Background to the programme
Since the City Health Workshop (ASV) was set up in 2001 in our town, the question of mental health has taken up a lot of time. In a difficult economic and social context (see IDH2 at 0.26 in 2010), the lack of a common culture and the difficulties in coordinating actions in the territory have been highlighted by professionals. RESAD is therefore one of the first actions resulting from the assessment carried out by ASV.
Objectives of the programme
To facilitate consultation and coordination between social and health professionals who deal with non urgent, individual or family situations which are characterised by a dovetailing of psychological problems and social difficulties:
> Establish monthly meetings where actors from medical and social sectors can present cases where they find themselves in difficulty
> Analyse each situation holistically
> Define a suitable action plan with the actors with a clear division of labour
> Strengthen inter-institutional links
- The Public Health Department puts a psychologist, the local coordinator for mental health advice and a secretary at our disposal at the equivalent of 0.1 of a full-time post for each
- The actors present at these meetings are the permanent members (advisers from local health and social organisations), the applicant and other guests (professional or associative workers from the fields of society and health).
- We have the opportunity to study 36 cases per year. An hour is devoted to each request. Three cases can therefore be evaluated on the 1st Thursday of each month.
Organisation of a RESAD:
> The administrative agent sends a reading table and an operation manual to the applicant.
> The applicant invites partners that he knows to intervene in the case.
> The permanent members encourage exchange and propose a work plan after the consultation.
> The recommendations are sent by mail to all participants.
> The psychologist advisor makes enquiries following the meeting and can be called upon in cases where implementing the recommendations is difficult.
The evaluation of the approach is ensured by the RESAD advisor in collaboration with the permanent members through a working group that has been integrated with LCMS since 2013.
Quantitative and qualitative results from the implemented actions
The contribution of RESAD based on internal and external annual evaluations made by the Council Agency for Collective Development (TDCA) in 2007:
- 23 cases were analysed on average per year from 2002 to 2009. In 2013: 15 applicants presented a case, 39 professionals and associative workers invited have participated.
- For the resident: a harmonisation of the responses to his needs. The responses are no longer separate, the individual is considered in their entirety.
- For the professional applicant: support. Objectivity / break the isolation / theoretical contributions / revaluation / legitimation of their action
- For institutions
> Formalisation: clear division of tasks for each / legitimation of action
> Networking: knowing participants, knowing "input methods" and functioning of other organisations, alerted to potentially dangerous situations
> A change in practices: articulation of practices - knowledge of the partners' limits - improved communication - understanding of the various positions
Program already being replicated in other cities (cf. Proceedings of the study day, "The RESAD and other professional consultation processes around complex psychosocial situations for a new paradigm " November 15, 2012, ARS IDF and CG93 ; A Brand ., Naranin C., Deparis R., ARS IDF and EPS Ville Evrard "Etude sur les instances de type RESAD", 2014)
According to the ACDC study, RESAD have contributed significantly to a positive change in 18% of cases in 2003, this percentage increased to 36% in 2008 and 2009. Over 80% of respondents thought it was useful to keep RESAD
First example of a resolution process for non urgent complex situations in France that engages and encourages the coordination of social and medical professionals
Partnership(s) developed in the context of the programme
- The permanent members are present at every RESAD depending on the public. These are local participants in social, medical and psychiatric work: the manager for the adult psychiatry department in Evrard 93G06, the Head Physician of the Centre of Municipal Health (CMH) and the deputy head of social service are consistently present.
- In addition, for the elderly: the head of the gerontology department, the head of nursing care in the home at CMS, a doctor from the city hospital network
- For under 26 years old: a manager from the local youth centre
Difficulties and/or obstacles encountered during the programme’s implementation :
- Certain cases remain unsolvable.
- Sometimes the sessions are cancelled by the participants.
- Low participation of private doctors
- No support with the implementation of the recommendations
- The approach is not suitable for urgent cases
Solutions used to overcome the difficulties and/or obstacles :
- Evaluation and regular improvement of the process through a working group established in the CLSM (Local Council of Mental Health) with the ability to treat recurring problem cases identified during RESAD.
- Communication renewed regularly
- Compensation for doctors' participation
- Establishment of case monitoring by a RESAD participant
Suggestions for future improvement :
- Offer the presence of users during the RESAD
- Improving the participation of private doctors
- Encourage the emergence of a similar body for emergencies
Summary of factors responsible for the programme’s success :
- The program has been replicated elsewhere having already been the subject of studies.
- Willingness of actors in the field and institutions to participate. An initiative supported by field actors, not imposed by higher authorities or legislation
- A joint ethical framework (Professional secrecy, ethics concerning confidentiality, authorisation and information of the person concerned ...)
- These reflections should lead to a written document after consultation with actors: for Aubervilliers, it took the form of a "procedural manual"; in other cities, it's a charter. Tools that allow a reproduction of the program (see Appendices: reading grid, procedure manual, table of proposals)
- A Framework: time, place, set frequency of meetings to enable better identification and to plan the agenda
- Coordination: person or team with time dedicated to supporting RESAD
- Formalise the multi-professional meetings for adults in the manner of RPP (Multi-Professionals Meetings) for children.
- Strong involvement from the sector of adult psychiatry, from the municipality and all the local actors.
- The permanent members should have decision-making power in their institution.
- Compensation for doctors
- A. Marks, C. Naranin, Deparis R., ARS and EPS Ville Evrard IDF "Study on RESAD type instances" (2014)
- Proceedings of the 29th Workshop DIHAL, Paris, 13 March 2014 "The support in housing for people with mental health problems."
- Proceedings of the study day "The RESAD and other professional consultation processes around complex psychosocial situations towards a new paradigm November 15, 2012 ARS IDF and CG93
- Heading Health Initiatives "Multiple Problems comprehensive response to Aubervilliers" Social Health Journal Gazette, No. 55, September 2009
- Arcella-Giraux, P. "Mental Health in the city of Aubervilliers Health Workshop" National Mission Support Mental Health mnasm. www.mnasm.com section Sharing experiences ASV 2008
- Interview by Denis Dangaix. Section "Quality of Life": "Mental health problems are a result of difficulties which interlock" Interview with Dr. Pilar Giraux, psychiatrist, municipal department of hygiene and health of Aubervilliers. Review The health of man, 384, pages 6-7, July / August 2006
- Arcella Giraux-P, N. Christodoulou "The experience of the city health workshop / mental health component of Aubervilliers. "Symposium organized by the association Espoir 54 in Nancy on 12 and 13 October 2006. http: //www.espoir.foreitic.net
- Arcella-Giraux P. "psychic sufferings. The RESAD. "The meetings of preventing risk behavior. Departmental mandate to prevent risk behaviors, General Council 93, June 2005
- Arcella-Giraux P. "A multidisciplinary work experience at city scale." National mental health and precariousness Bulletin: Rhizome16: 15 ORSPERE July 2004
- Arcella-Giraux P. "The experience of the city health workshop / mental health component of Aubervilliers. "Proceedings of the International conference" Mental health from social change "organized by the Orspere in October 2004.
- Arcella-Giraux P. "The City Health workshops in Aubervilliers". Study Day Mental Health and casualization, MIPES, p. 13-17 November 2003
- A. Marks, C. Naranin, Deparis R., ARS and EPS Ville Evrard IDF "Study on RESAD type instances" (2014) and Proceedings of the study day "The RESAD and other professional consultation processes around complex psychosocial situations towards a new paradigm November 15, 2012 ARS IDF and CG9