primary and secondary mental care: equality and complementarity e.h. (dineke) smit european forum of...
TRANSCRIPT
Primary and secondary mental care: equality and complementarity
E.H. (Dineke) Smit European Forum of Primary Care Galatasaray
University, IstanbulSeptember 9/10, 2013
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Content
The first step towards successful cooperation (primary / secondary care) is admitting the differences and see the primary and secondary care as equal.
The best of two worlds
The next step is to build bridges, clarify the valuable complementarity by co-creation.
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This is an elephant… (mental health)
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What do you see?
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How do you call it?
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What does it mean to you?
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What are you looking for?
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What is your aim and/or focus?
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So this what you mean when we talk about ‘an elephant’!?
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Let’s face our differences!
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Primary and secondary mental health care
Scientific Paradigm
Patients
Model of Care
Care orientation
Care organization
Good careMental Health
care
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So this what you mean when we talk about ‘an elephant’!?
Compared with the elephant (where do you look at, head or tail?) you can choose a position in mental health care, using a scale of 1 – 5.
1 2 3 4 5
Mental health care
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Scientific paradigm
“The constellation of beliefs, values and techniques that caregivers have in common as well as the common model from which one thinks and acts” (Kuhn, 2012).
Classical science
Complexity science1 2 3 4 5
1 2 3 4 5
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Model of care
The way you look at sickness and health.
Is a depression associated with brain abnormalities or ‘a bad mix and bad luck’?
Bio-medical model
Biopsychosocial model
1 2 3 4 5
1 2 3 4 5
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Care orientation
The amount of knowledge of a specific field / area or in general (concerning health care)?
Generalist perspective
Specialist perspective
1 2 3 4 5
1 2 3 4 5
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The patients population
Differences in patient population, varied or not varied? Only major disorders or minor, major and all in between?
Heterogeneous patient population
Homogeneous patient population
1 2 3 4 5
1 2 3 4 5
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Care organization
Community Health care, neighbourhood orientated or hospital Care, disorder orientated? Funded by local government or the national health care? Monodisciplinair or multidisciplinair?
Community Health care, neighborhood orientated
Hospital Care, disorder orientated
1 2 3 4 5
1 2 3 4 5
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Definition of good care
What is dominant: deontological ethics, virtue ethics, consequentialism? Or is an equal dialog between all ethics theories possible?
Pluralistic ethics
Monistic ethics
1 2 3 4 5
1 2 3 4 5
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Two ways to see an elephant?
Classic
al sci
ence
Complexity s
cience
Heteroge
neous pat.
Homogeneous p
at.
Biopsychoso
cial m
odel
Bio-medica
l model
Generalist
perspecti
ve
Specia
list p
erspecti
ve
Community Healt
h care
Hospita
l care
Pluralisti
c eth
ics
Monisti
c eth
ics
0
1
2
3
4
5
PC
PCSC
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Integration or co-creation?
Integration means: the intermixing of people / groups who were previously segregated.
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Integration or co-creation?
Integration means: the intermixing of people who were previously segregated.
Co-creation means: the action or process of several people bringing something into existence (what was not there before…)
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Primary CareBarbara Starfield, professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, defined primary care as:
“ the first point entry to a health care system; the provider of person-focused (not disease-oriented) care over time; the deliverer of care for all but the most uncommon conditions; and the part of the system that integrates or co-ordinates care provided elsewhere or by others “
(Starfield, 1998)
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Primary Care
I would like to add:
Primary care emphasizes complexity science; has a heterogeneous patient population; works from a biopsychosocial model; has a generalist perspective and a community health care approach; and it recognizes the different ethical theories as being equal.
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Final advise
Acknowledge the difference, see primary and secondary as equal, strive for a co-creation between primary and secondary mental health care to aim for better mental health care!
