPITAL UNIT Double Diagnosis /da Vinci / Biomed /VIENNA 2000

20. INPATIENT SERVICE SPECIALISED UNIT FOR DUAL DIAGNOSIS FUNCTIONS CRISIS INTERVENTION PSYCHIATRIC THERAPY PSYCHOTHERAPY PLANNING OF REHABILITATION TEAM PSYCHIATRISTS PSYCHOLOGISTS NURSING PERSONS PSYCHOTHERAPISTS PEDAGOGUES Double Diagnosis /da Vinci / Biomed /VIENNA 2000

21. NETWORKS WAYS OF CLIENTS HOSPITAL UNIT FOR DUAL DIAGNOSIS LIAISON - SERVICES GENERAL PSYCHIATRIC HOSPITAL UNIT TEAM OF SPECIALISTS FOR DOUBLE DIAGNOSIS GENERAL PSYCHIATRIC OUTPATIENT CARE STATION + EMERGENCY CARE PSYCHIATRISTS IN PRIVATE PRACTICES HOUSING WORKING LEISURE TIME Double Diagnosis /da Vinci / Biomed /VIENNA 2000