EPA-0295 – How a day hospital can become psychodynamic: considerations on the institutional treatment of psychosis and personality disorders

Abstract

Introduction The team work in institutions represents an evolution in the treatment of serious diseases when it makes the institution itself lightweight, affordable, reliable and effective at the same time. The present paper describes an experience of three years in a psychiatric day hospital where medical and psychotherapeutic aspects were incorporated into an original model, taking into account the valuable experiences of Racamier and Kaes in France, the observations on ‘something more’ of the Boston group (Stern et al .), the work of Correale in Italy. Objectives In the present work we describe and evaluate the therapeutic model using three main indicators: treatment compliance, acute episodes and hospitalizations required in the observed period. Aims To identify which factors of our therapeutic model are relevant to severe mental disorders treatment. Methods The model offers patients, in the same session of care, psychiatric, psychotherapeutic, test taking, medical and rehabilitation services. The process involves three steps: evaluation, core-therapy and follow-up. Approximately 300 patients were treated following this protocol within three years of observation. Results The indicators used in our model suggested a relationship between a successful treatment and patient's ability to actively use spaces of ‘institutional opportunity’ specifically designed in the project developed by the team. Conclusion An effective institutional treatment allows the patient to draw on personal coping skills, and not to be passivated thanks to the ‘real free spaces’ existing between a structured intervention and another.