PCC

Le Plan de crise conjoint

Exemple de plan de crise conjoint -PCC

Etude PCPCC_présentation résultats canton_Definitif

 

Development of user-friendly applications for shared decision in mental health

 Suter1, P. Ferrari2, J. Favrod3

  1. Paire praticienne en santé mentale, Laboratoire d’Enseignement et de Recherche Santé Mentale et Psychiatrie (LER SMP), Haute Ecole de Santé, La Source (HEdS ELS), Lausanne.
  2. Maître d’enseignement, LER SMP, HEdS ELS & Infirmière spécialiste clinique, Service de psychiatrie communautaire, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (DP-CHUV), Lausanne.
  3. Professeur HES responsable du LER SMP, HEdS ELS & Infirmier spécialiste clinique, Service de psychiatrie communautaire, DP-CHUV,

Although there is an international consensus to implement recovery-oriented practice in mental health settings all over the world, an important gap still remains (1). The development of these practices has proved to be challenging because it questions the traditional notions of professional power and expertise which prevailed in mental health services for years, and to a certain extent still does (2). First, the pessimistic issues of mental illness have been called into question by several longitudinal studies, showing optimistic becoming of the most chronical and invalidating troubles. Second, more and more personal accounts have attested experiences of recovery. Mental health recovery is a personal journey of healing and transformation. It means being able to have an enjoyable and meaningful life in the community achieving one’s full potential, with or without psychiatric symptoms or medication (3).

In the recovery process, giving and regaining hope is central, as well as being able to make informed choices about one’s health and life. Consequently, in a recovery-oriented practice, the locus of control remains with the service user to the greatest extent possible and decision making is shared rather than handed down by the professionals (4). Shared decision making seems to be preferred by psychiatric patients unlike patients in somatic care (5). Contrary to popular belief, persons suffering from severe psychiatric illness have most of the time the capacity to make choices and take rational decisions (6). But to do so, patients need first to know that they are engaged in a decision regarding their own care, which, half of the time, doesn’t seem to be the case, second to be objectively informed on the choices they face and, third, to be engaged in a partnership relation enabling the expression of their preferences and goals in order to take a shared decision (7).

A new form of advanced statement supporting this process has been recently created on the impulse of the psychiatric survivor movement: the joint crisis plan (8). The joint crisis plan (JCP) is formulated by users in collaboration with staff and « […] contains his or her treatment preferences for any future emergency, when he or she may be too unwell to express clear views. The assumption is that such active involvement by the patient in the process of crisis planning will increase the likelihood of averting major relapse and the need for compulsory detention » (9). Apart from great satisfaction in regard to the JCP format by its users and despite mitigate results on compulsory psychiatric admissions (9), research has shown lower levels of perceived coercion, negative pressures, and process exclusion (10), improvement of therapeutic relationships (9,11) and promises about less service use and lower average costs (12). But evidence also suggests that JCPs are not fully implemented and that clinical review meetings do not actively incorporate patients’ preferences (7, 9). These findings show that, despite a strong ethical imperative (13), the implementation of new shared decision making in routine clinical practice is highly challenging and an important gap still remains (7, 14).

Self-determination and partnership are both essential values and principles in a shared decision and recovery process. Giving access to objective information about psychiatric troubles and their issues and about psychiatric drugs, as well as empowering users’ and professionals’ capacities to conduct shared decision making is crucial. Both, professionals as well as users, need to be helped to sustain these developments. The first ones because the paternalistic approach still domains (2, 15), the seconds because their citizenship remains unconsidered (1) and as such, also their rights.  Recently, english web-based programs and applications have been created and tested to support shared decision making especially centered on medication (16, 17). These showed promising results in empowering both, professionals and users.

Although there is an international consensus to implement recovery-oriented practice in mental health settings all over the world, an important gap still remains (1). The development of these practices has proved to be challenging because it questions the traditional notions of professional power and expertise which prevailed in mental health services for years, and to a certain extent still does (2). First, the pessimistic issues of mental illness have been called into question by several longitudinal studies, showing optimistic becoming of the most chronical and invalidating troubles. Second, more and more personal accounts have attested experiences of recovery. Mental health recovery is a personal journey of healing and transformation. It means being able to have an enjoyable and meaningful life in the community achieving one’s full potential, with or without psychiatric symptoms or medication (3).

In the recovery process, giving and regaining hope is central, as well as being able to make informed choices about one’s health and life. Consequently, in a recovery-oriented practice, the locus of control remains with the service user to the greatest extent possible and decision making is shared rather than handed down by the professionals (4). Shared decision making seems to be preferred by psychiatric patients unlike patients in somatic care (5). Contrary to popular belief, persons suffering from severe psychiatric illness have most of the time the capacity to make choices and take rational decisions (6). But to do so, patients need first to know that they are engaged in a decision regarding their own care, which, half of the time, doesn’t seem to be the case (Loiselle, M.- C., Le soutien à la decision, une intervention à portée de mains des professionnels de la santé, Conférence du SIDIIEF, 2017), second to be objectively informed on the choices they face and, third, to be engaged in a partnership relation enabling the expression of their preferences and goals in order to take a shared decision (7).

A new form of advanced statement supporting this process has been recently created on the impulse of the psychiatric survivor movement: the joint crisis plan (8). The joint crisis plan (JCP) is formulated by users in collaboration with staff and « […] contains his or her treatment preferences for any future emergency, when he or she may be too unwell to express clear views. The assumption is that such active involvement by the patient in the process of crisis planning will increase the likelihood of averting major relapse and the need for compulsory detention » (9). Apart from great satisfaction in regard to the JCP format by its users and despite mitigate results on compulsory psychiatric admissions (9), research has shown lower levels of perceived coercion, negative pressures, and process exclusion (10), improvement of therapeutic relationships (9,11) and promises about less service use and lower average costs (12). But evidence also suggests that JCPs are not fully implemented and that clinical review meetings do not actively incorporate patients’ preferences (7, 9). These findings show that, despite a strong ethical imperative (13), the implementation of new shared decision making in routine clinical practice is highly challenging and an important gap still remains (7, 14).

Self-determination and partnership are both essential values and principles in a shared decision and recovery process. Giving access to objective information about psychiatric troubles and their issues and about psychiatric drugs, as well as empowering users’ and professionals’ capacities to conduct shared decision making is crucial. Both, professionals as well as users, need to be helped to sustain these developments. The first ones because the paternalistic approach still domains (2, 15), the seconds because their citizenship remains unconsidered (1) and as such, also their rights. Recently, English web-based programs and applications have been created and tested to support shared decision making especially centered on medication (16, 17). These showed promising results in empowering both, professionals and users.

According to past experiences, new technologies applications have not only shown to be feasible in the Swiss or French speaking contexts, but may also support shared decision making in the psychiatric field and empower its users (18). Currently we are running an exploratory study on the practices and contents of the JCP in the « canton the Vaud » (19). The aims are to better understand the barriers of its implementation in order to make recommendations for the future and to develop a validated French tool in both formats, paper and online. The promotion and dissemination of the JCP are crucial in that context, because compulsory and involuntary treatment rates are very high in Switzerland in comparison to other EU-Countries, and even more in the « canton de Vaud » (20). The process of that research already shows that the existence of the JCP has to be spread not only in the local mental health field, but also in the French speaking countries. It also suggests that the JCP tools we have identified are more institutions than users centered and that their implementation is as challenging as their accessibility. Developing a web-based application is therefore essential, and even more, considering the context of the future application of the new federal law on the « electronic patient file » (LDEP*). The LER SMP** is presently working on further products and programs developments to sustain the recovery process.

  1. Slade, M., Amering, M., Farkas, M., Hamilton, B., O’Hagan, M., Panther, G., … Whitley, R. (2014). Uses and abuses of recovery: implementing recovery-oriented oractices in mental health systems. World Psychiatry, 13,12-20.
  2. Boardman, J. , & Shepherd, G. (2012). Des services de santé mentale centrés sur le rétablissement Dans E. Jouet et al., Pour des usagers de la psychiatrie acteurs de leur propre vie (pp.113-29). Toulouse: ERES « Actualité de la psychiatrie »
  3. Andresen, R., Oades, L., & Caputi, P. (2003). The experience of recovery from schizophrenia: towards an empirically validated stage model. Australian and New Zealand Journal of Psychiatry, 37, 586–94.
  4. Atterbury, K. (2014). Preserving the person: the ethical imperative of recovery-oriented practices. American Journal of Orthopsychiatry, 14 (2), 182-89.
  5. Adams, J., Drake, R. E., & Woolford, G. L.. (2007). Shared decision-making preferences of people with severe mental illness. Psychiatric Services, 58, 1219-21.
  6. Carpenter, W., Gold, J. M., Lahti, A. C., Queern, C. A., Conley, R. R., Bartko, J. J, …Appelbaum, P. S. (2000). Decisional capacity for informed consent in schizophrenia research. Archives of General Psychiatry, 57:533-38.
  7. Farrelly, S., Lester, H., Rose, D., Birchwood, M., Marshall, M., Waheed ,W., … Thornicroft, G. (2015). Improving Therapeutic Relationships: Joint Crisis Planning for Individuals With Psychotic Disorders. Qualitative Health Research, 25(12), 1637-1647.
  8. Henderson, C., Swanson, J. W., Szmuckler, G., Thornicroft, G., & Zinkler, M.(2008). A typology of advance statements in mental health care. Psychiatric Services, 59(1), 63-71.
  9. Thornicroft ,G., Farelly, S., Szmuckler, G., Birchwood, M., Waheed, W., Flach, C., … Marshall, M. (2013). Clinical outcomes of joint crisis plan to reduce compulsory treatment for people with psychosis: a randomised trial. The Lancet, 38, 1634-41.
  10. Lay, B., Blank, C., Lengler, S., Drack, T., Bleiker , M., & Rössler, W. (2015). Preventing compulsory admission to psychiatric inpatient care using psycho-education and monitoring: feasibility and outcomes after 12 months. European Archives of Psychiatry and Clinical Neurosciences, 265(3), 209-217
  11. Bartolomei, J., Bardet Blochet, A., Ortiz, N., Etter, M., Etter, J.-F., & Rey-Bellet, P. (2012). Le plan de crise conjoint: familles, patients et soignants ensemble face à la crise. Schweizer Archiv f ür Neurologie und Psychiatrie, 163(2), 58-64.
  12. Flood, C., Byford, S., Henderson, C., Leese, M., Thornicrof, G., Sutherby, K .,&Szmuckler, G. (2006). Joint crisis plans for people with psychosis: economic evaluation of a randomised controlled trial. British Medical Journal, 333(7571): 729.
  13. Richards, T., Montori, V. M., Godlee, F., Lapsley, P., & Paul, D.(2013). Let the revolution begin. Patients can improve healthcare; it’s time to take partnership seriously. British Medical Journal, 346, f2614 doi:10.1136/bmj.f2614
  14. Ridley, J., & Hunter, S. (2013). Subjective experiences of compulsory treatment from a qualitative study of early implementation of the Mental Health Act 2003. Health Social Care and Community, 21(5),509–18.
  15. Glover, H. (2012). Un nouveau paradigme se fait-il jour ? in Emmanuelle Jouet et al., Pour des usagers de la psychiatrie acteurs de leur propre vie (pp. 33-59). Toulouse: ERES « Actualité de la psychiatrie ».
  16. Deegan, P. E., Rapp, C., Holter, M., & Riefer, M. (2008). A program to support shared decision making in an outpatient psychiatric medication clinic. Psychiatric services, 59(6), 603-605.
  17. Deegan, P. E. (2010). A web application to support recovery and shared decision making in psychiatric medication clinic. Psychiatric Rehabilitation Journal, 34(1), 2328.
  18. Favrod, J., Nguyen, A., Rexhaj, S., Ferrari, P., Ortiz, A., & Bonsack, C. (2014). Back to the patient. L’informatique dans les soins. Santé mentale, 189, 74-77.
  19. Ferrari, P., Golay, P., Besse,C., Lequin, P., Milovan, M., & Suter, C. (2017). Etude des pratiques et contenus des plans de crise conjoints. Protocole d’étude, Domaine santé HES-SO, Lausanne.
  20. Assises des placements à des fins d’assistance (PLAFA), juin 2015, Etat de Vaud.

* La Loi fédérale sur le dossier électronique du patient (LDEP) est entrée en vigueur le 17 avril 2017. Le DEP sera introduit progressivement dès mi 2018, mais son implantation sera obligatoire pour tous les hôpitaux dès 2020.

**  Laboratoire d’Enseignement et de Recherche Santé Mentale et Psychiatrie, Haute Ecole de Santé La Source, Lausanne

 

Présentations du plan de crise conjoint

Ferrari P, Chinet M, Roman A: Projet d’implantation du Plan de Crise Conjoint (PCC) dans le Canton de Vaud: Forum Managed Care. Berne, 14 juin 2017.

Ferrari P, Besse C, Lequin P, Golay P, Milovan M, Conus P, Bonsack C: Etude des Pratiques et Contenus du Plan de Crise Conjoint : Résultats préliminaires: 21e Journée de recherche des Départements de psychiatrie de Lausanne et de Genève. Genève, 7 juin 2017.

Pour en savoir plus sur nos travaux dans le domaine du numérique

Favrod J, Nguyen A, Rexhaj S, Ferrari P, Ortiz A, Bonsack C: Back to the patient, l’informatique dans les soins. Santé mentale 2014;189:74-77

Applications citées dans l’article, veuillez cliquez sur l’image pour savoir comment l’obtenir

Computers and games for mental health and well-being : a research topic in Frontiers in psychiatry

L’éducation thérapeutique à l’ère du numérique
Jerôme Favrod, infirmier spécialiste clinique, professeur à l’institut et Haute école de Santé La Source (Lausanne) et Alexandra Nguyen, infirmière, maître d’enseignement à l’Institut et Haute Ecole de la Santé La Source (Lausanne), Doctorante en Sciences de l’éducation (Université de Genève)
2es Rencontres Soignantes en Psychiatrie Montpellier 2016