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Sustainability in Dutch and Flemish mental healthcare: A descriptive and comparative study
- K. Van Den Broeck, K. Catthoor, J. Luykx, M. De Hert, P. Niemegeers, H. Peeters, W. Krudop, J. Detraux
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S752
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Introduction
There is an urgent need for sustainable thinking and practices in healthcare systems to meet the challenge of climate change (Charlesworth & Jamieson, 2019; Corvalan et al., 2020; Luykx & Voetterl, 2022; Madden et al., 2020). This need is accelerated by the recent energy crisis. According to an international NGO policy paper (Karliner et al., 2019) healthcare institutions are large energy consumers and major emitters. The (mental) health sectors of the Netherlands and Flanders, the northern part of Belgium, also greatly contribute to the global climate crisis. Both regions have per capita emissions (between the 0.50t and 1t) that fall just below the world’s healthcare top emitters.
ObjectivesTo evaluate the state of sustainability in Dutch and Flemish mental health institutions (including psychiatric hospitals, rehabilitation centers, and community mental health centers) and assess whether certain differences can be found in the climate policies of these institutions between both regions.
MethodsBoard members of mental health institutions were asked to complete a 20-item online survey in which concrete actions, objectives and ambitions in the field of sustainability were questioned. Frequencies and percentages were calculated for each question. For certain topics chi-squared tests were performed to test differences in sustainability issues addressed in the questionnaire between Dutch and Flemish mental healthcare institutions.
ResultsSurvey response rates for Dutch and Flemish mental health institutions were 38% and 20%, respectively. Ninety-five percent and 38% of respectively the Dutch and Flemish institutions fully agreed that sustainability is a very important theme (χ2(1)=2,25, p=0,13). Key focus areas in both regions included sustainable energy transition (with half of the mental health institutions sourcing at least half of their energy via renewable energy resources and technologies) and recycling (almost 80% of the institutions). Statistically significant differences were found between both regions with regard to monitoring the environmental impact (Flanders 24% vs. The Netherlands 60%, χ2(1)=6,41, p=0,01) and fostering more sustainable commutes (Flanders 72% vs. The Netherlands 15%, χ2(1)=17,35, p<0,0001). The climate impact of medicines and food, as well as investments in sustainable projects, received little attention.
ConclusionsAlthough a substantial part of Dutch and Flemish mental health institutions consider sustainability (very) important, a systemic ‘transformation’ will be necessary to make them climate neutral, as tenets of practicing mental healthcare sustainably include more than sustainable energy transition and recycling (Monsell et al., 2021). Moreover, a lack of sufficient investment opportunities, partly due to a lack of financial resources, seems to be the main barrier for many mental healthcare institutions for quickly reaching sustainability goals.
Disclosure of InterestNone Declared
EPA-0985 – Remission of Ect-Resistant Depression with Ketamine Anaesthesia
- P. Niemegeers, D. Schrijvers, B.G.C. Sabbe
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- Journal:
- European Psychiatry / Volume 29 / Issue S1 / 2014
- Published online by Cambridge University Press:
- 15 April 2020, p. 1
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Introduction:
Electroconvulsive therapy (ECT) is a highly effective treatment for major depression with response rates of up to 80%. However, a significant minority does not respond, and no evidence-based guidelines are available for the management of ECT-resistance. Ketamine is an anaesthetic agent with N-methyl-D-aspartate-receptor-antagonist properties, that has a rapid but short-lasting antidepressant effect in treatmentresistant depression.
Objectives:To present a case of ECT-resistant depression that responded when ketamine anaesthesia was used.
Aims:To review the available literature on ECT-resistance and augmentation of ECT.
Methods:A case is presented and discussed, followed by a systematic literature review.
Results:We present the case of a 75-year-old woman with severe major depression unresponsive to several adequate treatments with antidepressants, augmentation with antipsychotics, and ECT with anaesthesia using propofol or etomidate. When ketamine was used for anaesthesia, she experienced remission of her condition. She remained well with a continuation of this treatment at a decreasing rate. A literature review revealed that most augmentation strategies for ECT concerned the optimisation of seizures by using of substances that lowered the seizure threshold (e.g. xanthines) or anaesthetics that do not increase the seizure threshold (e.g. remifentanil). Ketamine anaesthesia was shown to speed up response to ECT, but did not increase response rates. However, these studies were not done with ECT-resistant patients. This case suggests that switching to ketamine anaesthesia may be beneficial in these patients.
Conclusion:There are little evidence-based augmentation options for ECT-resistance. This case suggests that ketamine anaesthesia may be efficacious as augmentation in ECT-resistance.