Sustainability initiatives in inpatient psychiatry: tackling food waste.

Background: Food plays a dual role in promoting human health and environmental sustainability. Yet, current food systems jeopardize both. Food waste poses a major global challenge due to its significant economic, social, and environmental impacts. Healthcare facilities generate the largest amounts of food waste compared to other forms of catering provision. Food waste correlates with environmental unsustainability and diminished patient satisfaction, compounding the prevalent challenge of hospital malnutrition and contributing to suboptimal patient outcomes. Materials and methods: In a three-year interventional study (2020-2022) at a psychiatric tertiary care center, we assessed and mitigated food waste using evidence-based measures. We conducted systematic food wastage audits over three years (2020-2022) in May and June, each lasting four weeks. Costs were analyzed comprehensively, covering food, staff, infrastructure, and disposal. Environmental impact was assessed using Umweltbelastungspunkte (UBP) and CO2e/kg emissions, alongside water usage (H2O - l/kg). Results: Economic losses due to food wastage were substantial, primarily from untouched plates and partially consumed dinners, prompting meal planning adjustments. Despite a >3% increase in meals served, both food waste mass and costs decreased by nearly 6%. Environmental impact indicators showed a reduction >20%. Vegetables, salad, and fruits constituted a significant portion of waste. Overproduction minimally contributed to waste, validating portion control efficacy. Conclusion: Our study highlights significant economic and environmental losses due to hospital food waste, emphasizing the importance of resource efficiency. The strategies outlined offer promising avenues for enhanced efficiency. The decrease in food waste observed over the three-year period underscores the potential for improvement.

Implementation of a Budo group therapy for psychiatric in- and outpatients: a feasibility study.

Introduction: Physical exercise has been shown to have numerous health benefits on co-morbid somatic conditions in psychiatry and can also enhance mental health. Thus, it is not difficult to recommend physical training programs as part of an integrated and holistic treatment approach for mental health disorders. However, getting patients to participate and keeping them engaged is a major challenge. Programs based on martial arts training could be interventions improving physical and mental health with higher attachment rates. The structured discipline, holistic approach integrating physical and mental elements, and empowering activities, may explain higher participant attachment rates. Methods: Thus, the main objective of this feasibility study is to describe a newly established group therapy program incorporating interventions from martial arts training with its physical and philosophical parts including mindfulness and breath work. Results: During the 14-month study period from April 2021 to May 2022, a Budo group therapy was used by 215 individual persons with a total of 725 group therapy participations. Retention in the program was good across all settings and very good for persons who participated as outpatients. The mean age of the participants was 33.5 years with a range from 14 to 69 years of age, and about 41% of the participants were female. The therapy program was able to address patients over the whole spectrum of psychiatric diagnoses. Satisfaction and motivation were uniformly self-reported as very good. Patients self-reported improved mental and physical health after participating in a Budo session compared to pre-session. Discussion: Budo group therapy thus can be seen as a feasible, well-accepted and promising new transdiagnostic treatment approach, combining physical activation with resilience enhancement. With minimal contraindications, a broad spectrum of individuals seeking mental health support can engage in this group therapy.

[Quality Development in Psychiatric Care: A Standardized Treatment Process for the Medical Therapeutic Services of UPK Basel]. / Qualitätssicherung in der psychiatrischen Versorgung: Ein standardisierter Behandlungsprozess für die Medizinisch Therapeutischen Dienste der Universitären Psychiatrischen Kliniken Basel.

OBJECTIVE: Within the framework of a quality development project, the aim of this study was to examine the existing, heterogeneous structures and processes and content of various specialised therapies offered by the Medical Therapeutic Services (MTD) at the University Psychiatric Clinics Basel (UPK), and the methods and documentation procedures, for internal and external evidence, in order to create transparency, and to standardise them where possible and thus to increase their efficiency and effectiveness. METHODS: The current-state analysis included a literature review of efficacy studies, guidelines, assessments and indications for the therapies. In addition, performance and personnel indicators of the MTD were systematically determined. The target definition was carried out by means of an iterative project procedure. In a working group, contents of the current-state analysis were compiled in open and exploratory procedures (brainstorming, mind mapping), analyzed in subsequent discussions, and used for developing criteria, evaluations, mapping of process flows and structural specifications. RESULTS: The project resulted in a comprehensive revision of the range of therapies, core concepts of the services and a sharpening of the indications. In addition, an overall process for the MTD was defined, checklists and sample job descriptions were developed, new functions were introduced (responsible for professional training) and a fixed allocation of staff to all departments was established. With the introduction of the ICF, a uniform basis was created with regard to diagnostics, intervention planning and documentation. CONCLUSION: This practical report shows how evidence-based care can be implemented from the perspective of medical therapeutic services with regard to inpatient psychiatric treatment, what effects are hoped for as a result and what challenges are associated with it. The project for quality assurance through standardisation offers clarity and and transparency for all professional groups in the treatment process, which enables patients to receive more effective and individualised treatment, especially through improved indications and diagnostics.

Work-related participation impairments and support needs of patients in a Swiss psychiatric university hospital.

Objective: To assess work-related participation impairments and support needs of adult patients in inpatient and day-care treatment at a Swiss psychiatric university hospital. Methodology: Cross-sectional survey on a department-dependent cut-off date in May and June 2022 using a standardized structured interview. Results: Data were available for 93 patients (response rate 59%), of which 51% (n = 47) stated that they had a job or training place. Patients in first hospitalization and with a job or training place were approached significantly more often. Regardless of age and first hospitalization, 76% of the patients expressed a need for support, of which 92% expressed interest in job coaching. A total of 54% of the patients stated that they had received support from the treatment team. Conclusion: From the patients' point of view, work and education were not addressed by the treatment team across the board and independently of patient characteristics. The need for support was insufficiently met. There is a considerable interest for support programs through job coaching, and this offers opportunities to promote the inclusion of patients in the regular labor market.

The perspective of staff members of two forensic psychiatric clinics in German-speaking Switzerland on the introduction of recovery orientation: An explorative study.

Recovery orientation (RO) is directed at living a worthwhile life despite being impaired by the constraints of mental illness. Although being quite common in general psychiatry in Switzerland, the dual mission of forensic psychiatry-safeguarding and therapy-challenges the idea of establishing RO as a work philosophy in this context. This explorative study qualitatively investigates baseline expectations and professional perspectives of forensic staff members concerning the idea of establishing RO in Swiss forensic psychiatric wards. Thereby, three central themes were worked out, namely "challenges associated with recovery," "expected barriers," and "possible recovery-oriented interventions." From a general point of view, the staff members were uncertain whether RO interventions could be introduced at all, and if so, to what extent. This, on the one hand, had to do with structural obstacles such as security requirements; however, personal obstacles in the form of different, sometimes contradictory attitudesand ideals and fearful anticipations-such as the loss of authority and power-also played a central role. As forensic psychiatric wards are non-existent in Latin-speaking Switzerland, the study does only refer to the German-speaking language region.

[Complex treatment of severe mental illnesses in old age]. / Komplexbehandlung bei schweren psychischen Erkrankungen im Alter ­ eine Positionsbestimmung.

BACKGROUND: The needs for assistance, support and treatment of older people with severe mental illnesses (SMI) are very high and linked to additional age-associated somatic diseases and impairments. Old people prefer to live independently in their own homes and to receive necessary treatment and support there; however, a resettlement in a residential nursing home is often necessary due to a lack of alternatives. OBJECTIVE: What is the current treatment reality in Germany for old people with SMI in their own homes and in residential nursing homes? How can coercive measures in this context be prevented? METHODS: Selected results from the scientific literature on psychogeriatric care models in older people with SMI are summarized and discussed. RESULTS: Multiprofessional psychogeriatric complex treatment models for older patients that include home visits and are adapted to the severity of mental disease are not available in Germany due to the lack of cross-sectoral network structures. Around 30% of the 730,000 nursing home residents in Germany experience coercive practices, whereas person-centered nursing concepts as well as guideline conform and individualized nonpharmacological treatment strategies and milieu therapeutic concepts are not sufficiently available. CONCLUSION: The German healthcare system is in urgent need of multiprofessional psychogeriatric home treatment models in old people with severe mental illness in order to prevent worsening of psychiatric and somatic symptoms, to maintain individual social involvement, to strengthen individual autonomy and participative decision making and to protect from coercion. Multiprofessional expertise is essential as well as effective age-appropriate service models with multiprofessional teams delivering domiciliary visits and connecting complementary services for individual treatment requirements as part of the German health care system.

Peer support worker training: Results of the evaluation of the Experienced Involvement training programme in Switzerland and Germany.

The 'Experienced Involvement' (EX-IN) training programme prepares and certifies individuals who have experienced mental health problems to work as peer support workers and to support others challenged by similar conditions. We aimed to assess the impact of the EX-IN training on hope, self-efficacy, introspection, stigma resistance, personal recovery, health-related quality of life and employment in participants. Data was collected using standardized assessment instruments before the training started (t1) and upon course completion (t2). Data from 103 participants who participated in both measurement times were included into data analysis. Participants significantly improved their recovery, stigma resistance and introspection during the EX-IN training. In addition, a significant higher proportion of participants were employed at t2. Participants whose last inpatient stay was 0-1 year before the start of the EX-IN training showed significantly lower levels of stigma resistance, and self-efficacy at t1 than participants with two or more years since the last inpatient stay. There were no significant changes in mean values over time, or in the mean values at t2 between the two groups. EX-IN training has a positive influence on the handling of stigma, on one's recovery path and introspection. This indicates that EX-IN training has a therapeutic effect on the participants. EX-IN training seems to meet the challenges of peer support work. Therefore, the training can be recommended as preparation for working as a peer support worker as well as an intervention to improve one´s recovery process.

[Perspectives and Opportunities for Psychotherapeutic Interventions in Inpatient Psychiatric Treatment Delivered by Nurses]. / Perspektiven und Chancen für pflegerisch-psychotherapeutische Interventionen in der stationären psychiatrischen Behandlung.

BACKGROUND: Psychotherapy is an essential part of treating people with mental illness. However, the implementation of psychotherapeutic interventions in the field of inpatient psychiatric treatment remains well behind demand. At the same time, the use of psychotherapeutic interventions by other professional groups - such as social workers and nursing - is not a common practice in Germany. OBJECTIVE: What can we learn from the international research with regard to nursing for Germany in view of the insufficient supply of psychotherapeutic care. METHOD: Based on a literature analysis, the German situation of care is related to international developments and a German training curriculum is presented. RESULT: A look at the international literature shows that in other countries especially trained nurses perform psychotherapeutic Interventions. In addition, there are effective training curricula whose transferability to Germany appears to be possible after appropriate adjustments.An 18 months lasting training program for nurses is presented. In addition to disorder-specific competences, this curriculum also provides psychotherapeutic interventions with a general approach. CONCLUSION: Collaborative care in the collaboration of different health professionals has been repeatedly and stably proven to be effective and helpful in treating people with various mental disorders. In order to better meet the growing need for psychotherapeutic interventions in the population in the sense of a stepped care model, trained nurses need to be more involved in the provision of psychotherapeutic services.

[Low-intensity Psychiatric Expert Monitoring and Counseling of Unemployed: Presentation of the Gütersloh Pilot Project]. / Gesundheitscoach ­ Niedrigschwellige Begleitung von psychisch belasteten Arbeitslosengeld II Empfängern: Darstellung des Gütersloher Pilotprojekts.

OBJECTIVE: Psychological problems are highly prevalent in unemployed people and can lead to impairments in several areas of life. Programs to support and assist those affected, especially the long-term unemployed, are scarce. Reservations by those affected present an additional barrier with respect to health care utilisation. The authors designed a collaborative care cooperation project between a local job center and a psychiatric clinic with the aims of counselling unemployed people with psychological distress as well as offering continuing psychosocial care if required. METHOD: This paper presents the methodological design, clinical procedure as well as a preliminary evaluation of the pilot phase. RESULTS: Within the first 12 months of the pilot phase, 57 long-term unemployed were enrolled in the project. Subjective psychological distress in the sample was comparable with other studies reporting high rates of psychological problems in the unemployed. The psychosocial intervention was well accepted not only by the unemployed but also by case managers and led to high re-assignment rates (n=37) to complementary services within the psychosocial health care system. CONCLUSION: Unemployment and psychological distress should be addressed together within collaborative care projects that can positively affect the negative interaction between unemployment and psychological distress. Low-intensity psychological interventions are well suited to address barriers that hinder health care utilization and to offer person-centered, psychological assistance.

[Dimensions of Luck and Happiness in Psychiatric Nursing]. / Dimensionen von Glück und Zufriedenheit bei beruflich psychiatrisch Pflegenden und in der psychiatrischen Pflege.

OBJECTIVE: The purpose of this article is to discuss various aspects of the concepts of luck and happiness within the field of psychiatric nursing. METHODS: Personal factors, work characteristics and work environment were included and combined with case studies from a local hospital. RESULTS: Fortune and happiness of psychiatric and mental health nurses are influenced by contextual factors and individual experiences with patients. CONCLUSION: Fortune and happiness are important factors for nursing situations and outcomes of care. They also affect the number and the quality of the workforce in psychiatric nursing.

[Low-Intensity Cognitive Behavioral Therapy (LI-CBT) - An Introduction in Concepts and Framework]. / Low-Intensity Cognitive Behavioral Therapy (LI-CBT) ­ Eine Einführung in Konzepte und Rahmenbedingungen.

Low-intensity cognitive behavioural therapy (LI-CBT) depicts interventions that aim at increasing access to evidence-based psychological therapies. This is achieved by (1) reducing the amount of time in which the practitioner is in contact with individual patients, (2) using practitioners that have been specifically trained to deliver low intensity interventions and without any prior formal health professional qualifications and (3) use of interventions with varying intensity. Stepped care and collaborative care constitute the organizational frame to deliver low-intensity interventions. Whereas large-scale research and health service projects abroad are focussing on LI-CBT, research in German is lagging far behind. Particularly in the light of the growing demands and utilization of mental health care as well as governmental claims to develop and evaluate new forms of providing mental health services, LI-CBT represents a promising approach.

["Nicht von schlechten Eltern - NischE": A Family Orientated Collaborative Care Approach to Support Children in Families with Mentally Ill Parents]. / Nicht von schlechten Eltern ­ NischE: Ein Brückenkonzept familienorientierter Versorgung von Kindern mit psychisch oder suchtbelasteten Eltern.

"Nicht von schlechten Eltern - NischE": A Family Orientated Collaborative Care Approach to Support Children in Families with Mentally Ill Parents The present work describes the setting- and multi-professional offer "NischE" in Gütersloh, a systemic approach for the care of children and their mentally ill parents. Children of mentally ill parents are a special risk group for developing their own mental illness. The aim of the collaborative care model between child and adolescent psychiatry, youth services and adult psychiatry is to enable affected families in terms of family-focused practice a low threshold access to different services. For this purpose, two positions have been created to advise the affected families and support access to the help system in the sense of a systemic case management in a project. The article describes the background and the need for the development of the offer, the current scientific knowledge base on the subject and illustrates the procedure using a case study from practice.

[Diagnosis of Metabolic Risk Factors in Psychiatric Inpatients]. / Diagnostik metabolischer Risikofaktoren bei stationär-psychiatrischen Patienten.

OBJECTIVE: Individuals suffering from mental illness have one to two decades reduced life expectancy. The increased morbidity and mortality is mainly due to cardiometabolic disorders. Despite these numbers, international studies give evidence that diagnoses and treatment of metabolic risk factors in psychiatric patients is insufficient. We assume that in Germany metabolic risk factors are also underdiagnosed and insufficiently treated. METHODS: We tested for the frequency of diagnoses of the metabolic risk factors obesity, nicotine dependence and abuse, disorders of lipid metabolism, hypertension and diabetes in 139 307 cases of residential treatment and semi-residential care in 47 psychiatric hospitals in Germany in the year 2012. Data were derived from the VIPP(indicators of treatment quality in psychiatry and psychosomatic medicine)-project, a project that comprises the routine data of psychiatric hospitals, that are sent to the InEK (institute for the lump sum payment system for hospitals). Frequencies were compared with prevalence of metabolic risk factors in the German population and prevalences of metabolic risk factors found in psychiatric patients in international studies. RESULTS: In particular obesity (2.8 %), disorders of lipid metabolism (2.8 %) and nicotin dependence (4.2 %) were underdiagnosed. We assume that also diabetes (6.8 %) and hypertension (17.7 %) were underdiagnosed. CONCLUSION: The results give evidence that metabolic risk factors are underdiagnosed and possibly insufficiently treated in German psychiatric hospitals. We cannot exclude that the results might also be due to poor documentation. It remains to be seen if the introduction of the PEPP (the new lump sum payment system in German psychiatry) will heighten the level of attention for metabolic risk factors and their treatment.

[Incidence and Costs of 1:1 Care in Psychiatric Hospitals in Germany - A Descriptive Analysis Based on the VIPP Project Data Set]. / Häufigkeit und Kosten der 1:1-Betreuung in der Erwachsenenpsychiatrie in Deutschland - Eine deskriptive Analyse anhand des VIPP-Datensatzes.

OBJECTIVE: 1:1 care is applied for patients requiring close psychiatric monitoring and care like patients with acute suicidality. The article describes the frequency of 1:1 care across different diagnoses and age groups in German psychiatric hospitals. METHODS: The analysis was based on the VIPP Project from the years 2011 and 2012. A total of 47 hospitals with more than 120,000 cases were included. Object of the analysis was the OPS code 9-640.0 1:1 care. The evaluation was performed on case level. RESULTS: Data of 47 hospitals were included. Of the 121,454 cases evaluated in 2011 3.8 % documented a 1:1 care within the meaning of OPS 9-640.0 additional code. Of the 66 245 male cases a 1:1 care was documented in 3.5 % and the 55 207 female cases was 4.1 %. Compared to 2011, the proportion of 1:1 care in 2012 rose to 4.8 %. CONCLUSION: The results show that 1:1 care is frequently applied in German psychiatric hospitals. The Data of the VIPP project have proven to be a useful tool to gain information on the frequency of cost-intensive interventions in German psychiatric hospitals. Further analyses should create the possibility of evaluation at the level of the individual codes.

[German translation of Suicidal Patient Observation Chart (SPOC) - an instrument for practice]. / Deutsche Übersetzung des Suicidal Patient Observation Charts (SPOC) - ein Instrument für die Praxis.

Nursing of suicidal in-patients is a complex and responsible task. A direct and immediate intensive caring and therapeutic supervision, also known as special observation is still recommended in guidelines (DGPPN, 2012) and maybe one of the most used interventions in the caring of suicidal patients in inpatient settings. It involves many kinds to develop the relationship between the observer and the patient. The original SPOC was developed in Sweden with the aim to increase the quality of a systematically documentation during the supervision of suicidal patients. It is an instrument to ensure systematic documentation of observational behavior or noticeable mood during acute suicidal crisis, for example feelings like "worried, anxious" or other possible influencing factors like "sudden mood variation". By this means the SPOC can ensure the process of systematic documentation of special observation and increase its quality, i. e. who documented what at what time. Furthermore SPOC can facilitate a better communication of the observation process to the multidisciplinary team and to the patient as well. The SPOC includes the 28 items and covers 24 separate observation periods. The aim of this paper is to constitute the translation process from the English to the German SPOC version. The translation process followed a five step model. In the first step the English version was translated from two German native speakers. In the second step, the first two translation results where discussed by the Expert group (authors) and a new version was developed. In the third step the first german version was translated back (two English native Speakers) into English. The fourth step was taken, to review the results by the expert groups (authors) and set up the so called "pre version". The last step includes the proof of content validity by 52 nurses. The proof was able to identify a few misunderstandings and helped to enhance the tool in its final version. With the translation, the German-speaking nursing practice in psychiatry has a tool that can be used by psychiatric nurses regarding their complex interventions to be undertaken in this special group of patients.

[Special observation in inpatient treatment of people with mental illness]. / Die intensive Überwachung von Patienten in der stationären psychiatrischen Akutversorgung.

OBJECTIVE: To report the state of research about special observation and to develop implications for the German-speaking countries. METHODS: Systematic literature search. RESULTS: The literature consists mainly of descriptive studies. There are no standardized approaches. Use of assistants can have a negative impact on quality of the intervention and may result in an accumulation and change of measures. Nurses play a responsible role in special observation. There are different experiences and perceptions of patients and nurses. Special observation includes both therapeutic and non-therapeutic components. CONCLUSIONS: The focus should be on therapeutic aspects of observation; particularly involvement and development of hope. Observation might restrict personal freedom and should be used as rarely as possible. Strengthening nurses in decision-making is associated with increased quality. More research is needed regarding the effectiveness, the frequency of utilization and opportunities for prevention. The importance of observation is in contrast to the lack of relevant data.