psychiatric patients in the active and proactive counselling

1. psychiatric patients in the active and proactive counselling Drs. Carl Simons STIVORO

2. * Who is calling? • * Using selection criteria • * Policy • * What to expect • * Registration and use of a list • * What about the counsellors • * How to prepare and handle • * Some cases • * Discussion

3. Who is calling? • Manish depressive Chronics psychiatrist patient • Post Traumatic stress disorder Borderline • Compulsive Obsessive Depressive • Afoul Anorexia Bulimia • Street phobia Schizophrenic • ADHD Phobic • Postnatal depressive Ex- psychiatrist patients • Self mutilation Suicide • Autistics • Medicine: • Sedative Antipsychotica Antidepressivia • Sleep medication Diazepam Oxazepam • Antriptilyne Efexor Prometazine

4. Using selection criteria • STIVORO does not use criteria for callers to join • pro active counselling • Everybody who has a desire to quit and is able to communicate can start with counselling . • To proceed with the counselling if there is less progress we have some demands

5. Policy to continue • Client must be willing to set a quit date • We cannot solve other problems, we have to stay concentrate on quitting • There must be some progress over time • For a new pro active counselling course there must some believe that the client can succeed

6. What to expect • 1) Client takes more time: more Counseling calls, more reactive calls. • 2) Motivation Interviewing does not work always so well • 3) Less success score • 4) Clients are more extreme in their reaction • ( positive and negative) • 5) Extreme changes in mood and behaviour

7. Registration and use of a list • Registration for monitoring (management) • Background information for the counsellor (active and pro active) • To find out if caller is excluded for pro active counselling • 250 callers are on the list • 24 are excluded for further counselling ( this is communicated with the client) • 20 or more are nominated

8. What about the counsellors? • 1 feeling responsible for • a) new depression • b) new psychotic period • Sometimes between patient and doctor • Sometimes hard to be positive

9. How to prepare and handle • Prepare: • Intervisie • Extra training / special programs • Using protocols • Handle: • Working without an appointment (they call). • Send them to right mental care organisation • Exclude for counselling

10. Some cases • John 30 years old, autistic, Jehovah, 30 cigarettes • Calls since 2005 last call march 2008 • Is emotional. Many quit attempts. Manny Questions. Many calls. Last contact about Champix. • Not Excluded from Counseling • Anna 56 years old, counselling in dec. 2007. psychiatric patient. 9 sessions and 12 reactive calls. Manny quit attempts. • Last call 15 may does not smoking at this moment. Want to start counselling again • Mary 50 years old, Manish depressive • Calls since 2004. Three times counselling. Last call jan. 2008, was two months without • Excluded from Counseling

11. Discussion • Do we need selection criteria? • Can all people Quit ?