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Ethical issues in assertive outreach and crisis intervention teams
- J. J. Martínez Jambrina
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S165
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Introduction
Assistance to people suffering serious mental illnesses has undergone large variations in the last twocenturies. After World War II, The community became a new destination for them.But hardly anyone knew how to cope with mental illness in thecommunity. Thus, several initiatives arose in the US. Both social work and psychiatry,moved towards a pragmatic point of view by the rising tide of patients seeking help: initiatives trying to providesolutions to themost basic needs of patients: accommodation, food,medical care, takingof medication, etc. By the 1970s, Mary Ann Test and LeonardStein had proven the effectiveness of theirLife Coaching in Madison, Wisconsin. In 1981 his program is disseminated by several states under the name of Assertive TreatmentCommunity and thus spread throughout the United Statesand Canada, Australia and Europe. Psychiatry has recognized it as the program that got the most for supporting the community model. 50 years later the basics of the TAC model remain more or less thesame. But home interventions caused a continuous conflict in the ethical field notwell addressed…
ObjectivesWHY IS AN ACT team a fertile ground for ethicalconflicts?This approach is coercive or assertive?There are several reasons. There is a specific ETHICAL ENVIRONMENT in THE ACT team
1.“Diffusion of Responsibility”-
2. Mutual confirmation bias:
3. There is a tendency to think that professionals areethical by nature.
4. Biased search for information when problems arise.
Sources are sought to confirm us before clarifying whathappened
5. A special tendency to conformism.
6.Repetitive responses.
MethodsWe will analyze the main ethical conflicts arising in ACT teams:
1. CONFLICTS OF AUTONOMY
2. PRIVACY AND CONFIDENTIALITY ISSUES
3. CONFLICTS OF DUTIES
4. ASSERTIVENESS VERSUS COERCION
ResultsThe great challenge is knowing how and when to intervenewith patients with variable decision-making capacity orwithout any insight, as well as the impact on theirautonomy. It is an exercise both in art and inphenomenological training: Because there are subtledeficits, difficult to appreciate, but there are otherdeficits that are obvious.
ConclusionsThe challenge: balancing the needs and safety of thecommunity with the needs and safety of the individual.ACT teams staff must juggle both perspectives, whilemaintaining a therapeutic alliance.
The continuous contact with the patient in an ACT teamgives, especially to clinicians, a privileged place ofobservation to act correctly in those situations and to be asupport so that whoever arrives lacking in affectivity orwith relational problems could grow until reaching a moreprudent and competent judgment.
WHAT COULD HAPPEN IF WE TRAIN PROFESSIONAL IN BIOETHICS MORE IN PATIENT´S RIGHTS, A FIELD FOR LAWYERS??
Disclosure of InterestNone Declared
TRANVIA: A program for continuum mental health assistance in transition period
- L. Pérez Gómez, A. González Álvarez, M. A. Reyes Cortina, E. Lanza Quintana, N. Álvarez Alvargonzález, C. Rodríguez Turiel, E. Lago Machado, J. J. Martínez Jambrina
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S728
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Introduction
Transition between adolescence and adulthood represents the most important challenge for personal development and involves several transformations: physical, psychological and social. It is a complex age bracket, concurring the transition from youth psychiatric units to adult ones, with an increased risk for the appearance of mental disorders and risky behaviours. TRANVIA program, developed in Avilés, provides psychiatric assistance to patients between 15 and 25 years old, diagnosed with a severe psychiatric disorder or with an increased risk of having one.
ObjectivesOur objectives are: ensuring clinical continuity assistance, promoting communication among professionals and the empowerment of our patients to improve their functionality and quality of life.
MethodsDescriptive study including patients involved in TRANVIA program from November 2019 to November 2021.
ResultsDuring this two-years period there have been 44 referrals to the program, 11 of them were rejected for failure to comply with diagnostic criteria. In November 2021 there were 33 patients included in the TRANVIA program with an average age of 17 years old (range: 15-22). 70% of them were men and 30% women. All of them had psychiatric assistance from different sources: youth mental health units, neuropediatrics… About 75% of the patients were diagnosed with autistic spectrum disorder and approximately three-quarters of the sample needed pharmacological treatment. Risperidone was the most prescribed drug. We have also developed other assistance alternatives as home-based care, relaxation sessions, social worker interventions and coordination with schools.
ConclusionsTRANVIA program has allowed us to provide continual attention to vulnerable patients that shift from youth psychiatric units to adult ones. Patients that meet inclusion criteria were enrolled independently the type of assistance they have previously received. Accessibility and flexibility were our priority. During the described period there was only one dropout, three patients required psychiatric hospitalization and two others visited the emergency department. There have been no cases of completed suicide.
Disclosure of InterestNone Declared
Kraepelin, the unitary psychosis theory and the classification in psychiatry
- J. J. Martínez Jambrina
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S750-S751
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Introduction
The history of psychiatry is the history of the unitary psychosis concept. Recent studies on this subject by prominent authors (Huda, Stanghellini, Broome, etc.) confirm that the problem has not been resolved but that it reappears now with more force from skeptical positions, based above all on the insufficiency of the classification criteria official (ICD-10, DSM-V). This skepticism has led to an attempt to make the line that separates normality from mental illness disappear with the weak argument that isolated psychotic symptoms are detected in the general population.The proposals to stop these movements that border on the denial of mental illness try to provide more information on the contextual and subjective factors of mental illness, thus reinforcing the so-called biopsychosocial model formulated by Engel in 1976, whose conceptual imprecision is largely responsible for the problems before indicated as well as other more serious ones for the organization of psychiatric care.
ObjectivesPoint out the insufficiencies of the biopsychosocial model.-Point out the advantages of acquiring a classic evolutionary approach such as the one designed by Iván Pavlov besides the Volga and improved by some followers.-highlight the differences between researching in psychopathology, a true science, or doing it in clinical psychiatry, its practical application. This distinction is essential.
MethodsThe works of some authors who have approached this conflict with dedication and rigor will be reviewed.Research lines followed during last hundred years in psychiatry will be contrasted with the results obtained.
ResultsNew points of view and new tools need to be incorporated to solve this conflict that confuses experts so much are proposed.Ways of working are indicated that should avoid confusion between psychopathology and clinical psychiatry
ConclusionsA psychiatric diagnosis must be established on solid conceptual basis that we currently lack.-Both Kraepelin and Kurt Schneider are two key figures to recover and keep current in our daily practice.-The importance of patient’s subjectivity when taking an anamnesis of their problems seems very important. The question is how to manage that subjectivity in order to analyze it from a classical scientific model, Pavlov’s great desire.-A revisiting of Husserlian phenomenology is essential in the training plans of young psychiatrists and in daily psychiatric care. But this is not enough. We need new tools and new conceptual frameworks so that the phenomenological perspective can contribute to put light in problems as important as those generated by the constant change of diagnosis that is carried out with many patients.If we want a scientific psychiatry we cannot handle with tools that have failed since their creation.
Disclosure of InterestNone Declared
2815 – Quality of the Assertive Community Treatment in the Avilés (Spain) Act Team
- J.J. Martinez Jambrina, G. Gonzalez Lopez, J. Alvarez Solares
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- Journal:
- European Psychiatry / Volume 28 / Issue S1 / 2013
- Published online by Cambridge University Press:
- 15 April 2020, 28-E1689
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Introduction:
Martinez Jambrina et al. (2010) developed the first research on the quality of assertive community treatment offered by Avilés ACT team to patients who were referred to this service with psychiatric diagnoses included in the group of severe and persistent. This research focused on the study of quality standards on internal organization, assistential activity, external coordination, accessibility and quality of care considered by the users and their families.
Objectives:To analyze the quality of the interventions of the Avilés ACT team during one year (april 2011–april 2012) and compare it with results reached in 2010.
Methods:Descriptive Research - No experimental - Transversal.
Population:ACT Team 11 members (2 psychiatrists, 6 nurses, 2 auxiliar nurses 1 social worker) and Users of ETAC: 110 users.
Variables- Internal Organization:- Assistential Activity- External Coordination- Accessibility- Quality of Care.
Conclusions:The results obtained are similar to our first research (2010) The ACT team of Aviles works with quality levels that can be considered optimal if referring to USA standards of quality in this intervention