WHERE WE ARE TODAY: PSYCHIATRIC HOSPITAL CARE AND EXISTING OUTPATIENT SERVICES IN MONTENEGRO

Dr Marina Roganović, neuropsychiatristDr sc Dragan Čabarkapa, executive

directorSpecial Psychiatric Hospital Kotor

MONTENEGRO

PRESENTATION OUTLINE

�Mental Health Facilities in Montenegro

�Special Psychiatric Hospital �Special Psychiatric Hospital Kotor

�Community Mental Health in Montenegro

�Project activities

MENTAL HEALTH SERVICES IN MONTENEGRO

�Primary Care: Mental Health Centers as a part of GP services.

�Secondary Care: Special Psychiatric Hospital Kotor and Psychiatric department within General Kotor and Psychiatric department within General Hospital Niksic

�Tertiary Care: Psychiatric clinic (40 beds) within Clinical Centre of Montenegro in Podgorica

Special Psychiatric HospitalKotor�Public health institution, established in1953;�Special psychiatric hospital Kotor provides psychiatric treatment for the patients from whole Montenegro.�8 departments: 3 Acute, 3 Chronic, Forensic Psychiatric Unit, Addiction Department�Number of employees – 149; �Number of employees – 149; neuropsychiatrists: 5 /one subspecialist for addicts/, psychiatrists: 4, hospital doctors: 7 /attending specialization/, nurses: 80, psychologists: 6, special educator and rehabilitator: 3, social workers: 3�Number of beds - 242�Annual budget 3.00 millions Euros

Special Psychiatric HospitalKotor

Special Psychiatric HospitalKotor

Distinctions in comparison with other psychiatric hospital services

� Involuntary admissions

�Forensic patients;

�Long term care (asylum);

�Separate facilities for drug and alcohol addictsAverage number of patents /250 to 280/ is higher

than number of beds

Treatment in our Hospital

�Treating acute psychaitric disorders: separate departments male and female, hospitalisation duration on average of 45 days,farmacotherapy, psychotherapy,farmacotherapy, psychotherapy,sociotherapy,occupational and recreational therapy work.

�Treating patients with chronic mental ilnesses: long term hospitalisation (asylum), even when in remission

�Forensic patients

Treatment in our Hospital

�Treating addicts: only male department with separation of alcoholic and drug addicts,hospital or outpatient treatment.Hospital treatment lasts from 21 days to three Hospital treatment lasts from 21 days to three months, depending on clinical evaluation,social support and family involvement.The treatment includes farmacotherapy,psychotherapy, sociotherapy, occupationaland recreation therapy work. Family group therapy and education of patients and their family members.

Community Mental Health Services in Montenegro- what we have done

Development of mental health services at community level is at it’s beginings in Montenegro� We started in 2005 year, opening Centers for mental health in Kotor, Podgorica, Bar, Niksic, � Working hours in these Centers is from 7 am until 9 � Working hours in these Centers is from 7 am until 9 pm, it is based on teamwork including psychiatrists, psychologist, social worker, nurses.� Special unit is Addiction counseling.� Community teams and early intervention teams-stopped working �Opening Detox-Units in General Hospitals

Opening our Hospital- what we have done

� Colaboration with Psychiatric hospital “Idrija”- Slovenia, “Sokolac”- Bosnia and Hercegovina, Psychiatric Clinic “Vrapce”- Croatia, Psychiatric Clinic Serbia, Psychiatric hospital “ Dr Laza Lazarević”- Belgrade, Serbia.

� Colaboration with Centers for mental health in Trieste.� Colaboration with Forensic hospital in Maribor, Slovenia� Colaboration with Forensic hospital in Maribor, Slovenia� Colaboration with Foundation Petrović Njegoš, Paris,

France “Centre de la Gabrielle” Bernadette Goszeux� Presentaion of ideas for deinstitutionalisation- Kotor,

Montenegro, march 2015. Bar, maj 2017.� Support groups for addicts in our Hospital, on

Department for treatment addictions. � Internship, volunteering and education for students of

Medical University and Psychology University

Opening our Hospital- what we have done

�Lectures and educations involving people of all ages and social profiles, with an emphasis on giving as much as possible informations for medical workers

� Involving Non Goverment Organisations � Involving Non Goverment Organisations (NGO) in occupational therapy- board games, meeting writers and discussing books, yoga, knitting, handcrafting, decoupage, painting, etc…..

�Metacognitive therapy (MCT)�Example of our associate- NGO Human rights

action Montenegro

Opening our Hospital- what we have done

Opening our Hospital- what we have done

Opening our Hospital- what we have done

�Patinets have their own clothes, and they have gym, growing their own garden, living rooms for gathering and watching tv.

�Managing own money, having mobile phones, going out for supplies in local stores, going to the beach in out for supplies in local stores, going to the beach in summer, going for a walk and visiting local caffes- all of the above depending on current stage of illness.

�There are educations for clients, sports activities, cultural events, exhibitions.

�Going for a weekends with family and friends is allowed for the ones in good remission.

Opening our Hospital- what we have done

Community Mental Health Services in Montenegro- what do we need

�Integration and cooperation of some segments of the healthcare and social services is present in individual cases, but without wider systematic application.�Accomodation for chronic patients in Homes for Elderly people, or even better making possible and Elderly people, or even better making possible and acceptable for their own families to take them home.�Group homes or single residences for users in community�Reinforcement of existing Mental health Centers�Providing home care services

Community Mental Health Services in Montenegro- what do we need

�Patients with court measures of obligatory treatmentshould be placed in Mental care unit of Prison.

�With strategy and the action plan of the Ministry ofJustice is provide establishment of judicial hospital inJustice is provide establishment of judicial hospital inPrison. In May 2017 formed working group forpreparing the construction of the judicial hospital.

�Establishing support groups for clients as well astheir families

Creating Former Alcoholic Assotiations.

Treating acute psychiatric patients in GeneralHospitals

Community Mental Health Services in Montenegro- what do we need

Education for health care workers, as well apopulation in general

Media support, destigmatising mental healthproblems

Goverment support in planing and realisation

Thank you for your attention!