The “poor relative of the French health system”: this depiction of mental health is now more evident than ever, even though 1 French person out of 5 suffers from a mental health disorder during his or her lifetime. Today, public authorities have the ambition to substantially improve psychiatric care organization offered to the French population through simpler, more integrated care pathways, and openness beyond hospital services. This ambition takes on the shape of the sector’s financing reform– whose challenge will be to establish common funding for public and private hospitals, aiming at reducing geographic inequalities, taking into account population epidemiological trends, while at the same time enhancing the value of outpatient care in mental health, specific activities and research. The challenge is also to raise the sector attractiveness. In this context of a systemic mental-healthcare financing reform, and on the occasion of the publication by the Cour des Comptes of the “The pathways in the organization of psychiatric care” report, our team puts forward 5 key trends to build the mental health hospital of tomorrow.
Indeed, despite the more than 50% decrease of inpatient beds per 100,000 inhabitants since the 90’s, the financial means allocated to the sector have not enabled the hoped-for transition to outpatient care – creating patient access difficulties, overburdened institutions, inequalities of care by geography, and suffering caregivers. In addition, the COVID-19 epidemic and successive health measures have reinforced the mental health problems suffered by the French population. In this way, they have provided a spotlight on the dysfunctions of psychiatric care organization. What are the 5 key trends to build the mental health hospital of tomorrow?
Tomorrow’s mental health hospital will be based on a logic of shared population responsibility with local health professionals
Hospital-centrism remains at the heart of hospitals’ current operating mechanisms. This strategy, however, excludes many local actors whose complementary roles, upstream, downstream and sometimes as alternatives to hospital care, are essential.
Because of its purpose to give an effective response to population needs, the hospital of tomorrow shall be positioned as one of the links in a wider range of services. This comprehensive offer allows for consistency in the health pathways offered to the population. To achieve this in psychiatric care organization, the hospital must consolidate its links with all the local health actors (from primary care to social-healthcare services), and operates in subsidiarity.
These interfaces are essential for a proactive territorial dynamic, ensuring smooth and relevant health pathways. Numerous impacts will follow: facilitated interpellations, creation of working committees to get the pathways even smoother, common responses to innovative calls for projects, etc.
Tomorrow’s mental health hospital ensures smooth and consistent pathways in the organization of psychiatric care
The aim of the reform is to enhance the value of fluid and coordinated health pathways. Thus:
- Long hospital stays are subject to a sliding scale of charges
- Ambulatory care is promoted through a tariff that increases according to the type and intensity of the care offered
It should be noted that certain activities (SAU, UMD, etc.) do not fall within this activity-based framework due to their specific nature.
In this logic of territorial coherence, the hospital of tomorrow shall consolidate patient pathways in a smoother and more consistent way:
- Smooth, because hospital organizations (hospitalization capacity, first- and secondline staff in outpatient structures, mobile teams, etc.) have been redesigned to ensure significantly reduced waiting times, but also because the roles of each party are clearly identified, allowing a clearer understanding of what is on offer, and facilitating relevant relays, for example between the primary care center and the CMP.
- Consistent, because patient support is intended to be seamless, from early identification to psycho-social rehabilitation, including somatic considerations and development of alternative services, such as mobile teams and outpatient structures.
Tomorrow’s mental health hospital promotes the empowerment of all… starting with the patient!
The patient is a key player in tomorrow’s hospital: he or she actively collaborates in decisions made about his or her care, and is a real pillar for other patients thanks to the peer-helper functions…
To ensure that every patient exercises/experiences empowerment, the hospital shall elaborate tools and processes that will ensure the creation of spaces for expression and respect/collaboration around the patient’s wishes (PPCS co-construction, participation in drawing up the hospital’s project, formalization of the expert patient function, therapeutic education actions, etc.). It also guarantees a real acculturation of health professionals, so that the patient can take his or her proper/rightful place.
Tomorrow’s mental health hospital rethinks psychiatric care spaces
As the ambitions of the hospital of tomorrow are to improve patient support, well-being of its staff, and more broadly to fight for mental health destigmatisation, rethinking the spaces from every angle should emerge as an obvious part of hospital strategy:
- Physical spaces, to ensure accessibility for all, to be able to evolve in environments promoting well-being, dialogue and rehabilitation, reducing the invisible distance between the hospital and the city by opening up to the outside world… Inclusive housing, a residence halfway between the hospital and the home, is a perfect example of this spirit.
- Digital spaces, in order to develop new modalities of care and coordination (such as telemedicine), but also to strengthen the transmission of knowledge of mental health as well as the collaboration with patients and their surroundings (for example through communication on social networks).
Tomorrow’s mental health hospital renews itself to retain professionals
In a global context of questioning the quality of the service provided, as well as medical and paramedical shortages, the hospital of tomorrow shall reinforce its attractiveness, through renewed communication strategies aimed at health professionals, and increased research involvement. Actions to enhance the value and responsibility of hospital teams should be implemented: work-sharing contracts with liberal activities, enhancement of research activities, increase of services contractualisation, leadership reinforcement of professionals in charge, etc.
In the context of reduced mental health funding and continuing stigma, it has become essential to reposition mental health institutions’ strategicprojects to align with funding reform.
Do these elements fit with your vision of the psychiatric care organization? Want to share your experience? Or be accompanied in your strategic transformation? Do not hesitate to contact us!
About the author
Axelle, Consultant in Alcimed’s Innovation & Public Policy’s team in France
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