1 A Christian Mental Health Service – experiences from SwitzerlandDr. med. Samuel Pfeifer, Switzerland CMS Psych Day London 2010
2 Switzerland - more than tourism
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5 History since 1900
6 Education, Supervision, Fellowship
7 Three pillars Compassionate Professional Christian
8 Therapeutic Concept Social Therapy Disorder- specific Therapy RehabWork Milieu-Therapy
9 Therapeutic Milieu ... A temporary community of persons who have been brought together by the individual course of their lives and the course of their illness – a community of suffering, but also a community of coping. Organizing and shaping the therapeutic milieu is one of the most important tasks of the treatment team. Basic principles of the ward structure are adapted to the individual needs of a patient. Precursors of this model: “Moral treatment”
10 Week Schedule Montag Dienstag Mittwoch Donnerstag Freitag08.10 – Andacht 08.30 – Morgentreff 08.35 – Laufgruppe 09.30 – 11.00 Kreativ-Atelier Gruppe III 09.30 – 10.05 Gymnastik Gruppe I 09.30 – 10.30 Gruppe II Gymnastik Gruppe III 10.40 – 11.15 Gruppe VI 10.30 – 11.30 Kreaitv-Atelier GruppeI Gesprächsgruppe 10.30 – 12.00 Gruppe „ A“ Gruppentherapie Gedächtnistraining 13.00 – 14.15 14.45 – 16.00 Malgruppe 13.00 – 14.30 ab 14.30 Gemeinsamer Nachmittag 14.30 – 15.30 Wochenausklang 14.30 – 16.00 16.00 – 17.00 Sing- und Spielgruppe im Ottilienhaus 14.15 – 15.15 Atem und Bewegung 16.00 – 17.30 Gruppe Essstörungen
11 Milieu-Therapy
12 Milieu-Therapy
13 Switzerland – Facts and Figures7.3 Million inhabitants (1.4 non-Swiss) Life expectancy: f 82,6 y; m 76,7 y squ. Km, half of it: alps Four languages (German, French, Italian, Rumantsch) CH: Confoederatio Helvetica 26 cantons Capital Bern Es gibt deutschsprachige, französischsprachige und einen italienischsprachigen Kanton, und es gibt Kantone, in denen deutsch und französisch und einen Kanton (der Kanton Graubünden), in dem deutsch, italienisch und rätoromanisch gesprochen wird. Es gibt Kantone, die praktisch nur aus einer Stadt bestehen, zum Beispiel den Kanton Genf, und es gibt Kantone, die fast nur aus Bergen und Tälern bestehen, wie der Kanton Uri. Im kleinen Halbkanton Basel-Stadt mit seinen 37 km2 leben mehr Menschen (188'500) als im Kanton Graubünden (7105 km2), in dem sich die 186'000 Einwohnerinnen und Einwohner auf 150 Täler verteilen. Der Kanton Zürich hat über eine Million Einwohnerinnen und Einwohner, andere Kantone füllen mit ihrer Bevölkerung nur ein kleines Fussballstadion, wie zum Beispiel der Kanton Appenzell Innerrhoden mit 14'900 Einwohnenden. Es gibt ältere und jüngere Kantone, der jüngste ist der Kanton Jura, der sich 1979 vom Kanton Bern trennen konnte, nachdem diese Trennung 1978 von einer Mehrheit der Schweizer Stimmenden gutgeheissen worden war. Drei Kantone bestehen aus je zwei Halbkantonen
14 Confederate Psychiatry is regionalEvery canton has at least one state psychiatric hospital Private psychiatric hospitals (since ~ 1880) Social Psychiatry (since ~ 1970) Therapeutic networks Trend: Reduction of inpatient services, more outpatient and partial hospitalization treatment.
15 Map of Switzerland Clinic Sonnenhalde Region
16 Cooperation with National Health SystemState funding for regional patients with basic insurance package (28 of 63 beds) Basic package plus «all of Switzerland» (25 beds) Patients with private insurance (10 beds)
17 Diagnostic Groups State ClinicFigures 2002 Psychiatric Clinic Canton Aargau
18 Diagnostic Groups Clinic SonnenhaldeOrganic Disorders 6 Subst. Abuse Dis. 36 Schizophrenia 56 Affective Disorders 239 Anxiety Disorders 32 Various D. 33 59 % Depressions
19 Comparison State Clinic Open Clinic F0 = Organic DisordersF1 = Substance Dependency F2 = Schizophrenia F3 = Affective Disorders F4 = Anxiety Disorders F5 = Eating Disorders F6 = Personality Disorders State Clinic Open Clinic
20 The therapeutic networkState Clinics Clinic Policlinics Day Care Clinic GP Psychiatrist Outpatient Dept. Counselors Inpatient Services: 63 beds, 400 intakes per year Day Care Clinic: 20 Patients Outpatient Dept: >11‘000 Consultations p.y., 1400 patients Sheltered Homes
21 Bild Ärzte 2008!! Our Team 2008
22 Facts and Figures Age Region Length of stay
23 Three pillars Compassionate Professional Christian
24 Compassion – the attitude of JesusMatthew 9,36: He was moved When he saw the crowds, he had compassion on them, because they were harassed and helpless, like sheep without a shepherd. (NIV) Then Jesus made a circuit of all the towns and villages. He taught in their meeting places, reported kingdom news, and healed their diseased bodies, healed their bruised and hurt lives. When he looked out over the crowds, his heart broke. So confused and aimless they were, like sheep with no shepherd.“ (The Message)
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26 Three pillars Compassionate Professional Christian
27 Professional Issues Medical interest, knowledge and continuing education. Having a model of disease and healing. Having a model of supportive treatment in chronic illness. Integrating Psychiatry and Theology on an academic and professional level. Boundaries: The problem of professional sexual misconduct; acknowledging your own limitations (“He grants peace to your borders” – Psalm 147,14).
28 What are the causes of depression?We have to give basic answers to the questions of our patients. PSYCHO-EDUCATION
29 The Bio-Psycho-Social Model
30 Publications 30
31 Psychotherapeutic methodsCognitive-behavioral Therapy Systemic Therapy Psychodynamic Therapy Client-centered Therapy (Rogers) Trauma Therapy Mindfulness (?) Body-oriented approaches Supportive Therapy
32 Three pillars Compassionate Professional Christian
33 Distinct Christian ElementsDoctors and nurses try to make their faith fruitful in their daily contact with the patients and to create a personal ward atmosphere, fostering a general attitude of friendliness, trust and feeling at home, which is so important for successful psychotherapy. Spiritual help in the form of daily devotions and personal application of biblical help are offered to those who wish it. However, we want to show love also to patients who are not yet open for the gospel in a personal way. They should see the love of God through our lives.
34 Christian aspects, contd.A pastoral counselor is an indispensable member of the therapeutic teams. His task is not to do counseling instead of doctors and nurses but rather to advise them how to do it and to support them in difficult situations. Psychotherapy is supported through prayer. Problems in human relations among team members are approached on the common ground of the gospel.
35 Christian perspectiveServing Christian patients – opening up perspectives “Let us read the Bible thinking constantly of our daily lives, and let us live our lives thinking constantly of the Bible.” Theology-Professor Emil Brunner
36 Challenges Keeping the vision: Medical director and director of nursing must have a clear view of the goal. Prayer and inspiration through contact with other Christians in the field. Finding the right doctors and nurses who support the concept of a Christian Psychiatric Hospital, and who fill it with their personal zeal. The human factor: Christians are human too, interpersonal problems need constant attention and - if possible Biblical solution. Giving freedom in personal matters, not demanding a distinct religious style. Wisdom in integrating new techniques and developments in the area of psychiatry and psychotherapy. Applying a "biblical grid “. Wise financial policy.
37 Areas of tension Inner Experience External Framework I D E A L SI want to do what is right and good, pleasing to God. *** other ideals ?? Needs, desires Drives, Impulses Emotions (Sub)cultural rules und limitations Even if there are no external limitations, they are created by negative experiences and transmitted to the next generation or the group of followers. Imagine a boy sleeping with a girl (in love and without moral restriction) and then disappointing the girl. She starts crying, clings to him, shouts at him – negative experience. He may learn from this experience and create new moral standards. SENSITIVE PERSONS perceive the consequences of their acts and behaviour more sensitively and thus create more subcultural (sensitive) rules and limitations, moral guideline, moral scruples. IDEALS An important ideal (without religion) is solidarity Love for a person R E A L I T Y General life situation Social network Physical/emotional constitution External Framework
38 Jars of clay For God, who said, „Let light shine out of darkness“, made his light shine in our hearts to give us the light of the knowledge of the glory of God in the face of Christ. But we have this treasure in jars of clay to show that this all-surpassing power is from God and not from us. 2 Corinthians 4:6-7
39 www.seminare-ps.net/en www.sonnenhalde.chDownload