Open Space
Day Hospital of the Psychiatry and Mental Health Unit of the Neuroscience Department of CHLN
Drª Paula Godinho (Team Leader of the Psychiatry and Mental Health Day Hospital); Profº Drª Luisa Figueira (Director of the Psychiatry and Mental Health Unit); Psicóloga Drª Maria João Centeno, Psicóloga Drª Teresa Fialho, Enfermeira Liliana Campos, Enfermeira Cristina Guerreiro.
The Day Hospital is a Santa Maria Hospital’s Unit of Psychiatry and Mental Health, under the direction of Professor Maria Luísa Figueira and is integrated into the Department of Neurosciences of the Centro Hospital Lisboa Norte.
In 1957, the Day Hospital was the first Hospitalization Unit to be established in the Psychiatry Service of this large General Hospital. It has been a therapeutic and training unit of reference in Portugal, namely in the field where group analytic and psychoanalytic principles are applied on psychiatric and mental health interventions. Moreover it has been sought by people and institutions from all around the country.
A meta-analysis of 18 investigations published between 1957 and 1997 found that psychiatric day hospitals with partial hospitalisation were
an effective alternative to inpatient treatment (Horvitz-Lennon & al., 2001). These authors concluded, “The outcomes of partial hospitalisation patients in these studies were no different from those of inpatients.” They also found that patients and families were more satisfied with this type of provision. Bateman and Fonagy (2008) studied treatment of borderline personality disorder and concluded that partial hospitalisation was effective in relation to decreased suicidal behaviour, self-harm, readmission and depression when compared to controls even after eight years of follow-up. Since 2005, the World Health Organisation (WHO) suggested that partial hospitalisation was a cost-effective alternative to full hospitalisation (Marshall, 2005).
The Patient Population
The Day Hospital has been dedicated to the treatment of young acute patients or under acute decompensation, with an average age of 30 years. The unit’s capacity and proportions of different diagnoses have varied over time. According to ICD-10 (WHO, 1992) they suffer from schizophrenia, schizotypical and delusional disorders (26%–38%), affective disorders (40%–50%), neurotic, stress related and somatoform disorder (15%–20%) and behavioral syndromes associated with physiological disturbances and physical factors (4%–10%). In the majority of cases (50%-60%) patients have co-morbid personality and behaviour disorders.
As for their professional situation, we observe that 21%–30% are unemployed without a professional qualification, 28%–36% are qualified professionals and employees with a career and 20–25% are students.
We emphasize high rates of symptoms’ remission, and improved social-professional functioning at discharge and follow-ups (Neto, Fialho, Godinho & Centeno 2010).
The Team and Trainees
The team is composed of two psychiatrists (one of them in part-time), two psychologists, with psychoanalytic or group analytic training, two nurses and an occupational therapist. There are, in addition, between 2 and 5 trainees from each of the core professions including psychiatry and paedo-psychiatry residents, psychologists and nurses.
Over the last six years the team has contributed to the training of an average of 30 medical students per year.
Through its grupal, clinical and training framework, the team encourages the knowledge, the reflexive questioning and curiosity. The atmosphere is one of freedom, spontaneity and mutual respect, promoting “psychic development and growth” of trainees (Neto, Fialho, Godinho & Centeno, 2010).
The Jane Abercrombie Prize
The team’s training activity and patients’ intensive care, achieved through groupwork, were recognized in 2008 by the Jane Abercrombie’s Award, attributed by the London's Group Analytic Society, to Isaura Neto and Paula Godinho, psychiatrists, and to the clinical psychologists Teresa Fialho e Maria João Centeno.
Jane Abercrombie (1909-1984) was a scientist and university professor, when she became interested in group psychoanalysis. Abercrombie was one of the founders of the London’s Group Analytic Society and its president during 1981. She carried out a pioneer research applying the group analytic premises to teaching groups of medical students, among others, becoming in late 1975 a leading member of the Cambridge Groupwork on Higher Education.
One of her main findings is that group discussion, if properly directed, can promote active and creative thinking instead of passive learning.
In recognition of the importance of her accomplishments, the London’s Group Analytical Society awards since 1984 the Abercrombie Prize to individuals who have undertaken remarkable work applying group analysis concepts in education and training.
The Treating Program
The treating program comprises a direct patient work based on therapeutic activities such as the admission interview, group analytic therapy, weekly individual psychotherapy, medication group, social skills training, and occupational therapy and family interventions. Besides these direct therapeutic activities, the team engages in clinical and staff supervision meetings, determinant for maintaining the quality of care.
The therapeutic program of the Day Hospital has been progressively adapted to the patient’s needs and the Hospital’s reality. Thus, in 2001, following Jorge Garcia Badaracco’s (2000) model, the team started the multifamily group which experience is now being applied in America and Europe, with good results. We also emphasise in our actual framework, the importance of the Mentalization Based Treatment developed by Bateman and Fonagy.
Team of the Psychiatry and Mental Health Day Hospital
The International Acknowledgement of the Day Hospital’s Good Practices
The Day Hospital’s work was recently published in “Psychological Groupwork with Acute Psychiatric Inpatients” edited by a group of authors from the Maudsley Hospital. This work was presented by its author, Dr. Isaura Manso Neto, in a conference held in the Institute of Psychiatry (King’s College / Maudsley Hospital) on the March 18th 2010. The ultimate goal of this book and conference was to promote and disseminate good practices within the psychological group therapy with psychiatric inpatients in the United Kingdom and abroad.
* Graduate Hospital Assistant Psychiatrist Doctor. Team Leader of the Psychiatry and Mental Health Day Hospital. Holder of a Postgraduate Diploma in Mental Health and of a Master Degree in Bioethics by the Faculty of Medicine of Lisbon. hdiahsm@gmail.com
** Clinical Psychologist. Health Senior Technician. Holder of a Master Degree in Clinical Psychology. hdiahsm@gmail.com
***Educational Psychologist. Health Senior Technician. Group analyst. Holder of a Master Degree in Educational Psychology. hdiahsm@gmail.com
Therapeutic, Psychotherapy Group and Multifamiliar Psychotherapy activities room
Paula Godinho*;Teresa Fialho**Maria João Centeno***
Day Hospital of the Psychiatry and Mental Health Unit of the Neuroscience Department of CHLN
Director of the Psychiatry and Mental Health Unit: Prof. Doctor Luísa Figueira
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References
Badaracco, J. G. (2000). Psicoanálisis Multifamiliar, Los Otros en Nosotros y el Descubrimiento del Sí Mismo. Buenos Aires: Paidós.
Bateman, A., Fonagy, P. (2008). 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. American Journal of Psychiatry 165:631-638
Horvitz-Lennon, M., Normand, S-L.T., Gaccione, M.A. & Frank, R.G. (2001) Partial versus Full Hospitalization for Adults in Psychiatric Distress: A Systematic Review of the Published Literature (1957-1997). American journal of Psychiatry 158, 5, 676-685.
Marshall, M (2005). How effective are different types of day care services for people with severe mental disorders. Copenhagen, WHO
Regional Office for Europe (Health Evidence Network report; http://www.euro.who.int/Document/E87317.pdf accessed May 2009.
Neto, I. M., Fialho, T., Godinho, P. & Centeno, M. J. (2010). Treating and Training: A 30 Year Experience of a Team with a Group-Analytic Framework: Part I. Group Analysis, March 2010; 43(1): 50-60.
Neto, I. M., Fialho, T., Godinho, P. & Centeno, M. J. (2010). Treating and Training: A 30 Year Experience of a Team with a Group-Analytic Framework: Part II. Group Analysis, June 2010; 43, (2): 107-126.
Neto, I. M., 2010 Moving groupwork into the day hospital setting. In, J. Radcliffe, K., Hajek, J. Carson & O Manor, (2010), Psychological Groupwork with Acute Psychiatric Inpatients (pp325-342). London: Whiting & Birch.