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Description
The project Education to improve the human rights situation is implemented by the Centre for Mental Health Care Development in cooperation with the Norwegian partner Universitetet and Sorost Norge. The Czech Government Council for Mental Health (MH) and the Department of Mental Health Care Reform at the Ministry of Health (MH) have promised to co-operate during the project implementation.
The aim of the project is to improve the human rights (HR) situation for people with MH problems in inpatient psychiatric facilities (IPF). The objectives to achieve this goal are: to increase the HR standard and treatment of patients in 6 participating IPFs by 2024 - University Hospital (UH) Ostrava, Psychiatric hospital (PH) Bohnice, Military UH, PH Jihlava, UH Pilsen, PH Horní Beřkovice.
Thanks to the project, the frequency of use of restraints will be reduced by 6% in the involved IPFs. At the same time, there will be qualitative changes in the setting of rules and regime measures in these facilities. The HR of people with MH problems in these IPFs will be discussed among experts in relation to the tools and means to respect their HR.
The goal will be met at the system level, i.e. by creating a Methodology of recording the restraints and preparing the Final Report on monitoring the impacts of project activities in the participating IPFs, and at the level of education and awareness of employees involved.
Through internships in Norway and training that they will undergo (HR training, workshop on How to create an environment that reduces conflicts and promotes HR, Safewards, De-escalation), the management and direct care staff will gain knowledge in the field of prevention of the use of restraints and setting regime measures.
Two pieces of training: Safewards and De-escalation, created within the project, will obtain accreditation from the MH. 10 trainers (6 professional lecturers, 4 peer lecturers) will be trained, as well as 108 direct care staff members of the IPFs involved.
Summary of project results
In Czech psychiatric inpatient facilities, there is an overuse of restraints and restrictive measures. Rigid routines contribute to the restriction of personal freedoms for individuals with mental illnesses. The project aimed to improve human rights in these facilities, focusing on increasing human rights standards and patient care in 6 acute psychiatric wards. System-level changes were needed to address the situation, and staff lacked the skills and knowledge to manage conflicts and implement changes.
The project logic was based on the concept of external support and monitoring of changes. To this end, a Methodology for Evidence of Restraint Measures was created and submitted to the Ministry of Health, serving as a background material for the emerging Recommended Procedure. A Final Report on Monitoring Changes in 6 acute psychiatric departments was also created, describing the changes and plans for changes after the project completion. Management and a direct care staff in the involved acute psychiatric departments were supported. Management representatives completed a study visit to Norway and training: human rights, creation of a conflict-reducing and human rights-promoting environment. Direct care staff participated in a study visit to Norway (12 people). A total of 122 employees underwent training in: Safewards Model and Verbal De-escalation. Both courses were accredited by the Ministry of Labour and Social Affairs, and the Verbal De-escalation course received certification from the Ministry of Health. A website www.bezpecivpsychiatrii.cz was created.
In all participating acute psychiatric departments, a search for client-centered solutions was observed. The involved departments planned and implemented a number of changes inspired by the Safewards Model. While it cannot be definitively proven that the project led to a change in the incidence of restraint use, the decrease in the use of isolation by 8% and the total time spent in this type of restraint by 18% is encouraging. Two courses were created and accredited - Safewards Model and Verbal De-escalation of Conflict Course. Changing the established practice in the involved psychiatric acute wards is a longer-term process. The project has started it. It is expected that changes in the staff''s approach to conflict resolution will be reflected in a decrease in the use of restraints rather in the long term. The benefits are: a greater sensitivity to restraint, a desire to seek alternative solutions to conflicts and actively improving the atmosphere in the wards using tried and tested procedures and communication strategies.
Summary of bilateral results
The project partner – representative of the University of South-Eastern Norway, Faculty of Health and Social Sciences - Bengt Eirik Karlsson was involved in the project as a constraint reduction expert for resources and regime measures. The opportunity to participate in foreign internships in Norway was central to the motivation and willingness of acute psychiatric departments'' employees to participate in all project activities. This activity was sponsored by the project partner and was a great inspiration for the participants to plan and implement changes in their departments. In addition to management representatives, direct care workers (mainly nurses), who do not have as many opportunities for foreign internships, had the opportunity to participate in internships. The internship appealed to them all the more and motivated them to further active participation in the project. The ongoing support and experience of the partner in implementing changes, which were used by the members of the expert group and the personal participation of the partner at the final conference, were important. Thanks to the project, it was possible to raise awareness of the importance of respecting human rights and start the process of systematic improvement in this area in the six acute psychiatric departments involved in the project.