Democratic psychiatry and cooperation with relatives ¹
Since its founding, ApK Berlin has been committed to promoting democratic processes in psychiatry. Participation is an important guiding principle in this regard. It is based on involvement and contributes to people being included in all decisions that affect their own lives. In order to successfully implement this in psychiatry, the ApK Berlin has developed a “concept for cooperation with relatives” that is intended to provide impetus for the further development of the psychiatric care system.
In contrast to “involvement of,” “cooperation with” relatives means that ....
- Family members can speak with their own voice,
- cover their own legal interests,
- help shape the future/relationships...
while taking into account the personal rights of patients, in particular their right to self-determination, while at the same time preserving the personal rights and self-determination of their personal social network.
Background
Social support is considered an important protective factor for mental health (RKI: DEGS 2010: Mental Health in Adults in Germany), and the same applies to a person's recovery. This is because how well each individual is integrated has a favourable/positive effect on health behaviour and the course of crisis events. For this reason, it is important to cooperate with the patient's personal network, especially when circumstances make a successful relationship difficult or impossible.
In order to strengthen the protective aspects, a conceptual framework for cooperation with relatives is required, while safeguarding the legal rights of each individual in the relationship structure and taking into account the framework conditions of service providers and service carriers. The aim is to avoid the functionalisation of relatives and to strengthen the self-determination of those involved in the personal network. Network discussions in open dialogue have proven helpful in this regard. Mutual references can also be experienced in trialogical discussions.
Relatives find themselves in a highly individual relationship constellation (1. children of parents with mental illness, partners, friends, parents, siblings; 2. living in the same household or not; 3. responsibility; 4. role) with the person in crisis, and they too experience a great deal of individual stress. To cope with the manifold challenges, they need their own strategies, but first and foremost information and education.
ApK Berlin has established itself as a point of contact for relatives of people with mental health crises/illnesses in Berlin. Its work is based on peer expertise from relatives. The association offers independent information and education for relatives in various formats (discussions, workshops and seminars, self-help groups) on the basics of the psychiatric care system and everyday challenges and problems.
If intervention is ultimately considered and a stay in a clinic is required, this also means a major change for relatives, especially for children of parents with mental illness. Social ties are not simply severed, but require special support during this period of uncertainty.
¹ Relatives include both members of the family of origin and chosen relatives who, due to their close ties, are also affected by the psychological trauma and are prepared to take on social responsibility.
- Conceptual anchoring for cooperation with relatives
Recommendations for a practice that includes family members and friends
Collaboration with family and friends
1. Integrated part of the strategy: quality standard
2. Concept (treatment tailored to needs)
3. Implementation of the concept (network counselling/trialogue)
4. Regular review
Staff competencies
5. Trained staff: role awareness when dealing with the social network
6. Responsibilities, accountabilities and competencies clearly defined
Building relationships with family and friends
7. Empathy and appreciation: health professionals understand the burdens faced by family and friends
8. Differentiated handling of the confidentiality requirement
9. Collaboration from admission to discharge: shared responsibility
10. Consideration of the interests of family members and friends: strengthen the (relationship) system
Information for family and friends
11. Clear clinic information policy (contact point, ward responsibilities)
12. Information material: particularly referencing ApK LV Berlin e.V.
13. Comprehensive, timely information
based on and further developed from: www.angehoerige.ch
- Cooperation with relatives using the example of a hospital
It is essential to establish a conceptual framework for the collaboration with family and friends (see below).
General: In the interests of participation, it is recommended to establish a contact person for family members and friends outside the wards in each hospital. The personal rights of patients are thus protected and those of family members and friends are promoted. The mission is to provide family members and friends with basic information (not referred to the patient) even in times of unsuccessful relationships and when contact has been broken off, thereby facilitating their personal coping processes. The aim is to strengthen natural and chosen relationships, to recognize each person's rights to self-determination and co-determination, and to acknowledge and protect the respective boundaries. The involvement of a peer is useful, networking with ApK Berlin is helpful.
In the wards: Working with the patient's personal social network requires clarification of responsibilities and clarity about shared responsibility and its limits (concept). Accordingly, differentiated handling of confidentiality is required.
Collaboration with family members and friends requires trained staff who recognise and acknowledge their various concerns, especially those of children. Transparent collaboration from the beginning of the hospital stay until discharge can help to reconcile the different interests of those involved and build mutual trust.
Each ward provides information material for family members and friends, in particular information about ApK LV Berlin e.V. and its services.1. In-patient, day care, home treatment (StäB) – General
1.1. Establish a conceptual framework for the collaboration with family and friends
1.2. Establish a contact person outside the wards
2. Ward(s)
2.1. Clarify responsibility (nursing service? social service? doctor?)
2.2. Adult family members/friends
− Implementation/measures:
1. Differentiated handling of the confidentiality requirement
2. Network counselling/Open Dialogue
3. Trialogue talks (all-party and equal)
4. Ward rounds addressing concerns/questions of family members and friends
− QM procedure for collaboration with family and friends −>
A) in case of hospitalisation of a patient
B) in case of institutionalisation of a patient
C) upon discharge, considering confidentiality requirements/waiver
2.3. Children of parents with mental health problems:
− Parent-child services in the clinic: A) Mother-child ward, B) Playroom/family room
− Collaboration with the contact person (other parent, grandparents, siblings) of the minor and the child itself
− Implementation/measures:
1. Differentiated handling of the confidentiality requirement
2. Network counselling/Open Dialogue — with the child
− Provide information on outpatient support services for children and their parent who has a mental health problem, initiate such services if necessary
− QM procedure for collaboration with family and friends −>
A) in case of hospitalisation of a patient
B) in case of institutionalisation of a patient
C) upon discharge, considering confidentiality requirements/waiver
−> These measures enable family members and friends to contribute their lived experience and clarify the areas of responsibility of the three perspectives involved (patient, family member/friend, healthcare professional) with the central question: Who is responsible for whom, for what and, most important, for how long?
By answering these questions, we explore the possibilities and limits of each area of responsibility, build trust, and strengthen the self-efficacy of the whole network.
Source: G. Weißenborn – Lecture at the Aktion Psychisch Kranke Dialogue
© ApK Berlin Gudrun Weißenborn