Social environment and health services

Chronic mental disorders have special treatment needs. Inpatient treatment and hospital settings must be different from acute psychiatric inpatient facilities. Outpatient care must be organized under a long term perspective. Of special importance is the understanding and support by their partners and their social environment.


•   The "Multidimensional Social Contact Circle, MuSC" has been developed for the assessment and evaluation of social relationships and the social network of a person. It is available both as an observer rating instrument and a self-rating scale, MuSC-S. The MuSC has been designed according to the social network mapping approach. In a first step it has to be determined in how many areas of life ("household", "family", "work ", "friends", "leisure contacts", "neighbors", “others ") the person has contact with others. Based on the theories of role accumulation, it assumed that social contacts should be given in all areas. Then "everyday contacts" and "basic contacts" are discriminated. Finally, emotional and practical support or burdens are rated. The MuSK allows an easy assessment of central parameters of the social network. It can be used for clinical and scientific purposes.

•   When inpatient treatment is needed, contacts with other patients are important under a diagnostic and therapeutic perspective. Studies were done with an adaptation of the MuSK on how patients support or burden each other (FEPB).


        Contacts between patients are one element of the therapeutic milieu when patients are treated in an inpatient setting. The therapeutic milieu is a core element of any inpatient treatment. It is of special importance in the treatment of psychosomatic patients. In order to assess the social and therapeutic milieu, the “milieu rating scale” was developed. It asks for the architectural set up but also the psychological organization of the hospital.


        Inpatient treatment can be provided on a full-day or day care basis. There are unanswered questions in respect to which type of patient should be treated in which environment. Patients of both treatment settings have been compared. Contrary to expectations it was found that day care patients were on average more severe cases. They were more often unable to work, which can be explained by a reluctance of some patients to accept treatment in general, so that they prefer day care.


        As inpatient treatment is by definition a short term intervention, it is important that pre- and post-treatment is taken into account. Under this perspective it has been studied who treated patients before they were admitted to inpatient treatment and who followed up.


        A form of aftercare can be internet contacts. Patients were given the opportunity to hold contact through a self-help internet forum. The results showed that only a small percentage of patients took part and that the contact duration was rather short. This could not be improved after a therapist regularly participated.


        Chronic patients need long-term care. This is primarily provided by general practitioners. Furthermore they need medical as well as social support. The question is how general practitioners care for this group of patients. In collaboration with 40 general practitioners the prevalence and type of patients with chronic mental disorders were assessed, and the spectrum of treatments monitored. A consultant, who had seen the patients personally gave recommendations on options for improvement. About one third of patients in general practice are suffering from chronic and impairing mental disorders. Over the course of time a large variety of treatments is applied, either by the general practitioners themselves or after referral to specialists. No indicators for undertreatment were found.



Research database

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