Clinical practice and the conditions of professional practice
Barcelona, November 11, 2005
Organize:
Catalan Association of Mental Health Professionals (AEN-Catalonia)
Catalan Congress of Mental Health Foundation (FCCSM)
Summary Document: 1st Conference: The Network in Debate
On the occasion of World Mental Health Day, the Catalan Association of Mental Health Professionals (AEN-Catalunya) and the Catalan Congress of Mental Health Foundation (FCCSM) decided to jointly organize a Conference to address two topics that we consider of utmost interest to professionals and users: the therapeutic relationship and the prescription of medication, and working conditions and future challenges. We wanted to share and exchange experiences on these issues that affect the practice and conditions of professional practice in the public Mental Health network.
This initiative was the expression of a broad consensus around the objectives of the two entities, which, from different perspectives, agree on the defense of public mental health from an integrative, non-reductive orientation, and in defense of the dignity and equity with which citizens' health deserves and has the right to be treated.
If health is a collective matter that is not solely the absence of illness and concerns the entire population and its organizations, AEN-Catalunya and FCCSM wanted, at this Conference, to address aspects related to what can interfere with the achievement of therapeutic goals and influence the distress of professionals and also of users.
Program Committee
Nora Acosta: “Ferran Salsas i Roig” Health Guidance Center. Rubí City Council. FCCSM.
Josep ClusaCatalan Congress of Mental Health Foundation.
Jordi CodinaSant Pere Claver Hospital Foundation. FCCSM
Paz CueCSMA de Martorell. Sagrat Cor, SSM. AEN-Catalunya
Roser Pérez SimóAEN-Catalunya
Xavier ReigDay Centers of Martorell and Sant Feliu de Llobregat. Sagrat Cor, SSM. AEN-Catalunya
INTRODUCTION
The psychiatric reform in our country has led to an increase in demand, without a parallel increase in professionals, nor a recognition of the real needs to achieve public, universal, and quality mental healthcare.
This has contributed to discomfort among users, families, and professionals, which is worth identifying to facilitate overcoming or improving it. We can only talk about psychiatric reform and overcome job dissatisfaction in the network if we identify the elements of discomfort and communicate them clearly and precisely.
At this time, when a new Mental Health and Addictions Master Plan and a Comprehensive Mental Health Plan are being presented and discussed, which will bring about a change in the culture and operation of the network, we hope it will not be limited to cosmetic changes: computerized clinical records, elimination of waiting lists, development of protocols and therapeutic guidelines… But rather that there will be a real change in the way of working; in such a way that we can carry out a therapeutic process (we are no longer talking about psychotherapy), which requires and needs minimum conditions, which are currently not met.
Let's talk about issues as fundamental as:
– How many hours of continuous work can a professional work before their mental availability degrades, and how can we detect this degradation?
– What is the minimum visit time required to create the right climate for shifting from a symptomatic discourse to a subjective narrative?
– What frequency of sessions should be given for us to say we are starting a therapeutic process, and how long will it last?
There is continuous talk of prevention, but in child and adolescent care, we encounter long waiting lists and difficulty addressing pathologies in a timely manner and with sufficient time, which end up becoming chronic.
This refers to the minimum direct work conditions; however, when we refer to the infrastructural conditions of the network, we find an insufficient and unequal distribution of resources that lead to professional burnout and a predominance of pharmacological treatment; we have a set of different networks
They have few points of contact with each other, are fragmented, piecemeal, and lack sufficient intermediate resources; and where the range of services has not yet been completed, especially with regard to psychotherapeutic resources.
The administration must play a very important role, not by increasing bureaucracy or shifting decision-making responsibilities to professionals, but by providing leadership for a true psychiatric reform, listening to the needs of professionals, users, and families.
Equally important is the postgraduate training of professionals. This is becoming increasingly partial, especially oriented towards the traditional medical model with an emphasis on biological aspects and symptom detection, resulting in the application of psychopharmacology and the classification of diseases as the objective and purpose of care interventions.
Psychological elements have been losing ground, not only in the ratio of psychologists to psychiatrists, but in the entirety of healthcare interventions, where both professions exclude the understanding of psychological aspects when concluding an individual or family diagnosis. They are losing the ability to manage effectively, both therapeutically and preventively, in the therapeutic process. Not infrequently, the very concept of process is lost, becoming obscure, incomplete, and even alien to the subject experiencing the illness, their biography, their healthy and preserved parts, their personality structure, and the family, social, and community resources available to them.
This omission of all things “psi” has to do not only with the training referenced but also with the limited time dedicated, both in the duration of visits and the infrequent follow-ups, which are necessitated by the overwhelming patient load in the facilities. This results in many professionals, unable to dedicate time to attending to the psychological and even human functioning of the patients under their care, experiencing discomfort in their work within the mental health network.
Regarding organizations, there is a lack of training spaces and content, spaces for participation and mutual support, and progress in the recognition of professionals. Thus, the complex function of clinical supervision and its importance as a space for joint and free thinking within institutions is often questioned by management.
SUMMARY OF THE ROUND TABLES
TABLE 1: “The Care Relationship and Prescription of Medications”
Participants: Joan Ramon Laporte, David Clusa, Dolors Capellà, Roser Guillamat, Jordi Marfà.
Table Summary
This table presented the initial conclusions drawn by a working group established within the CCSM Foundation. This group was created to analyze the reasons and consequences behind the unstoppable rise in the prescription and consumption of psychotropic drugs in our society. Simultaneously, the aim is to assess the impact that the growing and excessive expenditure on drugs has on the functioning of the healthcare system, specifically on Mental Health care, on other forms of treatment (psychotherapy, rehabilitation, etc.), and on the functioning of the teams themselves.
The initial conclusions presented, which are offered to Mental Health teams for discussion, are, in summary:
New mechanisms are needed to ensure that the drug authorization process better guarantees its effectiveness, relating it to cost.
Information on drugs provided to professionals should not be monopolized, as it has been until now, by the pharmaceutical industry.
Critically assess the reliability of the marketing that this industry uses to promote its drugs.
At the same time, teams must be provided with the necessary tools to access independent training.
This will also provide teams with resources to facilitate research from practice.
Teams must be able to evaluate the impact all these issues have on their own patient care practices and, as mentioned above, on the application of other non-pharmacological treatments, in order to take corrective measures.
Rafael Clusa López
TR Moderator
TABLE 2: “Working Conditions of Professionals and Future Challenges”
Participants
Luis Feduchi, Alfred Capellà, Joan López, Antoni Arteman
Table Summary
Alfred Capellà emphasized the insufficient and unequal distribution of resources, and how this leads to professional burnout and the predominance of pharmacological treatment. As necessary improvements, he proposed a single public network, to avoid current fragmentation, sufficient intermediate resources, and a clear and realistic service portfolio.
Joan López detailed a series of diagnostic elements such as increased bureaucracy, the displacement of decision-making responsibilities, and teamwork problems. As improvements to promote, he highlighted: those in training content, reaccreditation, spaces for participation and mutual support, and progress in professional recognition by organizations.
Luis Feduchi valued the complex function of clinical supervision and its importance as a space for joint and free thought within institutions, which is often questioned by its directive bodies.
Antoni Arteman explained various initiatives in which he is involved from the Galatea Foundation to assess the burnout of professionals and, above all, to try to generate lines of work to prevent it from institutions and the training of professionals.
Albert Mariné
TR Moderator
CONCLUSIONS AND FUTURE LINES OF WORK
The organization highly values the experience of this conference, as it allowed for a debate on fundamental elements of our healthcare practices and working conditions.
The fact that two mental health professional organizations, the FCCSM and AEN-Catalunya, worked together for the first time on the support proposal, which we had from the collaborating institutions from the outset, is also highly valued.
A single public network will be proposed, which will avoid the current fragmentation, with sufficient intermediate resources and with a worthy, realistic, and clear service portfolio.
We need to reclaim the thinking space of professionals, therefore we need to coordinate professionals to think and express their discontent, and we need to promote a process of collecting, compiling, organizing, and transmitting this discontent to the administration and politicians.
It would be good to be able to assess the burnout of professionals and, above all, to try to generate lines of work to prevent it from institutions and from the training of professionals.
Rationalize pharmaceutical spending and make a strong and determined claim for conditions that allow for a dignified and competent response to the problems posed by users.
Barcelona, November 2005
