[Crisis intervention for serious mental disorders. The example of the First Department of Psychiatry of Athens University].

We describe the crisis management and resolution service for serious mental disorders established by the First Department of Psychiatry of the National and Kapodistrian University of Athens. The service is intended to meet patients' needs for adequate management of acute mental crisis without hospitalization, while implementing modern standards in mental care and considering existing restrictions in mental health resources and public expenditure. Last decade we witness an increase in demand for psychiatric beds in Psychiatric clinics of General Hospitals resulting in a drastic increase of auxiliary beds that becomes a serious problem in mental health provision. The shutdown of big psychiatric hospitals in the process of psychiatric reform, accompanied by a delay in the establishment of all the anticipated beds in general hospitals together with overloaded and insufficient network of mental health services in the community are the major determinants. Additionally, fiscal economic crisis of the last decade intensified even more the problem by diminishing funding for the recruitment of new personnel and drastically reducing allocated funding for new and old services. In 2016 we set up a crisis intervention service for serious mental disorders within the operational framework of the emergency psychiatric services of the Department of Psychiatry in Eginition Hospital in Athens. The crisis resolution team is composed by two psychiatrists, a psychiatric nurse, social workers, a psychologist, mental health volunteers, and mental health trainees/students. The patient enters the service through the emergency service when an indication for hospitalization is given by the emergency psychiatrist, followed by the clinical estimation of a member of our team. The therapeutic team convenes twice a week for the new entrants and for follow-up sessions with the participation of the patient and the family members whenever feasible. The rest of the therapeutic interventions take place during the week. The work 'with' the person and not 'to' the person encapsulates the philosophy of the service, which is characterized by a holistic treatment approach aiming to empower the individual strengths and sense of control of the patient for crisis resolution on the basis of a safe therapeutic milieu. Therapeutic interventions include family and supportive members, as well as community interventions. In summation, interventions consist of a) comprehensive evaluation (psychiatric/ physical) and therapeutic plan, b) psychopharmacological treatment, c) psychotherapeutic support for the patient and the family for management of the crisis, d) training for the management of future crises and e) referral to appropriate community services for follow up management and treatment. Treatment lasts approximately 6-8 weeks. Initial data of the evaluation study indicate clinical effectiveness and high levels of satisfaction for patients and family. Conclusively, crisis management and resolution services are feasible even in a time of heavy restrictions in recourses, and anticipated benefits are multiple for the economy, mental health provision, the public health system, patients and relatives alike.

[New patients' access to psychiatric treatment services: Improving the quality indicators of mental health services].

Accessibility of patients to the health system as well as the system's rapid and effective response to patients' needs constitute basic quality indices of health services. Major parameter of accessibility is the required waiting time for a new patient to enter the health system. We present the results of the use of an organized system for the management of new requests for psychiatric treatment, which is based on the triage and evaluation of priorities. While taking into consideration the administrative distribution of the health services, our system intervenes in the waiting time by evaluating the requests in terms of medical and moral criteria, via gradual prioritization. Principal aim is waiting time reduction as well as the optimal response of our service to the needs of our patients. This perspective study was based on the new requests. The 1839 (100%) requests for first psychiatric evaluation at the outpatient clinic of Eginition University Hospital in 2019 were studied in relation to different parameters, as well as the efficacy of the system in terms of waiting-time management. Mean age of the petitioners was 45.8 (± 16.8), with statistically significant rate of women over men (N=1062, 59.1%, p˂0.05). The initial communication with the petitioners and the evaluation of the requests rendered the correct management feasible via immediate referrals to special psychiatric services depending on the nature of the cases, as well as redirection to their local psychiatric services for 1057 (57,5%) of the requests, where needed. The remaining 595 (33,4%) requests, after their assortment into three categories of graded prioritization, were placed in outpatient psychiatric clinics after waiting time of 25 days, 50 days and 76 days, respectively. In conclusion, the results of the study show that the systematic management of psychiatric treatment requests, when scientifically and ethically substantiated, may provide mental health services with manifold benefits.Accessibility of patients to the health system as well as the system's rapid and effective response to patients' needs constitute basic quality indices of health services. Major parameter of accessibility is the required waiting time for a new patient to enter the health system. We present the results of the use of an organized system for the management of new requests for psychiatric treatment, which is based on the triage and evaluation of priorities. While taking into consideration the administrative distribution of the health services, our system intervenes in the waiting time by evaluating the requests in terms of medical and moral criteria, via gradual prioritization. Principal aim is waiting time reduction as well as the optimal response of our service to the needs of our patients. This perspective study was based on the new requests. The 1839 (100%) requests for first psychiatric evaluation at the outpatient clinic of Eginition University Hospital in 2019 were studied in relation to different parameters, as well as the efficacy of the system in terms of waiting-time management. Mean age of the petitioners was 45.8 (± 16.8), with statistically significant rate of women over men (N=1062, 59.1%, p<0.05). The initial communication with the petitioners and the evaluation of the requests rendered the correct management feasible via immediate referrals to special psychiatric services depending on the nature of the cases, as well as redirection to their local psychiatric services for 1057 (57,5%) of the requests, where needed. The remaining 595 (33,4%) requests, after their assortment into three categories of graded prioritization, were placed in outpatient psychiatric clinics after waiting time of 25 days, 50 days and 76 days, respectively. In conclusion, the results of the study show that the systematic management of psychiatric treatment requests, when scientifically and ethically substantiated, may provide mental health services with manifold benefits.