Teaching psychiatry to large groups in society

Research article Open Access Open Peer Review Teaching psychiatry to large groups in society Susanne Bejerot1, 2Email authorView ORCID ID profile, Ann Lindgren3, Jörgen Rosén4, Eva Bejerot5 and Marie Elwin2 BMC Medical Education201919:148 https://doi.org/10.1186/s12909-019-1596-9 ©  The Author(s). 2019 Received: 13 June 2018Accepted: 7 May 2019Published: 16 May 2019 Open Peer Review reports Abstract Background There is a need to educate a range of professionals in caring for individuals with long-term mental disability who reside within our communities. Empathy alone is insufficient. The Kognus 4-Step Education Program was developed to achieve this goal. Method The program consisted of independent courses, including an 18-session basic course on psychiatric disability (on-site or online), advanced courses, and highly specialized training programs (Nidotherapy/Peer Consultation). Experts lectured together with clients with psychiatric disabilities. We first report Swedish reforms in which institutionalized patients were relocated to semi-independent individual households. We then describe the design and implementation of the education program. Approximately 50% of participants who were younger than 36 years old lacked any healthcare education. The participants’ backgrounds, perceptions, participation in the education program, and costs are presented. Results Between 2009 and 2014, 8959 participants attended the Kognus psychiatry courses online or on-site in Stockholm (basic on-site course, n = 2111; online course, n = 4480; advanced courses, n = 2322; highly specialized programs, n = 46). A total of 73% of the participants satisfactorily attended the basic sessions on-site compared with 11% of the online participants. The developers conducted the education program for the first 3 years. Thereafter, another course provider continued the program with other types of participants. The program was perceived to be equally interesting and meaningful to participants with low and high levels of education, demonstrating the generalizability of the program. The quality of the basic and advanced courses was rated as 4.4 and 4.3, respectively, on a 5-point Likert scale. Conclusions Personnel without appropriate education who work with people with psychiatric/intellectual disabilities can be educated in large numbers. The Kognus program represents a novel and successful way of training people who have no formal education about some essentials of good mental healthcare. Moreover, the model can be easily implemented elsewhere. Keywords Patient-centered careStaff developmentMental disorderIntellectual disabilityHealth educationSocial supportMental health servicesNidotherapy Background Assisting people with psychiatric and intellectual disabilities is difficult without adequate knowledge—empathy alone is insufficient. In this report, we present an education program that consists of independent courses that are based on a patient-centered approach. In person-centered care, the patient’s informed voice is imperative, and individual preferences, needs, and values are respected. The care is provided in an empathic and respectful way [1]. Client participation and the use of client narratives in healthcare education have been shown to promote a person-centered approach [2]. Such an approach was used throughout the planning and implementation of the Kognus project. The courses are aimed at professionals with various occupational backgrounds who encounter and care for these individuals in their everyday work. This report includes an introduction on the ways in which the care of psychiatric patients in Sweden has developed through a number of reforms over the years. The specific aim of these reforms is to provide psychiatric patients with the possibility of living a normal life within society. A similar shift in the mental health system from hospital-based care to community-based care has occurred in other economically developed countries [3]. We report the reasons why the education of psychiatric personnel has declined in this process. We also report why the Kognus education program was introduced and the ways in which it was designed, implemented, and eventually transferred to other educational providers. Lastly, we present the participants’ satisfaction with the program. Four major changes that are related to implementing the Community Mental Health Care Reform in 1995 [4] occurred during the last 20 years in Sweden. These changes impacted the educational needs of mental healthcare workers. First, the permanent care of patients in mental hospitals was replaced with long-term community-based residential services and daycare services, including occupational and vocational rehabilitation. The goal was to provide opportunities to live independently and integrate into the local community. Since 1991, 70% of all hospital beds in Swedish psychiatric wards have disappeared [5]. Although this is a positive trend, there is a correlation between the closing of mental hospitals and higher mortality rates among psychiatric patients [5–8]. Community-based mental health services have employed homecare assistants, a new profession in Sweden that requires no formal education or training, to help patients in their home lives. The division of responsibility between community-based care and hospital-based psychiatric services has often resulted in disagreements that have adversely affected such collaborations and may harm the client. The second change that was caused by the reform of 1995 involved the field of intellectual developmental disorders [9]. Primary care doctors would henceforth manage these patients and treat them no differently from any other patient. This was based on a desire to normalize the lives of intellectually disabled individuals. However, co-occurring medical conditions are common in people with intellectual disabilities [10–12], and their treatment outcomes are more difficult to evaluate than those who are intellectually able [13–15]. Misjudgments and inappropriate treatments for intellectually disabled patients have emerged over the years [16]. The third important change was the termination of free state-administered education programs for mental healthcare assistants that had been running since 1967 [17]. Accordingly, people with inadequate or poor educational backgrounds often carry the responsibility of caring for chronically ill psychiatric patients. The fourth change is related to psychiatric morbidity in the general population, which is the most common reason for sick leave in Sweden [18]. Between 2010 and 2015, sick leave in Sweden increased by 80, and 59% of this increase was attributable to psychiatric morbidity [19]. This increase in both sickness-related absence and incapacity benefits has been a major concern in most high-income countries [20]. State initiatives to curb insurance spending through more stringent assessmen (...truncated)