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Abstract, Background and objectives. COVID-19 has had a profound effect on mental health. Liaison psychiatry teams assess and treat people in mental health crises in emergency departments (EDs) and on hospital wards. During the first pandemic wave, new Mental Health Crisis Assessment Services (MHCAS) were created to divert people away from EDs. Our objective was to describe patterns in referrals to psychiatric liaison services across the North Central London care sector (NCL) and explore the impact of a new MHCAS. Methods. Retrospective study using routinely collected data (ED and ward referrals) from five liaison psychiatry services across NCL (total population 1.5 million people). We described referrals (per week and month) by individual liaison services and cross-sector, and patterns of activity (January 1st 2020 -September 31st 2020, weeks 139) compared with the same period in 2019. We calculated changes in the proportion of ED attendees (all-cause) referred to liaison psychiatry. Results. From 20192020, total referrals decreased by 16.5% (12,265 to 10,247), a 16.4% decrease in ED referrals (9528 to 7965) and 16.6% decrease in ward referrals (2737 to 2282). There was a marked decrease in referrals during the first pandemic wave (March/April 2020), which increased after lockdown ended. The proportion of ED attendees referred to liaison psychiatry services increased compared to 2019. Conclusions. People in mental health crisis continued to seek help via ED/MHCAS and a higher proportion of people attending ED were referred to liaison psychiatry services just after the first pandemic wave. MHCAS absorbed some sector ED activity during the pandemic.
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Humanos , Ciencias de la Salud , Servicios de Salud , Servicios de Salud Mental/organización & administración , Urgencias Médicas/psicología , Intervención en la Crisis (Psiquiatría)/organización & administración , Coronavirus Humano 229ERESUMEN
BACKGROUND: Surgical crises represent unrecognized opportunities for improving patient safety and adding value in healthcare. The first step in a crisis response is to contain and mitigate harm. While the principles of damage control are well established in surgery, methods of containing harm on broader clinical and organizational levels are not clearly defined. STUDY DESIGN: A multimethods qualitative study identified crisis containment strategies and tools in commercial aviation. These were translated and clinically adapted in 3 stages: semi-structured observational fieldwork with commercial airlines, interviews with senior pilots, and focus groups with both healthcare and aviation safety experts. Thematic analysis and expert consensus methods were used to derive a framework for crisis containment. RESULTS: Fieldwork with 2 commercial airlines identified 2 crisis containment concepts: the detrimental impact of surprising or startling events on operator performance; and the use of prioritization tools to take basic but critical actions (Aviate, Navigate and Communicate model). Twenty-two experts in aviation and healthcare practice informed the topic of crisis containment in 17 interviews and 3 focus groups. Three strategies were identified and used to form a crisis containment algorithm: 1. Manage the operators' startle response to facilitate meaningful mitigating actions (STOP tool); 2. Take priority actions to secure core functions. These included managing patients' physiologic shock, optimizing environmental risks, and mobilizing resources (Perfuse, Move and Communicate tool); 3. Deploy well-rehearsed drills targeting case-specific harms or errors (Memory Actions). This model requires validation in clinical practice. CONCLUSIONS: Crisis containment can be achieved by controlling operators' startle response, applying prioritization tools, and deploying drills against specific failures. The application of this model may extend to healthcare areas outside surgery.
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Intervención en la Crisis (Psiquiatría)/organización & administración , Seguridad del Paciente/normas , Especialidades Quirúrgicas/organización & administración , Aviación/organización & administración , Humanos , Modelos Organizacionales , Investigación CualitativaAsunto(s)
Defensa Civil/organización & administración , Intervención en la Crisis (Psiquiatría)/organización & administración , Planificación en Desastres/organización & administración , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division/organización & administración , Sistema de Vigilancia de Factor de Riesgo Conductual , Urgencias Médicas , Humanos , Técnicas de Planificación , Salud Pública/normas , Estados UnidosRESUMEN
INTRODUCTION: More than 2,500 crisis pregnancy centers (CPCs), which seek to convince people considering abortion to continue their pregnancies, exist in the United States. However, the characteristics of people who visit CPCs and their pregnancy outcomes are largely unknown. This study sought to describe the characteristics of people considering abortion who report visiting CPCs, and whether CPC visit is associated with abortion or continuing the pregnancy 4 weeks later. METHODS: Between August 2017 to May 2018, we recruited pregnant people searching for abortion services online, and 857 participants completed baseline and 4-week follow-up surveys. We described characteristics associated with visiting a CPC and compared pregnancy and abortion outcomes for those who reported CPC visit to those who did not using mixed-effects multivariable logistic regression. RESULTS: Overall, 13.1% of respondents visited a confirmed CPC. Living further away from a CPC was associated with lower odds of a CPC visit. At follow-up, respondents who had visited a CPC were significantly less likely to have had an abortion (29.5%) than those who had not visited a CPC (50.5%). In the adjusted models, respondents who had visited a CPC had higher odds of being pregnant and still seeking abortion (aOR: 2.26, 95% CI: 1.37-3.73) or continuing the pregnancy (aOR: 2.35, 95% CI: 1.33-4.15) (versus having had an abortion), than those who had not visited a CPC. CONCLUSIONS: CPCs may be providing resources to people who are considering continuing their pregnancy and/or they may be misleading people about the care and referrals they provide related to abortion. Pregnant people need access to accurate information, decision support, and resources to make the pregnancy or abortion decision that is best for them.
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Solicitantes de Aborto/psicología , Aborto Inducido/estadística & datos numéricos , Intervención en la Crisis (Psiquiatría)/organización & administración , Adulto , Consejo , Femenino , Estudios de Seguimiento , Humanos , Internet , Oportunidad Relativa , Embarazo , Resultado del Embarazo , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Summary: The main purpose of the current study was to assess whether there are significant differences among variables, such as social workers' familiarity with the crisis intervention model, receiving up-to-date information about the latest developments in COVID-19, having adequate information about what the symptoms of COVID-19 are, and willingness to work with COVID-19 patients, and social workers' ability to apply the crisis intervention model when they are working with clients and its three sub-scales (assessing and identifying the problem, establishing a relationship, and formulating an action plan). The cross-sectional survey method was used to conduct the sample of the study. The sample (N = 274) used in the study consisted of social workers in Kuwait.Findings: The results showed that CIS is valid and reliable and can be trusted to measure levels according to the purpose of the study. Analysis using T-test showed significant relationships between the CIS and study's variables at p < .05.Application: This study would help to raise the knowledge and awareness about the ability of social workers to apply the crisis intervention model during COVID-19 pandemic when they are working with clients and what variables may be associated with it.
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COVID-19 , Intervención en la Crisis (Psiquiatría) , Conocimientos, Actitudes y Práctica en Salud , Trabajadores Sociales , COVID-19/epidemiología , COVID-19/psicología , Intervención en la Crisis (Psiquiatría)/organización & administración , Estudios Transversales , Humanos , Kuwait/epidemiología , Modelos OrganizacionalesRESUMEN
The Public Health Agency of Canada is funding a new Canada Suicide Prevention Service (CSPS), timely both in recognition of the need for a public health approach to suicide prevention, and also in the context of the COVID-19 pandemic, which is causing concern about the potential for increases in suicide. This editorial reviews priorities for suicide prevention in Canada, in relation to the evidence for crisis line services, and current international best practices in the implementation of crisis lines; in particular, the CSPS recognizes the importance of being guided by existing evidence as well as the opportunity to contribute to evidence, to lead innovation in suicide prevention, and to involve communities and people with lived experience in suicide prevention efforts.
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Servicios de Urgencia Psiquiátrica/organización & administración , Práctica Clínica Basada en la Evidencia , Líneas Directas , Salud Pública , Prevención del Suicidio , COVID-19 , Canadá , Intervención en la Crisis (Psiquiatría)/economía , Intervención en la Crisis (Psiquiatría)/organización & administración , Servicios de Urgencia Psiquiátrica/economía , Gobierno Federal , Financiación Gubernamental , Prioridades en Salud , Humanos , Servicios de Salud Mental/economía , Servicios de Salud Mental/organización & administración , SARS-CoV-2RESUMEN
The ongoing pandemic has led to a sudden disruption of routine treatment services. Consequently, the already existing treatment gap for substance use disorders is likely to widen. There is an opportunity to expand the scope of Screening and Brief Intervention (SBI) to meet this unprecedented challenge. Its brevity, flexibility, and generalizability have positioned SBI to deal with additional systemic, structural, and attitudinal barriers that pertain to the pandemic. The standard content of SBI could be modified to adapt to the current context. SBI could also be used as a vehicle to render strategies for infection risk minimization. In this Perspective, we anticipate the challenges of expanding and implementing SBI in the present circumstances and present potential solutions. SBI, with adaptations, could bridge the augmented treatment gap for substance use disorders during COVID-19.
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COVID-19 , Intervención en la Crisis (Psiquiatría)/métodos , Trastornos Relacionados con Sustancias/terapia , Intervención en la Crisis (Psiquiatría)/organización & administración , Humanos , Trastornos Relacionados con Sustancias/diagnósticoRESUMEN
Crises, emergencies and times of unrest have been linked to increased interpersonal violence, including violence against women. Following the declaration of alarm status and quarantine, different measures have been implemented to mitigate the possible effect of gender violence (Contingency Plan against Gender-Based Violence in Coronavirus Crisis or Royal Decree Law on Emergency Measures). This document reviews the measures adopted so far by the government of Spain, the autonomous governments and the initiatives formulated in different countries. In the absence of concrete economic measures to date, and the scenario of economic uncertainty, we conclude that it is not possible to prevent gender-based violence in a comprehensive way, without considering the increase in unemployment, temporary and instability employment, economic dependency or the overload of household chores and reproductive tasks, among other elements that facilitate it.
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COVID-19/epidemiología , Control de Enfermedades Transmisibles/legislación & jurisprudencia , Violencia de Género/prevención & control , Pandemias , SARS-CoV-2 , Adulto , COVID-19/economía , COVID-19/psicología , Control de Enfermedades Transmisibles/métodos , Consejo/organización & administración , Intervención en la Crisis (Psiquiatría)/organización & administración , Violencia Doméstica/prevención & control , Sistemas de Comunicación entre Servicios de Urgencia/organización & administración , Refugio de Emergencia/organización & administración , Europa (Continente) , Femenino , Recursos en Salud/organización & administración , Líneas Directas/organización & administración , Humanos , Difusión de la Información/legislación & jurisprudencia , Violencia de Pareja/prevención & control , América Latina , Aplicaciones Móviles , Policia , Cuarentena , Apoyo Social , España/epidemiología , Estados Unidos , Servicios de Salud para Mujeres/organización & administraciónRESUMEN
This work places in context Spain's recent update of the defined limits for low risk alcohol consumption to 20g/day for men and 10g/day for women, and summarises data on the impact on individual health and the social costs of alcohol consumption. Furthermore, it considers the challenges that arise related to awareness of the risks of alcohol consumption, in the general population and among health professionals. The paper also reviews the implications of the new definitions in relation to the most effective policies for reducing alcohol-related harm. It looks at this from a public health perspective with particular emphasis on how to seize the opportunity to better promote the implementation of strategies for early identification and brief interventions in primary care in this country.
Este trabajo pone en contexto la reciente actualización para España de los limites de bajo riesgo del consumo de alcohol, que se sitúa en los 20 g/día en el caso de los hombres, y en 10 g/día en el caso de las mujeres. En este sentido, se resumen algunos datos sobre el impacto en la salud individual y los costos sociales del consumo alcohol. Así mismo, plantea los retos que se derivan en relación a la alfabetización en salud de la población y de los profesionales de la salud en cuanto a los riesgos del consumo de alcohol. El artículo también repasa las implicaciones de la nueva definición en cuanto a las políticas más rentables para disminuir los daños asociados al consumo de alcohol. Este repaso se hace desde una perspectiva de salud pública, haciendo especial hincapié en cómo aprovechar la oportunidad para promover mejor la implementación de las estrategias de identificación precoz e intervención breve en el consumo de alcohol en el ámbito de la atención primaria de salud en nuestro país.
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Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/terapia , Intervención en la Crisis (Psiquiatría)/organización & administración , Intervención Médica Temprana/organización & administración , Femenino , Humanos , Masculino , Atención Primaria de Salud/organización & administración , Medición de Riesgo , España/epidemiologíaRESUMEN
Between March and May 2020, the Spanish Ministry of Health and the Spanish Psychological Association created the Psychological First Care Service (Servicio de Primera Ayuda Psicológica-SPAP), a national helpline designed to provide early psychological intervention to those people affected by COVID-19. This service attended more than 15,000 calls and carried out more than 11,000 interventions and 9,500 follow-ups with the general population, healthcare and other essential professionals and the patients and relatives of the sick or deceased. Results show that the majority of calls (45.7%) came from the Autonomous Community of Madrid, that women significantly used this service in a higher proportion than men (73.5%) and that the commonest age range among users was 40-59. 75.9% of consultations were related to psychological problems linked to anxiety and depressive symptoms. However, grief symptoms also stood out among the patients or relatives of the sick and deceased and, to a lesser extent, stress symptoms were prevalent in the group of professionals. These data show the usefulness of this early psychological care service and the need for similar resources to be implemented in coordination with or within the National Health System.
Entre marzo y mayo de 2020, el Ministerio de Sanidad y el Consejo General de la Psicología de España, pusieron en marcha el Servicio de Primera Ayuda Psicológica (SPAP), un servicio telefónico para toda España, diseñado para proveer atención psicológica temprana a las personas afectadas por la COVID-19. En el tiempo en que el servicio estuvo disponible, se gestionaron 15.170 llamadas, que condujeron a realizar 11.417 intervenciones psicológicas con personal sanitario y otros intervinientes, con enfermos y familiares de enfermos o fallecidos, y población general. Los resultados muestran que la mayoría de llamadas (45,7%) provenían de la Comunidad Autónoma de Madrid, que hubo significativamente más mujeres que utilizaron el servicio (73,5%) y que el rango de edad más común entre los usuarios era el de 40-59 años. El 75,9% de las consultas tuvo que ver con problemas psicológicos relacionados con sintomatología ansiosa y depresiva, aunque también destacaba la sintomatología de duelo entre los enfermos o familiares de enfermos y fallecidos y, en menor medida, la sintomatología de estrés en el grupo de intervinientes. Estos datos muestran la necesidad de este servicio de atención psicológica temprana y sugieren que recursos como este deberían implementarse de manera integrada en el Sistema Nacional de Salud.
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Betacoronavirus , Infecciones por Coronavirus/psicología , Intervención en la Crisis (Psiquiatría)/métodos , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Servicios de Salud Mental/estadística & datos numéricos , Neumonía Viral/psicología , Telemedicina/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/epidemiología , Ansiedad/etiología , Ansiedad/terapia , COVID-19 , Niño , Infecciones por Coronavirus/terapia , Intervención en la Crisis (Psiquiatría)/organización & administración , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Depresión/epidemiología , Depresión/etiología , Depresión/terapia , Femenino , Pesar , Humanos , Masculino , Servicios de Salud Mental/organización & administración , Persona de Mediana Edad , Programas Nacionales de Salud , Pandemias , Neumonía Viral/terapia , Prevalencia , SARS-CoV-2 , España/epidemiología , Estrés Psicológico/diagnóstico , Estrés Psicológico/epidemiología , Estrés Psicológico/etiología , Telemedicina/organización & administración , Telemedicina/estadística & datos numéricos , Teléfono , Adulto JovenRESUMEN
BACKGROUND: Clinicians working in the ED setting are exposed to traumatic and stress-inducing incidents, which may increase the incidence of psychological sequelae, including burnout and acute stress disorders. The purpose of this project was to develop and implement a novel debriefing program as an early intervention for acutely stress-inducing events in the emergency department. METHODS: The 2-stage Acute Incident Response program was developed and implemented in the emergency department of the John Hunter Hospital to guide an interprofessional response to acutely stress-inducing incidents. This psychological support framework draws on existing concepts of critical incident stress management along with elements of contemporary "hot debriefing" models to create a concise, clinician-led response program incorporating elements of both work group peer support and clinical team performance improvement. The Acute Incident Response program is novel in its concurrent focus on both salient clinical factors and emotional responses of affected clinicians. RESULTS: The developed Acute Incident Response program framework predominantly focuses on the wide dissemination of a peer-driven debriefing model. When additional support is deemed necessary by trained clinical champions after the Hot Acute Incident Response process, escalation to a central response coordinator ensures targeted secondary support follow-up for all affected team members. This program has been introduced at 1 site and warrants further targeted investigation to determine its efficacy and utility in a broad range of clinical contexts. CONCLUSION: The Acute Incident Response program is an accessible and meaningful model to guide a functional, clinician-led response to acute incidents in the ED setting. The model could feasibly be applied in a wide variety of clinical contexts.
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Agotamiento Profesional/prevención & control , Intervención en la Crisis (Psiquiatría)/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Modelos Psicológicos , Trastornos por Estrés Postraumático/prevención & control , Adaptación Psicológica , Adulto , Humanos , Salud Laboral , Grupo Paritario , Desarrollo de Programa , Evaluación de Programas y Proyectos de SaludAsunto(s)
Salud del Hombre/estadística & datos numéricos , Trastornos Mentales/terapia , Salud Mental/estadística & datos numéricos , Congresos como Asunto , Intervención en la Crisis (Psiquiatría)/organización & administración , Humanos , Masculino , Servicios de Salud Mental/organización & administración , Calidad de Vida , Prevención del SuicidioRESUMEN
Problems with alcohol, marijuana and gambling are major public health challenges in Greenland but their prevalence in a hospital setting has not been explored. Healthcare facilities play a significant role in Greenland. One important aspect is their provision of both primary and secondary healthcare services to a small and scattered population while their potential as settings for screening for problems with alcohol, substances and gambling is an unexplored area with large public health potential. This study explored the prevalences of problems with alcohol, marijuana and gambling in a hospital and the potential for the use of a hospital as a setting for screening for alcohol, substance and gambling problems. Patients from the Northern Ilulissat Hospital filled in a self-administered questionnaire regarding their behaviour related to alcohol, marijuana and gambling. Data were weighted and compared to the nationally representative 2018 Health Survey. In the Ilulissat Survey, a large proportion were abstainers but there were still problems related to alcohol, marijuana and gambling indicating a potential for screening in a hospital setting. The results based on data from 2,554 respondents showed that prevalences of problems with alcohol, marijuana and gambling are lower in the Ilulissat Survey compared to the 2018 Health Survey.
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Alcoholismo/epidemiología , Juego de Azar/epidemiología , Administración Hospitalaria , Abuso de Marihuana/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Alcoholismo/diagnóstico , Alcoholismo/terapia , Regiones Árticas , Intervención en la Crisis (Psiquiatría)/organización & administración , Femenino , Juego de Azar/diagnóstico , Juego de Azar/terapia , Groenlandia/epidemiología , Humanos , Masculino , Abuso de Marihuana/diagnóstico , Abuso de Marihuana/terapia , Tamizaje Masivo/organización & administración , Persona de Mediana Edad , Prevalencia , Distribución por Sexo , Factores Socioeconómicos , Adulto JovenAsunto(s)
COVID-19/epidemiología , Intervención en la Crisis (Psiquiatría)/organización & administración , Brotes de Enfermedades/estadística & datos numéricos , Hospitales Militares/organización & administración , Despliegue Militar , Anciano , Estudios Transversales , Francia , Historia del Siglo XVIII , HumanosAsunto(s)
COVID-19 , Psiquiatría Comunitaria/tendencias , Intervención en la Crisis (Psiquiatría)/organización & administración , Educación en Salud , Salud Mental/tendencias , Asistencia Social en Psiquiatría , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/psicología , China/epidemiología , Educación a Distancia , Educación en Salud/métodos , Educación en Salud/organización & administración , Humanos , Sistemas de Apoyo Psicosocial , SARS-CoV-2 , Asistencia Social en Psiquiatría/métodos , Asistencia Social en Psiquiatría/tendenciasRESUMEN
INTRODUCTION: Emergency department (ED) crowding is a growing problem. Psychiatric patients have long ED lengths of stay awaiting placement and transportation to a psychiatric facility after disposition. METHODS: Retrospective analysis of length of ED stay after disposition for voluntary psychiatric patients before and after the use of Lyft ridesharing services for inter-facility transport. RESULTS: Using Lyft transport to an outside crisis center shortens time to discharge both statistically and clinically from 113 minutes to 91 minutes (p = 0.028) for voluntary psychiatric patients. Discharge time also decreased for involuntary patients from 146 minutes to 127 minutes (p = 0.0053). CONCLUSION: Ridesharing services may be a useful alternative to medical transportation for voluntary psychiatric patients.
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Intervención en la Crisis (Psiquiatría)/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Tiempo de Internación/estadística & datos numéricos , Trastornos Mentales/terapia , Transporte de Pacientes/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ambulancias , Aglomeración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Admisión del Paciente , Estudios Retrospectivos , Adulto JovenRESUMEN
The COVID-19 pandemic is an unprecedented challenge for society. Supporting the mental health of medical staff and affiliated healthcare workers (staff) is a critical part of the public health response. This paper details the effects on staff and addresses some of the organisational, team and individual considerations for supporting staff (pragmatically) during this pandemic. Leaders at all levels of health care organisations will find this a valuable resource.
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Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/psicología , Personal de Salud/psicología , Cuerpo Médico/psicología , Salud Mental/normas , Neumonía Viral/psicología , COVID-19 , Comunicación , Infecciones por Coronavirus/epidemiología , Intervención en la Crisis (Psiquiatría)/organización & administración , Cuidados Críticos/psicología , Cuidados Críticos/estadística & datos numéricos , Atención a la Salud/organización & administración , Empoderamiento , Personal de Salud/estadística & datos numéricos , Humanismo , Humanos , Control de Infecciones/métodos , Relaciones Interpersonales , Liderazgo , Cuerpo Médico/estadística & datos numéricos , Pandemias , Médicos/psicología , Neumonía Viral/epidemiología , SARS-CoV-2 , Trastornos por Estrés Postraumático/psicología , Trastornos de Estrés Traumático Agudo/epidemiología , Trastornos de Estrés Traumático Agudo/psicologíaRESUMEN
A causa del envejecimiento de la población, se cree que entre 2015 y 2050 la población mundial mayor de 60 años se multiplicará casi por dos, pasando del 12% al 22% (Diciembre 2017), conllevará como consecuencias ,un cambio de paradigma y unos nuevos retos sociales y sanitarios. En Catalunya se prevé un aumento de la proporción de personas de más de 65 años, cerca de 1,5 millón en el 2020. Debido a estas evidencias se crea la Unidad de Atención en Crisis al paciente Psicogeriátrico en el domicilio. Se crea un programa piloto durante el año 2013, actuando en área Barcelona Norte, hasta que a finales de 2015 empezamos a dar servicio a la ciudad de Barcelona. En 2018 se desarrolla por completo la Unidad, concierto con el CatSalut. La población atendida son pacientes psi-cogeriátricos con alteraciones conductuales disruptivas en domicilio. Se podrían dividir: Paciente mayor con enfermedad mental y disminución de la funcionalidad (pacientes desvinculados de la Red de Salud Mental y que requieren múltiples intervenciones de AP y Ucias) paciente mayor con trastorno cognitivo (demencia+ SPCD prominentes; PCC/psicogeriátrico/frágil: deterioro funcional y/o cognitivo; paciente con demencia, alta dependencia y multi morbilidad (MACA)Los objetivos específicos serán, mejorarlos síntomas conductuales, evaluar la situación clínica y mejorar la coordinación de la atención con otros servicios en atención a las necesidades que se planteen, garantizar la Hospitalización Domiciliaria en una unidad especializada, si así se requiere, decidir el recurso adecuado. Se realiza valoración integral del paciente en domicilio. Se ajusta tratamiento para control sintomático. Si se consigue estabilidad clínica y cuenta con soporte, retorna a la comunidad bajo la supervisión de Atención Primaria. Si no se consigue estabilización de síntomas solicitamos ingreso en HMDM, en plaza de ME, LE o UPG. Hasta que tengamos cama en hospitalización, el paciente queda en el domicilio con seguimiento de los profesionales de la Unidad. Después de realizar la valoración inicial y a la espera del recurso adecuado, se han podido evitar un considerable número de ingresos en medio hospitalario, continuando el seguimiento en el domicilio o derivados a consultas externas. En el artículo se presentarán los resultados referentes a los años 2016-2019 que incluirán el total de pacientes atendidos y los que lo han sido en Hospitalización domiciliaria
Due to the aging of the population, it is believed that from the year 2015 to 2050 the world population over 60 years old will almost double, they will go from 12% to 22% (December 2017). One of the consequences that this will bring, is a paradigm shift and new social and health challenges. In Catalonia, an increase in the ratio from people over 65 is foreseen in 1,5 million in the year 2020. Given these facts, the Crisis Attention Psychogeriatric Patient Unit is created. n 2013 a pilot program was created, providing services in the North area of Barcelona. At the end of 2015, the Unit was providing attention to the entire city of Barcelona. In 2018 the program was fully developed and subsidized by the CatSalut.The target population, are psychogeria-tric patients that have behavioural alte-rations which affects their daily lives and put them at risk. This group includes two subgroups: older patient with mental issues and disabilities (patients who do not go to their medical appointments and require a multidisciplinary intervention, with AP and UCIAS); patients with cognitive impairment (dementia, neurological pathologies, fragile: with functional o cognitive decline, high dependency of caregivers and various chronic pathologies ( MACA).The Unit's objectives are the following: improve the behavioural alterations, assess their clinical state and improve the coordination between different health services, to be able to guarantee that all the patient ́s needs are taken care during home hospitalization, with the follow up of a specialized unit, and decide which is the most adequate resource for the patient.When the patient is visited at home by the Units sanitary resources, it receives a thorough assessment. The treatment is checked and if it is required, it is adjusted according to the symptoms. If by making these adjustments, the behavioural alteration disappear and the patient has support to maintain the treatment, returns to a fo-llow up by the Primary Unit in its area. If the patient 's symptoms cannot be stabilized, it is requested that the patient be admitted at the Hospital Mare de Déu de la Mercè (HMDM), until a bed is available at the hospital, the patient will remain at home with the Unit 's services provided by professionals to have the follow-ups. The hospitalization could be for 60 days a media stay, more than 90 days a long stay or 30 days a Short stay.We can conclude, that after the first assessment and finding the right resources for the patient, a significant number of patients are not required to be sent to the hospital. They had their follow-ups and treatment at home, and the go to their periodic appointments in external units. At the presentation the results from the 2016-2019 will be shown, they include the total of patients that were assessed and the ones who have benefitted from hospitalization at home
Asunto(s)
Humanos , Anciano , Anciano de 80 o más Años , Servicios de Atención de Salud a Domicilio/organización & administración , Intervención en la Crisis (Psiquiatría)/organización & administración , Psiquiatría Geriátrica , Trastorno de la Conducta/psicología , Pronóstico de Población/métodos , Atención Dirigida al Paciente/métodos , Trastornos del Conocimiento/terapia , Trastornos MentalesRESUMEN
OBJECTIVES: In the field of suicide prevention, the identification of risk groups is important, as is the training of front-line workers, to raise awareness of suicide issues. Agricultural workers represent a group at high risk of suicidal behavior due to various factors (low income of farmers, work related to climatic conditions, social isolation, poor access to primary care). The main objective of this article is to present the implementation of prevention training in suicide prevention for a population of agricultural workers in two cantons of French-speaking Switzerland (Vaud and Neuchâtel) which represent a population of about 980,000 inhabitants. The second objective is to identify the experiences of the participants in this training and their expectations. METHODS: Suicide prevention training sessions are organized in collaboration with public health departments, agriculture departments and suicide prevention professionals. Each session is led by four trainers experienced in suicide prevention and belonging to the "Groupement Romand Prévention du Suicide" (GRPS) which manages the training and other training modules on this topic in French-speaking Switzerland. The GRPS guarantees the content of the training as well as the updating of scientific knowledge. The training model is based on a concept that alternates between brief theoretical contributions, exchanges between participants in plenary sessions and role playing in small groups. The training has two main objectives: on the one hand to work on the participants' representations of suicide and to modify their posture by training "sentinels", i.e. "peers" who can establish a link between suffering individuals and the available support resources. On the other hand, to give key messages: dare to talk about the suicidal question and to not remain alone with this. RESULTS: Between December 2016 and May 2018, nine sessions were held in the two cantons of Vaud and Neuchâtel with a total of 220 participants. The sessions took place in agricultural schools or buildings related to agriculture. Invited to express themselves on the theme of suicide as well as on the concept of training, agricultural workers all verbalized the importance of this issue and were often very moved when the subject was discussed. The topics addressed by the participants were the taboo aspect of the subject, the difficulty of talking about it and the need to be able to address the subject (breaking the isolation). Participants also highlighted the need for peers to act as relays for help. CONCLUSIONS: The sessions were highly appreciated by the organizers concerned, particularly by the public health and agricultural departments. Participants expressed their satisfaction at the opportunity to express their views on this subject, regretting that such initiatives are all too rare. Although studies highlight the difficulty of emotional expression in the agricultural field, we observed on the contrary a great facility of the participants to express their emotions in relation to the suicidal theme. We have highlighted that the issue of suicide in this population is linked to several causal factors, as is the suicidal issue more broadly. Factors specific to this population emerged from the sessions, including working conditions and difficulties related to the family environment of farmers. There is a need to strengthen suicide prevention with training programs among the agricultural population. We also note the major importance of improving access to mental health care which is often very deficient in rural areas.
Asunto(s)
Agricultores , Psiquiatría Preventiva , Vigilancia de Guardia , Prevención del Suicidio , Adulto , Intervención en la Crisis (Psiquiatría)/educación , Intervención en la Crisis (Psiquiatría)/métodos , Intervención en la Crisis (Psiquiatría)/organización & administración , Agricultores/psicología , Agricultores/estadística & datos numéricos , Femenino , Humanos , Masculino , Psiquiatría Preventiva/educación , Psiquiatría Preventiva/organización & administración , Psiquiatría Preventiva/normas , Desarrollo de Programa/métodos , Desarrollo de Programa/normas , Derivación y Consulta/organización & administración , Servicios de Salud Rural/organización & administración , Servicios de Salud Rural/normas , Servicios de Salud Rural/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Ideación Suicida , Suicidio/psicología , Suiza/epidemiología , Adulto JovenRESUMEN
Entre marzo y mayo de 2020, el Ministerio de Sanidad y el Consejo General de la Psicología de España, pusieron en marcha el Servicio de Primera Ayuda Psicológica (SPAP), un servicio telefónico para toda España, diseñado para proveer atención psicológica temprana a las personas afectadas por la COVID-19. En el tiempo en que el servicio estuvo disponible, se gestionaron 15.170 llamadas, que condujeron a realizar 11.417 intervenciones psicológicas con personal sanitario y otros intervinientes, con enfermos y familiares de enfermos o fallecidos, y población general. Los resultados muestran que la mayoría de llamadas (45,7%) provenían de la Comunidad Autónoma de Madrid, que hubo significativamente más mujeres que utilizaron el servicio (73,5%) y que el rango de edad más común entre los usuarios era el de 40-59 años. El 75,9% de las consultas tuvo que ver con problemas psicológicos relacionados con sintomatología ansiosa y depresiva, aunque también destacaba la sintomatología de duelo entre los enfermos o familiares de enfermos y fallecidos y, en menor medida, la sintomatología de estrés en el grupo de intervinientes. Estos datos muestran la necesidad de este servicio de atención psicológica temprana y sugieren que recursos como este deberían implementarse de manera integrada en el Sistema Nacional de Salud
Between March and May 2020, the Spanish Ministry of Health and the Spanish Psychological Association created the Psychological First Care Service (Servicio de Primera Ayuda Psicológica-SPAP), a national helpline designed to provide early psychological intervention to those people affected by COVID-19. This service attended more than 15,000 calls and carried out more than 11,000 interventions and 9,500 follow-ups with the general population, healthcare and other essential professionals and the patients and relatives of the sick or deceased. Results show that the majority of calls (45.7%) came from the Autonomous Community of Madrid, that women significantly used this service in a higher proportion than men (73.5%) and that the commonest age range among users was 40-59. 75.9% of consultations were related to psychological problems linked to anxiety and depressive symptoms. However, grief symptoms also stood out among the patients or relatives of the sick and deceased and, to a lesser extent, stress symptoms were prevalent in the group of professionals. These data show the usefulness of this early psychological care service and the need for similar resources to be implemented in coordination with or within the National Health System