Transcript 1.thou shalt not make the same garment fit all

IMPLEMENTING EVIDENCEBASED SERVICES with
CLINICAL COMPETENCIES in
COMMUNUNITY MENTAL
HEALTH
The TEN COMMANDMENTS of
COMMUNITY MENTAL HEALTH
Robert Paul Liberman
Stockholm Sept 27, 2002
1.THOU SHALT NOT MAKE THE
SAME GARMENT FIT ALL
Indvidualize treatment planning and
service…
Individualize treatment planning
and service by linking intervention
with phase and type of disorder,
disabilities, strenghts, resources
and personally relevant goals
2. THOU SHALT NOT SEPARATE TREATMENT
(PSYCHOPHARMACOLOGY)
FROM
REHABILITATION
(PSYCHOSOCIAL SERVICES)
Comprehensive and coordinated
services require integration…
Comprehensive and coordineted
services require integration within
a single practitioner or frequent
and high quality communication
among members of a
multidisciplinary team
3. THOU SHALT INTEGRATE
ASSESSMENT WITH
TREATMENT IN CLINICAL
PRACTICE
Optimal treatment of individual
patients...
Optimal treatment of individual
patients, as well as inseminating
the art of psychiatry with
scientific progress, requires
initial and ongoing measurement
of symptoms, medication
adeherence, psychosocial
functioning and goal attainment
4.THOU SHALT ASSURE
CONTINUITY OF CARE WITH
CLINICAL AND ADMINISTRATIVE
ACCOUNTABILITY
Psychosocial and pharmacological
treatments must be bridged across
time and place by systems of care
Psychosocial and pharmacological
treatments must be bridged across
time and place by systems of care;
modus, locus and focus of
services require planning,
organization, communication,
liasion, consultation among
agencies and individuals
providing care
5. THOU SHALT USE
EVIDENCE-BASED
PRACTICES
”Doing your own thing” in clinical
work will no longer ”cut the lutefisk”
”Doing your own thing” in
clinical work will no longer ”cut
the lutefisk” or ”bring home the
bacon (dollar, euro, krona, pound,
peso, ruble)”
6.THOU SHALT NOT SERVE ALL
WHO KNOCK ON YOUR DOOR
OR RING YOUR PHONE
Prioritization of services for those
with greatest disabilities...
Prioritization of services for
those with greatest disabilities
and for whom there are evidencebased services will help to
improve clinicians´ competencies
and reduce expenditures of the
mental health system
7.THOU SHALT BE STEADFAST
IN DESTIGMATIZING MENTAL
ILLNESS
Destigmatizing must be an ongoing
responsibility...
Destigmatizing must be an ongoing
responsibility of practioners. Stigma busting can
be accomplished bu judicious self-disclosure of
mental illness and sucessful treatment by
practioners and celebrities, as well as by
consumers; demonstrating how treatment makes
outcomes more positive and predictable;
engaging non-compliant and symptomatic
patients in treatment; reducing violent behavior
by the mentally ill; and hiring stable and
recovered consumers as paraprofessionals
8.THOU SHALT AVOID
PRIVITIZATION AND
MANAGED CARE BY
FOR- PROFIT
ORGANIZATIONS
Managed care has been a colossal
failure in the USA...
Managed care has been a colossal failure
in the USA for the seriously mentally ill
and a calamity for psychiatrists´autonomy.
Beware of saving money while losing
quality of care, but psychiatrists, other
mental health professionals and
stakeholders and their organizations must
be proactive in cost attainment and
accountability od cost-effectiveness
9.THOU SHALT BECOME
POLITICALLY ACTIVE, NOW
AND FOREVER MORE
The financial and political tail always
wags the clinical dog...
The financial and political tail
always wags the clinical dog.
Psychiatry and mental ilness have
always been beholden to society
as much as influenced by
medicine and science
10.THOU SHALT
DISSEMINATE AND
MULTIPLY YOUR EFFECTIVE
METHODS OF TREATMENT
Overcoming obstacles to adoption of
evidence-based, ”best practices” is
aided ...
Overcoming obstacles to adoption
of evidence-based, ”best
practices” is aided by social,
psychological, economic,
organizational, legal and political
tools