PRIORITIES IN MENTAL HEALTH IN SOUTHERN EUROPE IV

Mental Health and General Health: Still Two Separate Systems In Israel Prof. Zvi Zemishlany President Of the Israeli Psychiatric Association WHO Consensus (2001) There is no health without mental health. 5 out of 10 causes of disability are mental problem (major depression, schizophrenia, alcohol, OCD, bipolar disorder). Mental disorders are under treated (due to stigma, unawareness, poverty, lack of knowledge). The WHO world health report – 2001 4 chapters and summary 1. Mind and body are linked. 2. Mental diseases are common (20-25%). 3. Services close to home (community, general hospitals). 4. Policy and financing: the legal basis for community based services, including integration of mental health into primary care. The WHO world health report – 2001 summary: solutions 1. Provide treatment in primary care. 2. Give care in the community. 3. Educate the public. 4. Involve communities, families and consumers. 5. Establish national policies, programs and legislation. 6. Link with other sectors. The Insurance Reform   National Health Insurance Law (1.1.95) (Psychiatry not included). To be included in: 1998-not done 2003-not done 1/1/2004-not done 1/1/2006, 1/1/2007 ?? The problem: How much will it cost ? $40-50M Psychiatric Beds in Israel Ministry of Health General Health Provider 95% 5% The Psychiatric Reform 1. The Insurance Reform: Responsibility will be transferred to the 4 national health providers. 2. The Structural Reform: Resources should be transferred from psychiatric hospital to the community. The Insurance Reform (cont.) 1. The scope of mental health service Adults: Israel-2% of population Western Countries-5% of pop. Children: Israel-1% of population Western Countries-3% BUT: Up to 30% at the GPs’ office are associated with psychiatric disorders Who should be responsible to treat: Depression (15%) Panic Disorder (4%) Anxiety Disorder (10-25%) Depression and medical illness Leading cause of disability in adults (15 – 44) By 2020 : Second leading cause of disability ( after cardiovascular disease ). 10.3% of population each year. Depression is associated with 50% increase in medical costs of chronic medical illness. Editorial, Biological Psychiatry,8 , 2003 Increased risk and morbidity by depression Coronary heart disease (x 1.5 – 3) Stroke (x 2 – 4 ) Cancer ( 88% ) Desire and Erectile dysfunction HIV disease progression Diabetes Mellitus Obesity, Alcohol abuse Neurologic diseases :Alzheimer’s, Parkinson’s, Poststroke, Epilepsy (x 4 -6 ). Chronic pain Negative Consequences of the Separated Mental Health System Prevents development of community Psychiatry. Continuity of care with GPs Stigmatization of Mental Patients The Structural Reform A 50% reduction of psychiatric beds Year 1995 Beds 7500 Beds/pop. 2000 Shortening of hospital 2001 stay to 33 days 2002 (currently- 40 days) 6000 5470 (1:1000) 5439 4300 3500 (0.5:1000( 2004 2005 The Structural Reform (Cont.( Long term residential facilities in the community Outpatient clinics in the community Day patients Liaison and training of GP’s Home treatment teams-clinical psychiatric nurse (CPN) The role of the Psychiatric Association Enhancing psychiatric reforms: to reduce the stigma of mental disorders Education of the public: mental disorders are not different in nature from medical disorders (Asthma, Hypertension) To convince the Ministry of Health and the health care providers that the reform is cost effective. Obstacle: The forceful involvement of the Ministry of Economy