AACP Newsletter, Volume 7,
Number 2, Spring 1993
International Conference on the Organization of Services for People with Severe Mental Illness
The conference began with a theme central to planning services for the affected population. Donald Steinwacks, MD and Laurie Flynn discussed the evaluation of unmet needs and presented findings from a survey conducted nationally with participants associated with NAMI. Needs were assessed along several parameters including self-care, community living skills, productive activities, crisis and illness management. This discussion set the framework for the subsequent consideration of organizing services to better meet those needs in a variety of settings.
Jacque Dubuis, MD described the sectorization system developed in France. Paul Deci, MD and Joseph Bevilaqua described service delivery systems developed in South Carolina. Celine Mercier and Deena White described the service systems developed in Quebec. The mental health reform in Ontario was described by David Wasylenki, MD and Paula Goering.
Also, Martin Cohen, MD, David Shern, MD and Howard Goldman, M.D presented the variety of organizational models developed by states participating in The Robert Wood Johnson Foundation Demonstration Project for Severely Mentally Ill Adults.
The problems faced by all of the systems were quite similar but approaches developed to meet these needs were diverse. All the programs described attempted in some way to provide integrated services and continuous care to clients in the community, de-emphasizing the traditional dependence on institutional care. Despite the diversity of organizational structure, principles which emerged included local control, unified funding streams, and the provision of continuity in care; all in the context of the limited resources often encountered with public financing. The need for shifting resources to community services from hospital centered structures was a priority in all of these discussions.
The second day of the meeting focused on the development of human resources for mental health and community support programs. Topics included the training of home health nurses and aids to provide services for persons with severe mental illnesses with acute exacerbations; the design of a model curriculum for the training of psychiatrists to work in community settings; and the development of consumer managed support organizations and employment in an intensive case management program.
Jean-Loc Reolandt, MD of Lille-Armenteere, France described a program of public education about mental illness which enlisted the talents of local artists to help persons in treatment to create a changed perception of difficulties they might present to the community. This campaign helped pave the way for a rational deinstitutionalization with community support and services in place for the sector described.
The final day of the program considered various innovative approaches to psychosocial rehabilitation and community treatment and support. Rehabilitation strategies included development of social skills, independent living skills, and vocational training and job opportunities. Various approaches were examined to address needs in each of these areas, and for special subgroups within the spectrum of persons who suffer from severe mental illness. Issues such as quality of life, family interventions, cross cultural services and factors influencing responses to diverse approaches to care delivery were part of the rich exchange of ideas which concluded the program.
The meeting was arranged to accommodate the use of small discussion groups where participants could discuss and exchange ideas regarding issues developed during the formal program. It successfully presented innovative and diverse approaches to common problems and enabled participants to meet colleagues outside their usual sphere of interaction. It provided refreshing new perspectives on the delivery of community services across a diverse array of organizational structures and enabled participants and presenters to evaluate current practices with new insights.
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