Hi Community Mental Health: What Interventions? What Models?
Barcelona, November 23, 2018
Organize:
Catalan Association of Mental Health Professionals (AEN-Catalonia)
Catalan Congress of Mental Health Foundation (FCCSM)
Summary document and conclusions
Last Friday, November 23rd, the ninth edition of the conference “The Network in Debate” was held at the Official College of Doctors of Barcelona, with the title “Hello mental health and community: What interventions? What models? Reflections on the vitality of the network”Organized by the Catalan Foundation for Mental Health Congress (FCCSM) and the Catalan Association of Mental Health Professionals (ACPSM– AEN Catalonia), it had a high level of participation from professionals from various care and community resources within the network.
The conference—taking advantage of the fact that the current Health Plan of the Generalitat de Catalunya 2016-2020 recognizes mental health as a priority and starts from an integral conception of health with a community-based model—aimed to delve into the concept of community mental health and present different experiences from this model.
At the inaugural dinner, the presidents of ACPSM and FCCSM, Daniel Cruz and Josep Vilajoana, introduced some of the questions that we, as an organization, were posing: can we consider home visits to be community-based, or should we include people close to the patient in the therapeutic approach?
Is it possible to always include actors from outside the healthcare world, such as education, social affairs, housing, employment, and justice, in mental health treatment to broaden the scope of action? To what extent should the role of users and families be included in the organization of care so that it is considered community action? What conditions of the healthcare organization are necessary to ensure quality and ethical care? If we need to work in an interdisciplinary rather than multidisciplinary way, perhaps we should also consider working *with* the community rather than *in* the community. If this means facing new situations, leaving our offices and comfort zones, and learning from the perspectives and interventions of others to build new interventions, are professionals culturally prepared and sufficiently trained to embark on this path?”
In the inaugural session, Pilar Solanes, Head of the Health Department of the Barcelona City Council, representing the Commissioner of Health of the Barcelona City Council, Gemma Tarafa, insisted that the Health Plan must be the framework for articulating mental health with other networks and emphasized the need to focus on promotion and prevention in order to move forward.
Summary of Table 1:
“Mental health and community: conceptual foundations, Moderated by Lluís Albaigès, Marcel Cano, professor of ethics at the University of Barcelona and of bioethics at the University of Victoria, and Claudi Camps, assistant director of the mental health and addictions network for Girona and its surrounding counties, took part. Claudi Camps, who made his commitment to people suffering from severe mental illnesses clear—especially notable was the effort to reduce long hospital stays—brought to the table issues such as the correlation between precariousness and mental health or the importance of ensuring equal rights in all communities, as well as the need to deploy community resources that promote both access to psychotherapy interventions and psychosocial rehabilitation, including access to housing and dignified employment, especially when the psychosocial situation is the trigger. Marcel Cano, in turn, emphasized that going out into the community should not be solely for an assistentialist purpose, but also to include diversity and different visions of what health is, with a more intercultural perspective.
Among many other topics, there was discussion about how mental health is approached in primary care, the imbalance of resources between primary and hospital care, the training of future doctors in relation to mental disorders, the role of family associations, and support for healthcare teams to work in a healthy manner.
Summary of Table 2:
“Presentation and analysis of experiences, moderated by Mercè Teixidó, different experiences of working in the territory were presented. Specifically, Mark Dangerfield presented the project of the Clinical Home Intervention Team of the Vidal i Barraquer Foundation, which consists of carrying out home intervention to reach those high-risk adolescents who are not connected to the network; José Ramón Ubieto explained the Interxarxes program developed in the Guinardó neighborhood; Maria Martinez described the “Néixer i créixer al barri Roquetes” project, which coordinates all neighborhood services aimed at supporting parenting and families in general and is understood as a project for the promotion, prevention, and mental health care of early childhood; and, finally, to conclude, Clara Santamaria commented on a community project promoted by the Tot Raval Foundation, a collaboration of various stakeholders involved in mental health in the Raval neighborhood. The presentations generated great interest, and it was pointed out that for its implementation, community work requires commitment, sustainability, cultural adaptation, and reflective questioning about whether our interventions foster dependency on the healthcare system or are aimed at empowering the community.
The day concluded with José M. López and Myriam Garcia, representing the two organizing entities.
By way of synthesis, we can conclude:
- Health prevention and promotion focuses more on preventing disorders than on treating them once diagnosed. It is a fundamental task in a community health perspective that requires the involvement of normalized social spheres so that families, schools, the workplace, associations, justice, administrations, media, and others become agents of health within the community.
- The community perspective in health goes beyond the biomedical model and includes other actors besides the traditional ones, who belong to diverse areas such as social affairs, housing, work, education, culture, economy, or security, among others, enabling interventions within the patient's life context.
- Coordination between the different areas involved in a community-based mental health care perspective requires the reorganization of traditional times, spaces, and ways of working.
- There is a great deal of heterogeneity in how community mental health is conceived within the network; reflective spaces need to be incorporated to assess the advisability of initiating/maintaining ongoing interventions.
- Training is required for professionals that includes aspects beyond a purely biomedical model, which is more focused on identifying deficits and addressing them from a perspective limited to physiopathological causes, fostering empowerment and support for diagnosed individuals from a place of difference.
- A reorganization of budgets is needed, focusing greater investment on the creation and allocation of community devices that work towards the aforementioned perspective, rather than on maintaining long-term hospital beds.
- We must also take care of the health of professionals in the reorganization processes that this change in perspective in mental health care involves.
- The work dynamics in community mental health that have been developed by care teams are performing well in terms of the reintegration and rehabilitation of patients with severe mental disorders. Both these teams and the associations of family members and individuals with lived experience are also doing important work at the community level, which needs to be well articulated and coordinated with the care teams.
Download summary document and conclusions
