Re-thinking mental health: Innovations of Pfalzklinikum · resources, and aims to strengthen the individual skills for coping with life and at building health-promoting environmental

Re-thinking mental health:Innovations of Pfalzklinikum

Mental health promotion requires social change: a

communicational challenge (p. 6)

Healthy in every sphere of life:“The Palatinate makes itself/you

strong – ways to resilience” –Projects (p. 4)

Social communication:Pfalzklinikum’s CEO Paul Bomke

discusses challenges in thehealthcare setting (p. 10)

2 www.pfalzklinikum.de Pfalzklinikum

Pfalzklinikum is a provider for mental health andneurology services in the Rhineland-Palatinate inSouthwest Germany with over 2,000 employees in 14

locations. Its work encompasses approximately 1.4 millionpeople in the Palatinate, focusing on community-based,child and adolescent, general psychiatry and neurology services.

As mental health is its daily business, Pfalzklinikum focuseson more than helping people becoming mentally healthyagain. Rather, maintaining mental health is the overallobjective of the institution and its declared duty – not onlyfor its patients and clients, but also for its employees andthe people living in the Palatinate.

Therefore, Pfalzklinikum is always working on new offersand projects, following the institution’s aim of creating aresilient and mentally healthy Palatinate region by the year2025. By founding the initiative “The Palatinate makesitself/you strong – ways to resilience” (p. 2-5), establishing asalutogenetic company health management (p. 13) anddeveloping decentralised community-based services (p. 14-15), Pfalzklinikum continually follows its objective. Inorder to make people focus on mental health instead ofdisease, a general rethinking and a development of health

literacy are crucial (p. 6-7). Here, Pfalzklinikum co-operatesstrategically with different international partners such as theFrameWorks Institute (p. 12). In an interview (p. 10-11),Pfalzklinikum CEO Paul Bomke explains which economicand political challenges Pfalzklinikum is facing on this way.

Re-thinking mental health:Innovations of Pfalzklinikum

3Pfalzklinikum www.pfalzklinikum.de

What does resilience mean?Resilience is originally a term from materials science. It is thecharacteristic of a material to return to its original form afterit has been strongly stressed or modified. Transferred to ushumans it can be described as a mental resistance. It is theability to remain mentally healthy and stable whenconfronted with crises and challenges in your life.

What is the aim of the initiative?The initiative “The Palatinate makes itself/you strong” wasfounded 2014 by Pfalzklinikum and national andinternational project partners such as universities,communication experts and think tanks, amongst othersthe Hanover Center for Health Communication and theFrameWorks Institute in Washington D.C. It aims to developa resilient Palatinate region by 2025. People will be enabledto help one another to remain healthy and to cope well withtheir personal challenges and crises.

How will you achieve that? We want to help the people developing a health literacythat starts long before the topic disease even comes up.

That means the competence of remaining healthy and benefitting from the strength and support of their social environment.

What are the challenges?At first we have to overcome an important obstacle: for along time medicine and psychology have strongly focusedon the treatment of diseases – the healthcare system hasreacted instead of acting preventively. Whereas in somaticmedicine prevention is gradually becoming established, inthe psychiatric field it is still rarely the case. Accordingly, theimages that come to mind when people are asked aboutmental health and disease are rather negative. They thinkabout depression and burnout – things a healthyuninvolved person does not want to think about. So they donot think about what keeps them healthy either. Ourchallenge is to initiate a re-thinking about mental healthbefore we can really start with offerings that foster healthliteracy. How this social communicational challenge can beovercome, is explained on pages six and seven.

What makes your approach new?Focusing on individual resilience alone is quite common inpsychology. Of course we also concentrate on this aspectbecause it is an important starting point. But we areespecially interested in examining how individual resiliencein the context of the social environment of people works,that means when they are surrounded by their families andfriends, the communities they belong to and their workingenvironment. We call this a socioecological approach.Accordingly, we have developed three work fields: Myselfand Others, Me/Us in the Community, and The Job and theCompany. The projects we are currently working on aredescribed on pages four and five.

The Initiative“The Palatinate makes

itself/you strong – ways toresilience” – questions and

answers with projectassistant Romina Männl

Romina Männl


ATthe moment, the initiativeis involved in differentprojects that illustrate its

three work fields ‘Myself and Others’,‘The Job and the Company’ and‘Me/Us in the Community’.

Fostering emotionregulation of schoolchildren – a project byMe and the OthersHow does it feel to be angry orhappy? How do I recognise ifsomeone laughs about me or withme? How do I show other people thatI like them? Why do I have emotionsand why is it important to allowthem? – Developing basic emotionalcompetences is as important forchildren as acquainting rules of socialconduct. It is an essentialprecondition for resilience. Theinitiative is currently working on theexpansion of emotional trainingwhich has been implemented in morethan 50 classes in Palatinate schools. Itwas developed and tested byProfessor Tina In-Albon andpsychology students of the Universityof Koblenz-Landau. The trainingtransfers knowledge about emotionsto the children and develops theircompetences in being empathetic,controlling their impulses, copingwith conflicts and communicatingviolence-free. The older children andteenagers from classes eight to nineare also trained in coping withdepression and building cognitivestrategies and resources.

“The Palatinate makes itself/you strong – ways toresilience” - Projects

Healthy in every sphere of life


Healthcare centre in Donnersberg – aproject by Me/Us in the CommunityA completely new concept in healthcare service is theDonnersberg healthcare centre, which will be developed inthe Palatinate town of Rockenhausen and its neighbouringcities in the administrative district of Donnersberg. On theone hand, Pfalzklinikum for psychiatry and neurology as wellas Westpfalz-Klinikum for somatic medicine are pooling theircompetences in terms of mental and physical health. On theother hand, both stationary and ambulatory, as well ascaring and preventive services will be narrowly interlinked.

Both partners aim to maintain the people’s health andquality of life in that region for as long as possible –especially regarding the ageing population and theshortage of doctors and other skilled professionals in thecare sector. The healthcare centre will merge thecompetences of hospitals, resident doctors, and aftercareinstitutions such as stationary living or welfare centres. It isnot only the patients who can benefit from the closeexchange and spatial proximity of the institutions. Theconcept also offers an incentive for young doctors: in thisway, they can establish themselves in the rural area withoutbeing forced to become self-sufficient. With this idea,Pfalzklinikum and Westpfalz-Klinikum are facing importantchallenges in the country: a rural exodus, lack of doctorsand ageing. In addition, they plan to involve differentstakeholders of the population at an early stage of the

planning. The focus lies here on the positive impact ofparticipation and the development of health literacy.

Tool box for sustainable companies – aproject by The Job and the CompanyWhether it is the implementation of new technologies, astrategic re-alignment, an ageing staff or an internal shift ofculture – change often bares both potential and risks forcompanies. But there is often a lack of practicableimplementation concepts in order to deal with suchsituations successfully without burdening the people in acompany. Therefore it is necessary to develop a new kind ofimplementation process that strengthens companies andtheir employees against crises. The solution approach is tobalance individual and organisational resilience.

In their work field The Job and the Company, The Palatinatemakes itself/you strong is currently working with small andmedium sized enterprises in order to developmeasurements that make them fit for challenges andresistant against crises. For example, before change projectsare decided, the management and the employeeorganisation check which alternatives of implementationbare the least burden for the staff. In these processes, thefocus is laid on preserving mental health instead ofdiscussing diseases.

By Romina Männl, project assistant of the initiative “The

Palatinate makes itself/you strong – ways to resilience”


INthe field of mental health, the paradigmaticdistinction between the treatment of diseases onthe one hand and health promotion on the other

becomes particularly evident. Despite the increasing costfor mental healthcare in Germany, the major part of theresources is invested reactively, i.e. there is rather atreatment of diseases than a promotion of health.

Health promotion, however, has another focus. From asalutogenetic perspective it looks at protective factors andresources, and aims to strengthen the individual skills forcoping with life and at building health-promotingenvironmental conditions. A decisive point here isresilience. Sufficient resilience enables the individual tomaintain a balance between the subjective perception ofstress and one’s own coping resources.

Such an approach has a special potential to sustainablyimprove the population’s mental health, because in thedevelopment process of mental disorders it starts at theearliest possible time. So it should be possible to reduce notonly the incidence rates and the individuals’ disease burden,but also excessive treatment and follow-up cost. If the‘individual responsibility’ for preserving mental health isemphasised, there will be the risk that the social aspects,

Mental health promotionrequires social change:a communication challenge

particularly of mental health promotion, are not sufficientlytaken into account. Precisely the empirical experienceshows that the current conceptions of mental health andresilience have to be extended, amended and thusabolished. Therefore, it is important to include this systemicand socioecological perspective when reflectingcommunications processes.

From disease to health communicationAt its core, the promotion of health is a communicativechallenge – at the level of the individual, of socialenvironment, of politics and of the society as a whole. Inorder to initiate a ‘salutogenetic change of perspective’, anawareness for the value and the necessity of resilience mustbe developed first. In the same way as the health system isfocusing on the treatment of diseases rather than on healthpromotion, communication and public debate areconcentrating on diseases instead of health. ‘Diseasecommunication’ is dominating. It focuses on diseases andtheir risk factors, while a salutogenetic perspective and,thus, mental health and conditions promoting mentalhealth are hardly discussed.


Accordingly, mental stress and its consequences aremainly recognised as important social topics. This can beidentified as one of the reasons for the lack of publicawareness, understanding of and support for measures tostrengthen resilience and it calls for a change of thinkingin all social areas, which can only be initiated andaccompanied by communication. By emphasising thesignificance of mental stability and the possibilities tostrengthen it, changes in the social debate and the publicawareness can lead to political and programmaticinnovations and, finally, make change happen.

Cognitive schemes and culturalmodels as starting pointsCommunicators face the challenge that they frequently donot reach people with their messages or that theinformation is understood differently than intended. Thebackground to this is the discrepancy between the demandfor specialist information and the available knowledge, theproblem perception as well as the willingness and ability todeal with information and process it. Therefore, the analysisof the factors influencing whether and how informationreaches the people is fundamental. It depends on theavailable cognitive schemes. These are structured and quitestable knowledge complexes including knowledge ofevents, situations and objects forming a network ofassociations. This network has an impact on how peopleprocess and respond to information. A cognitive schemethat is socially shaped and shared is referred to as a culturalmodel. Concerning resilience, it is to be assumed that in thecontext of mental health no differentiated or a ratherdistorted cognitive scheme or cultural model has existed sofar, and therefore the necessity of a resilience-sensitiveattitude and of the promotion of resilience has not beenconsidered really relevant in the broad public.

Changing the individual and thepublic agenda by framingWith the respective communications strategies it is possibleto influence cognitive schemes or cultural models, impartknowledge and thus open up new roads for our thinking. Incase of so-called ‘strategic framing’ certain elements of a setof facts are specifically selected, stressed and assessed,while other elements are neglected. When you strive tomodify attitudes and structures relating to resilience, thehealth aspect and the strengthening of protective factorshave to be emphasised, in order to put this facet of thetopic on the public and individual agenda.

An adequate framing strategy considers the subjective andthe collective value-related backgrounds as well as thesociocultural coherences (key phrase: socialcommunication), by considering the individuals’ everydayreality and living environment when developing themessage. Using narrative metaphors is a successful way totransfer scientific information appropriately for each targetgroup, because they are easy to understand and activateemotions. As a result, it is possible to organise informationin new ways, fill in gaps of understanding, and thereforereframe dominating frames and cultural models. Thisframing process should take place on all levels ofcommunication in order to change the social debate andinitiate a change in the system towards the promotion of resilience.

This text is an extract of the eponymous article by Paul Bomke, CEO of

Pfalzklinikum, Professor Dr Eva Baumann, professor for communications science

and Mareike Schwepe, research assistant both of the Hanover Center for Health

Communication, and the Hanover Academy for Music, Theatre and Media.


thinking – a more recent form of CBT, more akin to thetypes widely practised today, was developed bypsychiatrist Aaron T Beck in the 1960s. His idea of cognitivetherapy is similar to REBT but places a special emphasis onthe patient identifying and challenging their negativeways of thinking of themselves, and stresses theimportance of a warm therapist/patient relationship,something Ellis largely disregarded.

According to Beck’s theory, people with depressionexperience a ‘cognitive triad’ of negative thoughts about theself, the world, or the future, which occur spontaneouslyand which they perceive to be true even despite evidence tothe contrary. These ‘automatic thoughts’ interact with oneanother and interfere with more logical ways of thinking.

Added to that, says Beck, individuals prone to depressionoften develop a negative self-schema in response to atraumatic childhood event, i.e. a set of assumptions aboutthemselves which are critical and pessimistic, and whichlead to self-defeating thoughts and errors in logic. Amongthese distortions, Beck identified personalisation (blamingsomeone else’s low mood on yourself ), selective abstraction(focusing on just one part of a situation and ignoring otherfactors) and overgeneralisation (drawing negativeconclusions about something on the basis of one smallthing) as causes of anxiety and depression.

Unlike REBT, Beck’s cognitive therapy bases its method onthe particular disorder being treated, rather than thepersonality of the patient, and has most commonly beenused to treat depression, for which it is considered one ofthe most effective treatments.

Cognitive behavioural therapy (CBT) is an innovativeform of psychotherapy based on the idea thatnegative and inaccurate thought patterns (i.e.

cognitions) result in and maintain psychological distressand harmful behaviour. Today one of the most widelypractised psychotherapies in the world, CBT represents amove away from the more traditional psychoanalysispioneered by Josef Breuer and Sigmund Freud and insteadoperates on the basis of three main principles: the waypeople think influences the way they feel and the way theyact; problematic thought patterns sustain mental disorders;and people can be taught to identify these thoughtpatterns, change their outlook, take constructive action,and feel better.

Rational emotive and cognitive behaviour therapy The history of cognitive behavioural therapy can be tracedback some 60 years ago to 1955 with the development ofrational emotive and cognitive behaviour therapy (REBT)by renowned American psychologist Dr Albert Ellis. Ellis’theory states that each individual has a unique set ofbeliefs about themselves and their world which determinehow they react to events in their life. In some individuals,those beliefs can be irrational and illogical, which can leadsomeone to act in ways that cause them emotional and/orphysical distress. Common irrational assumptions include,amongst others, the idea that you have no control overyour own happiness, that your past determines andinfluences your present, that you are a failure if not lovedby all who know you, and that perfect solutions exist forhuman problems.

REBT works by employing highly emotive techniques to helppeople to identify and challenge their irrational assumptionsand replace them with healthier thoughts which promoteemotional wellbeing and support them towards an endgoal. It follows five basic steps, commonly referred to as theABCDE method: 1) Activating event – that which triggers theanxiety; 2) Belief system – how the event is (negatively)interpreted; 3) Consequences of the irrational belief system;4) Disputing irrational thoughts and beliefs; and 5) Effects ofexamining and challenging your belief system.

Cognitive therapyEllis’ approach relies on the therapist acting as a teacherand forcing the patient to confront their negative ways of

Talking about CBTCognitive behavioural therapy is today one of the mostwidely practised forms of psychotherapy in the world;

PEN explores where it came from and some of thearguments in its favour


represents almost half of all therapy courses and is themain psychological treatment provided by the NHS, CBThas received significant financial investment through theIndividual Access to Psychological Therapies (IAPT)programme, which provides particular individuals withaccess to a number of cognitive behaviour therapysessions over a fixed period of time. The IAPT programmehas demonstrated an increase in rate of return toemployment of around 5%, suggesting the programmemore than pays for itself given the reduction in welfarebenefits that have to be paid.

What’s more, in its ‘No health without mental health’strategy, the UK Department of Health estimates that theNHS could make some £179m (~€232m) in savings over fiveyears, and almost 3,000 quality adjusted life years could begained, by an investment of £67m into the provision of CBTto people with medically unexplained symptoms.

Nonetheless, while CBT may be for many the therapy ofthe moment, it remains a relatively young field of studyand research is of course ongoing into its use and long-term effectiveness.

Evaluating CBTCBT has advantages over other ‘talking therapies’, whichexamine causes of distress or symptoms in the past, in thatit offers a shorter term approach, focuses on immediateproblems and difficulties, and looks for ways to improvesomeone’s state of mind and functionality in the present.However, this common sense approach has led to criticismfor its apparent superficiality and failure to provide insightinto difficulties, and has received backlash from someexperts who argue that not enough attention or funding isbeing placed on psychoanalytic research.

Nonetheless, CBT has a long tradition of empirical evaluationand is among the interventions best backed up by evidencefrom randomised controlled trials. In her paper ‘Cognitive-Behavioral Therapy and Neuroscience: Towards CloserIntegration’, published in the journal Psychology Topics,Nataša Jokic-Begic of the University of Zagreb, Croatia,makes the case for the neurobiological justification of CBT.Indeed, neuroscientific research, she points out, emphasisesthe ‘significance of positive emotional states as facilitators ofa neurobiological change’.

Jokic-Begic writes: ‘New scientific research onneuroplasticity suggests that positive emotional states maytrigger lasting, durable changes in the structure andfunction of the brain ... which instantiate and promotefurther adaptive thoughts and behaviours. Therefore, CBTorientation towards creating a positive and optimisticatmosphere, which is attained by removal of symptoms, isneurobiologically justified.

‘With a new generation of research methods includingbrain imaging, new insights have been gained into themediators of change during CBT. The findings of thesestudies are consistent with the notion that CBTinterventions alter brain functioning associated withproblem-solving, self-referential and relational processing,and affect regulation. Research designs including pre- andpost-treatment neuroimaging measurements revealed thechanges in cortical and subcortical structures. It has beenpostulated that cognitive therapy influences top-downbrain regulation; therefore, the changes are permanentand generalised to different areas of life.’

Economic benefitsCBT has also witnessed growing political support thanks toits proven cost-effectiveness, which has been well-documented. For example, in the UK, where CBT

Mental health at workMental health in the workplace is an area on which MentalHealth Europe (MHE) is placing particular focus at themoment. Asked about some of the issues here, OphélieMartin, who is in charge of communications at MHE, said:“Prevention is key to better mental health at work, and likethe promotion of physical health, the promotion of mentalhealth in the workplace should be seen as a virtuous circlerather than a burden. There is a strong business case forpromoting mental health and wellbeing at work. Recentresearch in the UK has shown that FTSE 100 companieswhich prioritise employee engagement and wellbeingoutperform the rest of the FTSE 100 by an average of tenpercentage points. Healthy employees make for healthyworkplaces: for many years, MHE has promoted evidencethat positive mental health in the workplace lessens theneed for time off and increases productivity and costsaving on the short and long-term.”

She added: “Early signs of mental ill health can varyenormously from person to person, and can includephysical, psychological, and behavioural changes. Physicalchanges could include changes in sleep patterns, appetiteor weight changes, or physical pain such as back pain.Psychological changes could include anxiety or distress,mood changes, or indecision. Behavioural changes mightbe increased smoking or drinking, persistent lateness, andworking longer hours than normal.

“Therefore, good line management is key to creatinghealthy workplaces, spotting early warning signs, andintervening early. Therefore, training on how to deal with mental health at work should be mainstreamedthrough both mental health literacy training, and bestpractice in management.”


Social communication:Pfalzklinikum’s CEO PaulBomke about the challengesin the healthcare setting

IT is increasingly clear that greater dialoguebetween stakeholders and innovative newapproaches go far in addressing the challenges

facing healthcare systems today. Pfalzklinikum’s CEO, PaulBomke, underlines the importance of communication inan interview with PEN.

What are the primary challengestoday in the healthcare setting – andhow can a focus on leadership helpovercome them?The primary challenge at the moment is confronting the so-called ‘VUCA-World’: volatility, uncertainty, complexityand ambiguity. These four criteria are increasing in our workat the moment, in Germany and across Europe in healthissues and particularly when it comes to mental health.

As a leader I am dealing with new forms of complexity whileworking to increase contact with more stakeholders. Forleaders generally, we need to encourage the spread of skillsbeyond those that make a good administrator or manager;you need an understanding of what is important across thesector. For example, you have to find ways to implementnew instruments for scanning the (social) environment.

How can healthcare leaders betterengage with policy makers? Why isthis so important?As the complexity is increasing, policy makers need to beaware that they are part of the complexity. Sometimes weencourage them to reduce the complexity through theirown interventions when it comes to health legislation. Atthe moment, in Germany there are two big legislative issuesunder discussion in our field. The first is about social welfare

and the second about financing mental health. My job is tospeak to policy makers about the issue of interdependenceof the two sectors, which are involved (welfare and health)when they discuss new laws and what is important for dayto day work.

We take the approach of working to understand how othersare organised to confront challenges. Taking account of theEuropean view can help policy makers understand thatthere are other solutions for the challenges we face acrossEurope. I always try to bring this into discussion whenmeeting with policy makers in Germany; for instance,looking at how the UK is dealing with prevention or howmental health is being treated in Scandinavia. New ideasmust always be brought into the discussion to help policymakers widen their understanding.

Do you feel the European institutionscan play a greater role in this arena? The EU work on health is focused on bringing together allthe different healthcare systems. Improvements could bemade on how experts come together at the European levelto enhance their understanding of innovation and differentpractices. In many ways Europe should act to improvedialogue between countries rather than taking up newpowers and its own legislation issues.

How do you feel dialogue betweenthe healthcare system, policy makersand the public can be enhanced?This is a key area in which we are working at the moment –what we call ‘social communication’. We have to invest andembrace a broader view of communication issues: ratherthan how can I convince a partner, or market, of a solutionto a problem, the emphasis should be on social change for


all and the role that communication plays. For example,when it comes to interest in our work on mental health, wehave seen that experts like to have a disease marketing andcommunication strategy. However, there is no view onhealth literacy in the mental health context. The reason isthat we are trained to focus on things that are not working,always trying to convince people that if they do not dosomething they will get ill. Our frameworks approach ismore about improving health literacy or improving

competence in the communication process. This is more anapproach of focusing on what is good for health, rather thanwhat helps to avoid becoming ill. This kind of thinkingrequires a totally different approach to communication withpartners and stakeholders.

The approach is a new form of dialogue which I am workingto implement in our region when it comes to preventionaround mental health.


For 15 years, the FrameWorks Institute has pursued aportfolio of research projects investigating howAmericans view health access, immigration, food

quality and safety, fitness and obesity, community andmental health, children’s issues, gene-environmentinteraction, environmental degradation, climate change,racial disparities, public safety, and the role of government.Over this period, we have built a highly regardedinstitution that has contributed to the development of acommunity of active framers who use our research to buildpublic will and redirect public thinking. In 2015,FrameWorks received the MacArthur Foundation Award forCreative & Effective Institutions.

The FrameWorks Institute uses empirical research toinvestigate current patterns in public thinking about socialissues and delivers its findings to advocates, researchers,practitioners and service providers to help them engageand inform the public and achieve their communicationsand policy goals.

We have pioneered a new approach to communications –Strategic Frame Analysis™ – that is grounded in theories andmethods used across the social and cognitive sciences tomeasure how humans understand complex, abstractsociopolitical issues and how communicators can reframethese issues to affect outcomes, ranging from publicunderstanding and attitudes to communications efficacyand policy support. Our work has been published in peer-reviewed journals and is used widely in various forums,

ranging from the National Academy of Sciences to theMonterey Bay Aquarium.

Moreover, because we pay equal attention to adult learnersand their specific needs in approaching our work, we areable to point to entire coalitions of non-profit sectorprofessionals, scientists and policy advocates who haveadopted FrameWorks’ language, implemented itsrecommendations, and become master framers to goodeffect. These conclusions are supported by both externaland internal impact evaluations.

Strategic Frame Analysis emphasises the importance of anexplanatory approach to improving public understandingof social issues. Numerous studies in the cognitive sciences,as well as a growing body of FrameWorks’ research, haveestablished that the public’s ability to reason aboutcomplex, abstract or technical science and public policyconcepts relies heavily on the framing cues provided byvalues, metaphors and other frame elements. As a result,FrameWorks actively develops simple, concrete metaphorsand other tools to help people organise information in newways, take in and understand new information, and shiftattention away from unproductive default thoughtpatterns. FrameWorks identifies, empirically tests andrefines explanatory metaphors and other reframingstrategies for complex social problems using a wide rangeof discrete methodologies.

By Nathaniel Kendall-Taylor, CEO of FrameWorks

About the FrameWorks Institute


Maintain health, cope with stress

Especially in times of a shortage of skilled labour in thehealth and social economy, economic pressureconnected with higher demands, and changing work

processes, it is crucial to equip the company and itsemployees with strategies to cope successfully withchallenges and remain healthy. In organising its companyhealth management (CHM), Pfalzklinikum is following arather innovative approach. Instead of focusing on thecommon disease-oriented (pathogenetic) view, all CHMmeasures follow the salutogenetic approach by theAmerican sociologist Aaron Antonovsky. The approachdeals with the question of how to keep people healthyrather than identifying the reasons why they become ill.Based on this idea, it has been possible to offer a wide rangeof services for the Pfalzklinikum employees.

As the first step, Pfalzklinikum designated representativesfor CHM in all facilities and areas. These ‘CHMrepresentatives’ meet periodically in order to improve andcritically scrutinise the working conditions along with thepersons concerned. In so-called ‘health circles’, problems areanalysed and requirements identified. In further trainingcourses, the CHM representatives deal with issues such asstress reduction, methods of coping with extra work load,and the correct way to identify problems in the workingenvironment at an early stage.

Stress, gender and leadershipAll employees of Pfalzklinikum can take part for example instress coping workshops where they learn how to reduce

stress most effectively, and how to identify and handlestrain. The conditions that can cause stress are alsoinvestigated. This is done through practical exercises such asbreathing techniques, body journeys, visualisation andactivation tricks, those participating learn to quickly relievetension and regain new strength during their workday.However, they also develop methods for how to preparethemselves for stressful situations and to prevent one’s ownstressors from gaining too much ground.

The gender aspect plays an important role in the field ofclinical, outpatient or home care. It may happen thatpatients or clients coming from a different culture refuseto be treated by a female care giver and vice versa.

Workshops covering this subject are meant to help buildup gender-specific skills in treatment, support and care ofpersons with mental impairments. The participants willreflect on their roles and their behaviour and work offsubconscious stereotypes.

Salutogenesis and maintenance of health is offered inmanagement lectures for Pfalzklinikum middlemanagement staff. In workshops, they learn how health canbe maintained, particularly with reference to their ownleadership behaviour. The aspect of diversity and the offerof equal opportunities for employees of different origin, sex,age or culture group is also taught. In addition, executiveslearn how to benefit from these differences in a group.

By Romina Männl and Elena Posth, deputy director of publicrelations of Pfalzklinikum

Company health management at Pfalzklinikum


Evaluation of decentralised community services formental health

What is the state of thequality of life?

Over the course of the last few years thePfalzklinikum’s Betreuen – Fördern – Wohnen (caring– fostering – living) department has decentralised its

community-based mental health residential services. Theaim for them is to become ‘part of the community’ of townsin the Palatinate. In collaboration with a student practiceproject of Aalen University and Professor Anke Rahmel,suitable and easily deployable instruments for measuring ofthe quality of results have been tested in order to provide abasis for a longer-term evaluation of specific projects.

Level of satisfaction in differentspheres of lifeThe Berliner Lebensqualitätsprofil (Berlin life quality profile,BELP- K)1 is an assessment of subjectively perceived qualityof life. It is the German version of the Lancaster Quality ofLife Profile and was used as an ‘easily applicable instrumentfor detecting the subjective quality of life’, supplemented bytwo areas from the personal outcome scale (POS). Thesubjective quality of life is rated as satisfaction in generaland in different areas such as social relations, leisure, work,finances, living situation, family and security.

The POS2 domains – social inclusion (e.g. how manyneighbours do you know by name?) and social relationships(e.g. how frequently do you have contact with friends?) –were integrated into the questionnaire in order to queryexpectations, wishes and fears.

The first survey was attended by 40 residents with mental impairments (36 men, four women, 75% with anF.20 – F.29 diagnosis, i.e. with schizophrenia, schizotypy ordelusional disorders).


Results of the first surveyIn relation to the individual questions, financial satisfactionand physical health reached the lowest average means. Thehighest scores were found in family and contact with others.

Living with others is positively perceivedBased on the methodological experiences of the baselinesurvey, two surveys on decentralised locations have beenconducted by a second student project group: eightresidents in a recently opened assisted living setting in asmall town environment and 15 residents in a more urbansituation – in the Palatinate city Speyer – were interviewed.

The results of the follow up survey (small town) some weeksafter the move to the new environment show no dramaticchanges: mean value t1 = 4.77; mean value t2 = 4.86. Thelowest satisfaction value remains in the domain of financialresources. A positive trend was found considering thehousing conditions and to living together with people inthe same apartment. The level of subjectively perceivedsecurity feeling has not changed.

Habitants reflect their new living conditionsPositive: more independence, better local trafficconnections, people are more normal, good generalpractitioner, shopping, more silence, better reputation,better feeling of freedom (…)

Negative: Missing old friends, doing more everyday activitieson my own, longer distance to occupation or work (…)

Recommendations for other people who think aboutmoving: Less negative thoughts, no fear, gain your ownexperiences (…)

In Speyer the overall mean of BELP-K is 5.2 (satisfied) andthe town is generally described in positive terms: good city,great townscape, street music and atmosphere, shops (…)

ConclusionThe concept of the subjective quality of life is viewed as one– among others – quite true to life indicator for the successof efforts to decentralise and normalise residential services

for people with mental impairments. It is alsounderstandable for the interviewees and provides a basisfor a more extensive dialogue about questions such as‘What does quality of life mean for me personally?’, ‘What isa good life for me?’

The development of new residential and care forms must bemeasured against the benefits for the individual.Pfalzklinikum is planning follow-up studies in larger intervalsat other decentralised locations and seeks for opportunitiesfor network and exchange with similar projects.

By Hans Frech, deputy director of the Pfalzklinikuminstitution Betreuen – Fördern – Wohnen

(community-based services)

1 Kaiser W, Isermann M, Hoffmann K, Huxley P, Priebe S. (1999) Shortassessment of subjective quality of life. Application and results of ashort form of the Berliner Lebensqualitätsprofil (BELP – KF). Fortschritte

der Neurologie – Psychiatrie, 67. Jg., Nr. 9, S. 413 – 425

2 Josefs – Gesellschaft gGmbH (2014): 10. Kongress der JG Gruppe,Dokumentation: Wissen, was wirkt. Bonn, JG – Gruppe Köln, S. 40 – 45

Satisfaction with living situation

Pfalzklinikum for Psychiatry and Neurology

www.pfalzklinikum.dewww.resilienz-pfalz.de

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Documents

Re-thinking mental health: Innovations of Pfalzklinikum · resources, and aims to strengthen the individual skills for coping with life and at building health-promoting environmental