Part of Symposium about Mental health care from theory to outcome. Community Mental Health Care in Europe: Learning from each other. ENMESH - European Network For Mental Health Service Evaluation. In Lisbon, Portugal, June 2019. www.enmesh.eu www.eucoms.net

1. ENMESH, JUNE 2019
Tor Helge Tjelta
Member of the steering
group for EUCOMS
Study visit in Spain 1.-2.th of October 2018
LEARNING FROM EACH OTHER!

2. TOR HELGE TJELTA
Chair of the Norwegian Association for Mental Health
Work
Head of a local devolopment center in the City of Oslo,
District Gamle Oslo
Project Manager for FACT Gamle Oslo
Mentor/Coach for ACT/FACT in Oslo (+ FACT Youth,
addiction and elderly with SMI over 65 years)
Master in collaboration management and PhD-fellow in
Innovation in Services in the Public and Private Sectors
(FACT – INNOFACT)
Member of the steering group of EUCOMS and in the
board of Erfaringssentrum

3. MALAGA, SPAIN & OSLO, NORWAY
Hospital Universitario Virgen de la Victoria
950 000 inhabitans

4. WORKING GROUP FROM NORWAY
Tor Helge Tjelta
City of Oslo (District Gamle Oslo),
Norwegian Assosiation for Mental
Health, FACT Gamle Oslo
Leader, Chair, Project
Manager (master in
collaboration management
in health and social sector)
Torbjørn Mohn-
Haugen
City of Oslo (District Gamle Oslo),
Erfaringssentrum (new national
network for peer specialists in
Norway).
Peer specialist, Chair
Anne Helene
Tveit
Lovisenberg Diaconal Hospital,
District Psyciatric Center, Addiction
outpatient services
Section chief (psychology
specialist)
Møyfrid Kjønsdal
Norwegian resource center for
community mental health (NAPHA)
Academic Advisor
(psychology specialist)
Stig Nygård County Governor (Oslo) Senior Advisor

5. WORKING GROUP FROM NORWAY

6. EBP-WORKING GROUP
(KNOWLEDGE BASED PRACTICE - WG)

7. SIX PERSPECTIVES
1. Ethics
2. Public health
3. Recovery
4. Effectiviness of interventions
5. Community network of care
6. Peer expertice

9. RESULTS FROM THE STUDY VISIT –
LEARNING FROM EACH OTHER
We are nearly finished with the
final report.
Points of improvement do not
indicate that we are good on this
in Norway.

10. ANDALUCIAN HEALTH SERVICE
Vision and mission
The mission of the Andalusian Health Service, a public health service,
is to provide health care to Andalusian citizens, offering public health
services, ensuring accessibility, equity and user satisfaction, seeking
efficiency and optimal use of resources.
Brief history
The Andalusian Health Service, created in 1986, in accordance with
the provisions of Article 64 of Law 2/1998, of June 15, of Health of
Andalusia, is attached to the Ministry of Health and develops the
functions attributed to it under the supervision and control of it.

11. 1. ETHICS HUMAN RIGHTS

13. ETHICS – OVERALL OPPORTUNITIES FOR
IMPROVEMENT
Can be better on the plan of the
implemention of Ethics and Human
Rights.
Can be more subject-subject. There
are still some subject-object praxis.

14. ETHICS – OVERALL POINTS TO TAKE
HOME
They don’t use seclusions in Spain (we
do that in Norway).
Focus on coercion – decrease.
Good collaboration between
services. Good transitions.
Holistic approach.
Project on prevention of physical
restraints (have to look into that).

15. ETHICS – OVERALL LESSONS LEARNED
Ethical consideration are in focus
and worked on.
Human rights are on the agenda,
and it seems that there are good
work on stigma (media, user
involvement, next of kin and
services).

16. 2. PUBLIC HEALTH Adressing the needs of
the population

18. PUBLIC HEALTH – OVERALL
OPPORTUNITIES FOR IMPROVEMENT
Mental health can be a larger part of the
Public health promotion.
Make mental wellbeing more visible. How
about Act, Belong and Commit – ABC?
https://www.actbelongcommit.org.au/
It seems to be little integration of
addiction and mental health. Addiction is
organized as a social issue, mental health
organized as health issue.

19. PUBLIC HEALTH – OVERALL POSITIVE
POINTS TO TAKE HOME
Look at different programmes and networks
(EU-programmes, Erasmus +, INDIGO
Network (Thornicroft), TLC3: Local actions in
Andalucia).

20. PUBLIC HEALTH – OVERALL LESSONS
LEARNED
Spain has also a way to go here on the
perspective on public health, but there are a
holistic approach.
And like us, they want to do better on this
perspective.

21. 3. RECOVERY Building on personal
goals and strengths

22. YOUR
JOURNEY

23. RECOVERY – OVERALL OPPORTUNITIES
FOR IMPROVEMENT
Still some window dressing.
Recovery seams to be implemented
in the leadership, but not in the hole
organization.
The use of peers inside the services.
Can be more subject-subject (are still
some subject-object). “Who am I –
and what do I want?”

24. RECOVERY – OVERALL POSITIVE POINTS
TO TAKE HOME
Peer-to-peer training and user led courses as a
rule. The organization funds the user and next of
kin associations.
Tidal-model (El modelo Tidal) . Also in
Denmark. We will look into this.
They got their own name: Recuperation and
uses The Andalucian School of Public health in
the implementation.

25. RECOVERY – OVERALL LESSONS LEARNED
They also struggle here in
Andalucia with the change in
education of new health & social
workers.
Many things can be done without
lots of financial recourses.

26. 4. EFFECTIVENESS Interventions based
upon needs

28. EFFECTIVENESS OF INTERVENTIONS –
OVERALL OPPORTUNITIES FOR IMPROVEMENT
More integrated health- & social care.
Establish peer support and work with the
attitudes on this issue.
Use of systematic feedback from
patients/service users (i.e. FIT – Feedback
informed treatment).

29. EFFECTIVENESS OF INTERVENTIONS –
OVERALL OPPORTUNITIES FOR IMPROVEMENT
Are there different ways of doing this
better? Innovation?
More primary mental health care. You don’t
have to have specialists services to manage
everything.
Can do better on monitoring?

30. EFFECTIVENESS OF INTERVENTIONS –
OVERALL POSITIVE POINTS TO TAKE HOME
Patients can administrate their own medicine on
the hospital (supervised by a nurse). They
learn/memorise name, shape/form and colour.
Engage the hole society in the care for persons
with mental illness.
We will also look at I.roc again after our visit
here in Spain.
http://www.penumbra.org.uk/innovation/iroc/

31. EFFECTIVENESS OF INTERVENTIONS–
OVERALL LESSONS LEARNED
We can do more in Norway since we have a
more recourses, if we use them right/better.
(We are rich of oil and gas in Norway, and
don’t have to be so innovative?).

32. 5. COMMUNITY NETWORK
OF CARE
A wide network of
services and resources

33. NETWORK

34. COMMUNITY NETWORK OF CARE – OVERALL
OPPORTUNITIES FOR IMPROVEMENT
More integrated services.
More primary mental health services.
More teamwork?
More assertive outreach, home visits, etc.

35. COMMUNITY NETWORK OF CARE – OVERALL
POSITIVE POINTS TO TAKE HOME
Look at Spain for family network (caring),
especially the rural areas.
Good cooperation and attitude, and they have
worked a lot on this the last year.
FAISEM – specialized social work.

36. COMMUNITY NETWORK OF CARE –
OVERALL LESSONS LEARNED
In spite of a lack of resources they have
achieved much on this perspective.
Holistic approach.

37. Rehab.(9)
Acute Care (20)
Child/Adoles.(14)
Day Hosp.(15) Therap. C (15)
Com. MH
Centre (78)
CMD+SMD
SPECIFIC
SOCIAL
SERVICES
CSSCPrimary HC
PERSON
FAMILY
COMMUNITY
Mental Health
Network in
Andalusia
Workshops
Apartments
F
A
I
S
E
M
Training courses
Social Firms
Day Centres
Home Care
Support for employment
Boarding Houses

38. 6. PEER EXPERTICE Patient is cocreator of
care

40. PEER EXPERTISE – OVERALL
OPPORTUNITIES FOR IMPROVEMENT
Find out how they can manage to
employ/engage peer specialists in the services.
Decrease stigma so service workers can use
their own experience (many have that).
Let more earlier patients be coursed to be
volountary peer specialist.

41. PEER EXPERTISE – OVERALL POSITIVE
POINTS TO TAKE HOME
Peer-to-peer education

42. PEER EXPERTISE – OVERALL LESSONS
LEARNED
It seems that Spain has a way to go before
they can hire peer specialists. But they are
starting a pilot now.

43. SUMMARY OF THE STUDY VISIT

44. SUMMARY – OVERALL OPPORTUNITIES
FOR IMPROVEMENT
Mental health and addiction together.
Establish Peer support and work with the attitudes
towards this.
Systematic feedback from the patients/service users.
Can we do more with the resources we have?
(Innovation).
More primary mental health work.

45. SUMMARY – OVERALL POINTS TO TAKE
HOME
Good cooperation and systematic
approach.
Good attitude.
FAISEM (study this more and learn).
Look outside your country for good
solutions.

46. SUMMARY – OVERALL LESSONS LEARNED
It is possible to do a lot with less
recourses, if you got the right
attitudes.
Recourses (financial/number of
staff) aren't everything!

47. WE HAVE A LONG JOURNEY OF
TO GO
HOPE

48. THANKS TO!
Javier Romero, Psychiatrist. Head of MH serv.
Antonio Reyes, MH Nurse spec. Head of Nursing.
Ana Belen Jurado, MH Nurse spec.
Ricardo Romero, MH Nurse spec.
and of course Evelyn Huizing, Political advisor,
Andalucia region.

49. THANK YOU SPAIN!
For giving us hope that we can with less
resources, good attitude and hard work over
time go from this….

50. OPE
Area with in the
hospital

51. OPE
To this….
Oasis made by
the patients and
the staff-
members.
Co-creation &
Co-production 