Psychosomatic Medicine Psychosomatic Medicine 2005 2005 Clinical - - PDF document

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Psychosomatic Medicine Psychosomatic Medicine 2005 2005 Clinical - - PDF document

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Psychosomatic Medicine Psychosomatic Medicine 2005 2005 Clinical Care & Education Clinical Care & Education Portugal Portugal Berlin, 2005 July 8- -9th 9th European Network on Psychosomatic Medicine European Network on

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Berlin, 2005 July 8 Berlin, 2005 July 8-

  • 9th

9th European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8-

  • 9th

9th

Psychosomatic Medicine Psychosomatic Medicine 2005 2005

Clinical Care & Education Clinical Care & Education Portugal Portugal

European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8-

  • 9th

9th

Psychosomatic Medicine 2005 Psychosomatic Medicine 2005

1. 1.

Rationale Rationale

2. 2.

Portugal Portugal

  • Past

Past

  • Present

Present

  • Future

Future

3. 3.

Identification of crucial points Identification of crucial points

  • Weaknesses accounting for ultra

Weaknesses accounting for ultra-

  • stability

stability

  • Strengths to reinforce in order to promote change

Strengths to reinforce in order to promote change

4. 4.

Debate suggestions Debate suggestions

  • Lines of action

Lines of action/

/opportunities for lobbying at an European level

  • pportunities for lobbying at an European level
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European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8-

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9th

Psychosomatic Medicine: Psychosomatic Medicine: theoretical context theoretical context

  • The road to specialization

The road to specialization

  • The biomedical deterministic approach

The biomedical deterministic approach

  • Increasing need for a holistic approach

Increasing need for a holistic approach

  • Systems thinking:

Systems thinking: The bio The bio-

  • psychosocial model

psychosocial model (Engel, 1977)

(Engel, 1977)

European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8-

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9th

Psychosomatic Medicine Psychosomatic Medicine in Portugal

in Portugal

  • Past

Past

  • Scarcely represented in Health Care

Scarcely represented in Health Care

  • Mostly psychoanalytical oriented

Mostly psychoanalytical oriented

  • Portuguese Psychosomatic Society (90s)

Portuguese Psychosomatic Society (90s)

  • Present

Present

  • Future

Future

  • Crucial characteristics

Crucial characteristics

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European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8-

  • 9th

9th

Psychosomatic Medicine Psychosomatic Medicine in Portugal

in Portugal

  • Past

Past

  • Present

Present

  • Assistance

Assistance

  • Unrecognized as a clinical area of expertise

Unrecognized as a clinical area of expertise

  • Clinical practice almost excluded from NHS

Clinical practice almost excluded from NHS (no facilities whatsoever)

(no facilities whatsoever)

  • Conceptual model adopted in an individual basis

Conceptual model adopted in an individual basis

  • Liaison

Liaison-

  • Psychiatry

Psychiatry embodying mainstream

embodying mainstream “ “asylum type asylum type” ” intervention intervention

  • Teaching and research

Teaching and research

  • Idiosyncratically adopted to teach psychological and

Idiosyncratically adopted to teach psychological and communicational skills to medical pre communicational skills to medical pre-

  • graduates

graduates

  • Also adopted,

Also adopted, eventually transvestite

eventually transvestite, in some Psychology Schools

, in some Psychology Schools

  • Fruitful paradigm adopted in post

Fruitful paradigm adopted in post-

  • graduation studies

graduation studies

  • Future

Future

  • Crucial characteristics

Crucial characteristics

European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8-

  • 9th

9th

Psychosomatic Medicine Psychosomatic Medicine in Portugal

in Portugal

  • Past

Past

  • Present

Present

  • Future

Future

  • Transversal obstacles

Transversal obstacles

  • Knowledge accumulation and need for specialized care

Knowledge accumulation and need for specialized care

  • Pressure of pharmaceuticals economical power shielded behind

Pressure of pharmaceuticals economical power shielded behind recent developments in neurosciences and molecular biology recent developments in neurosciences and molecular biology

  • Psychotherapy felt as a menace and considered as exclusive

Psychotherapy felt as a menace and considered as exclusive

  • Case studies

Case studies

  • Crucial characteristics

Crucial characteristics

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European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8-

  • 9th

9th

Psychosomatic Medicine Psychosomatic Medicine in Portugal

in Portugal

  • Crucial characteristics

Crucial characteristics

  • Weaknesses

Weaknesses (factors of

(factors of morphostasis morphostasis) ) 1. 1. Cultural, political and socio Cultural, political and socio-

  • economic context

economic context

  • System ultra

System ultra-

  • stability

stability

  • “

“Least effort Least effort” ” principle principle

  • Tension regarding the concept

Tension regarding the concept

  • Theory and ethics neglect

Theory and ethics neglect

  • Low political commitment

Low political commitment

  • “

“Established interests Established interests” ”

  • Limited resources

Limited resources

2. 2. Organizational / institutional constrains Organizational / institutional constrains

  • Critical relations between clinical teaching and assistance

Critical relations between clinical teaching and assistance

  • Teaching

Teaching exclusively in the

exclusively in the highly highly specialized specialized hospital environment hospital environment

  • Need of action

Need of action

  • There are no

There are no integrated teams in medico

integrated teams in medico-

  • surgical wards

surgical wards

  • Psychologists

Psychologists role role within the NHS within the NHS still is almost non still is almost non-

  • existent

existent

  • Strengths

Strengths (factors of morphogenesis)

(factors of morphogenesis)

European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8-

  • 9th

9th

Psychosomatic Medicine Psychosomatic Medicine in Portugal

in Portugal

  • Crucial characteristics

Crucial characteristics

  • Weaknesses

Weaknesses (factors of

(factors of morphostasis morphostasis) )

  • Strengths

Strengths (factors of morphogenesis)

(factors of morphogenesis) 1. 1. Post Post-

  • graduation

graduation

  • There is a multiplicity of professionals who have carried out

There is a multiplicity of professionals who have carried out their post their post-

  • graduation studies within this framework

graduation studies within this framework

  • Mutual recognition of Continuing Medical Education (EACCME)

Mutual recognition of Continuing Medical Education (EACCME)

2. 2. Pre Pre-

  • graduation

graduation

  • There is also some pre

There is also some pre-

  • graduation psychosomatically oriented

graduation psychosomatically oriented teaching within the discipline of teaching within the discipline of Medical Psychology Medical Psychology

  • This could prove to be an asset as a framework to C

This could prove to be an asset as a framework to C-

  • L

L in order to implement proper in order to implement proper administrative models administrative models

3. 3. Unmet needs Unmet needs

  • There are multiple clinical areas willing of such support

There are multiple clinical areas willing of such support

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European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8-

  • 9th

9th

Possible lines of action Possible lines of action

  • Debatable suggestions

Debatable suggestions: :

  • pportunities for lobbying at an European level
  • pportunities for lobbying at an European level

1.

  • 1. European Network on Psychosomatic Medicine

European Network on Psychosomatic Medicine

  • Objectives and priorities

Objectives and priorities

2.

  • 2. European Transnational Study

European Transnational Study

  • Key Messages

Key Messages

3.

  • 3. Common

Common European

European Curriculum

Curriculum in Bio

in Bio-

  • psychosocial Medicine

psychosocial Medicine

  • European Credit Transfer and Accumulation System

European Credit Transfer and Accumulation System

4.

  • 4. Community Support Framework

Community Support Framework

  • European Social Fund

European Social Fund and and European Regional Development Fund European Regional Development Fund [ [Operational Programs Operational Programs under the under the National Development Plan National Development Plan] ]

5.

  • 5. Action Plan for equity in Mental Health across Europe

Action Plan for equity in Mental Health across Europe

European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8-

  • 9th

9th

Possible lines of action Possible lines of action

1. 1.

European Network European Network on Psychosomatic Medicine

  • n Psychosomatic Medicine
  • Objectives

Objectives

  • Enhance the value and visibility

Enhance the value and visibility

  • f Psychosomatic Medicine at European Level
  • f Psychosomatic Medicine at European Level
  • Seek synergies and agree on strategies

Seek synergies and agree on strategies

  • n European cooperation
  • n European cooperation
  • Define priorities in the field

Define priorities in the field

  • Develop European Psychosomatic Medicine policies

Develop European Psychosomatic Medicine policies

  • Stimulate relevant actions through various projects

Stimulate relevant actions through various projects

  • Priorities

Priorities

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European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8-

  • 9th

9th

Possible lines of action Possible lines of action

1. 1.

European Network European Network on Psychosomatic Medicine

  • n Psychosomatic Medicine
  • Objectives

Objectives

  • Priorities

Priorities

  • Discuss priorities and propose activities

Discuss priorities and propose activities (starting/ongoing)

(starting/ongoing)

  • Exchange experiences between countries

Exchange experiences between countries (starting/ongoing)

(starting/ongoing)

  • Strengthen

Strengthen international collaboration

international collaboration (starting/ongoing)

(starting/ongoing)

  • Support actions toward Psychosomatic Medicine promotion

Support actions toward Psychosomatic Medicine promotion

  • Support research and development

Support research and development

  • Plan and implement joint activities in the field

Plan and implement joint activities in the field

European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8-

  • 9th

9th

Possible lines of action Possible lines of action

2. 2.

European Transnational Study European Transnational Study

  • Key Messages

Key Messages

  • Unapparent/

Unapparent/somatized somatized anxiety and depression anxiety and depression must be assumed as utterly important health hazards must be assumed as utterly important health hazards

  • Psychosomatic Medicine

Psychosomatic Medicine must be seen as must be seen as indissociable indissociable from public health from public health

  • National strategies need to be developed

National strategies need to be developed

  • Psychosomatic Medicine should be taken into account

Psychosomatic Medicine should be taken into account in all levels and sectors of health policies in all levels and sectors of health policies

  • Increasing cooperation can but result in added value

Increasing cooperation can but result in added value

  • Psychosomatic Medicine must have its emphasis shifted

Psychosomatic Medicine must have its emphasis shifted away from mental disorders into enhanced health away from mental disorders into enhanced health and health related quality of life and health related quality of life

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European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8-

  • 9th

9th

Possible lines of action Possible lines of action

4. 4.

Community Support Framework Community Support Framework

  • National Development Plan

National Development Plan [Operational Programs]

[Operational Programs]

  • EU Cohesion & Structural Funding

EU Cohesion & Structural Funding

  • European Social Fund [Education and training]

European Social Fund [Education and training]

  • European Regional Development Fund

European Regional Development Fund [infrastructure projects and local development initiatives] [infrastructure projects and local development initiatives]

  • Portugal 2004

Portugal 2004-

  • 2005: Health XXI

2005: Health XXI (Berlin ES, 1999)

(Berlin ES, 1999) Strategic priorities: Strategic priorities: 1.

  • 1. Promote health and prevent disease

Promote health and prevent disease 2.

  • 2. Improve access and quality of health care

Improve access and quality of health care (70.6% of the funds)

(70.6% of the funds)

  • 2.1.

2.1. Hospital Referral Network

Hospital Referral Network

  • 2.5.

2.5. Modernization

Modernization and

and Humanization

Humanization of Hospital Services

  • f Hospital Services

3.

  • 3. Promote new partnerships and new actors in health

Promote new partnerships and new actors in health

European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8-

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9th

Possible lines of action Possible lines of action

5. 5.

Action Plan Action Plan for equity in

for equity in Mental Health across Europe Mental Health across Europe

[Helsinki Conference, Jan 2005] [Helsinki Conference, Jan 2005]

  • Fellow Networks within EC

Fellow Networks within EC

  • European Network on Mental Health Policy

European Network on Mental Health Policy (ENMHPO)

(ENMHPO)

  • Mental Health Europe/Sant

Mental Health Europe/Santé é Mentale Mentale Europe Europe

  • EuroHealthNet

EuroHealthNet

  • European Network of Health Promoting Schools

European Network of Health Promoting Schools

  • Projects that may prove of some interest

Projects that may prove of some interest

  • Implementing Mental Heath Promotion Action

Implementing Mental Heath Promotion Action (IMHPA)

(IMHPA)

  • Mental Health Economics European Network

Mental Health Economics European Network (MHEEN)

(MHEEN)

  • Mental Health Information and Determinants for the European Leve

Mental Health Information and Determinants for the European Level l

  • Implementation of Mental Health Promotion and Prevention Policie

Implementation of Mental Health Promotion and Prevention Policies s and Strategies in EU Member States and Strategies in EU Member States

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European Network on Psychosomatic Medicine European Network on Psychosomatic Medicine Berlin, 2005 July 8 Berlin, 2005 July 8-

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9th

Main references Main references

  • Engel GL. The need for a new medical model: a challenge for bios

Engel GL. The need for a new medical model: a challenge for bioscience. cience. Science Science 1977; 196: 129 1977; 196: 129-

  • 136.

136.

  • Engel GL. The Clinical Application of the

Engel GL. The Clinical Application of the Biopsychosocial Biopsychosocial Model.

  • Model. Am J

Am J Psichiatry Psichiatry 1980 137: 535 1980 137: 535-

  • 544.

544.

  • Marmor

Marmor J. Systems Thinking in Psychiatry: Some Theoretical and Clinica

  • J. Systems Thinking in Psychiatry: Some Theoretical and Clinical

l Implications.

  • Implications. Am J Psychiatry

Am J Psychiatry 1983; 140: 833 1983; 140: 833-

  • 838

838

  • Gallagher RM, McCann WJ, et al. The Behavioral Medicine Service.

Gallagher RM, McCann WJ, et al. The Behavioral Medicine Service. An An administrative Model for administrative Model for Biopsychosocial Biopsychosocial Medical Care, Teaching, and Medical Care, Teaching, and Research.

  • Research. General Hospital Psychiatry

General Hospital Psychiatry 1990; 12: 283 1990; 12: 283-

  • 295

295

  • Novack

Novack DH, DH, Waldstein Waldstein SR, Schindler B, SR, Schindler B, Ochitill Ochitill H. Designing and

  • H. Designing and

Implementing a Comprehensive, Integrated, Longitudinal Medical S Implementing a Comprehensive, Integrated, Longitudinal Medical School chool Curriculum in Curriculum in Biopsychosocial Biopsychosocial Medicine. Medicine.

  • Bentes

Bentes et al. et al. Health Care Systems in Transition: Portugal Health Care Systems in Transition: Portugal. Copenhagen, WHO . Copenhagen, WHO Regional Office for Europe on behalf of the European Observatory Regional Office for Europe on behalf of the European Observatory on Health

  • n Health

Systems and Policies, 2004. Systems and Policies, 2004.

  • ECTS User

ECTS User’ ’s Guide s Guide -

  • European Credit Transfer and Accumulation System and

European Credit Transfer and Accumulation System and the Diploma Supplement the Diploma Supplement. Brussels: Directorate . Brussels: Directorate-

  • General for Education and

General for Education and Culture, 2005 Culture, 2005

  • The Bologna Declaration. Joint declaration of the European Minis

The Bologna Declaration. Joint declaration of the European Ministers of ters of Education Education June 1999 June 1999