Abstract
Objective: To develop an innovative initiative to improve (access to) somatic care for people with severe Mental Disorders (MD) and to facilitate (access to) mental health care for people living in the community.
Context: As in many countries, people suffering from (severe) mental disorders in Belgium are at increased risk of somatic pathologies such as hypertension, diabetes, chronic obstructive pulmonary disease, and transmissible diseases such as hepatitis B and C. Life expectancy is reduced by 15 to 20 years, mainly due to premature death from cardiovascular disease. These people experience difficulties in accessing quality somatic care, partly because of the overriding focus on mental disorders and persistent stigmatization. In addition, there is a persistent lack of integration and continuity between mental health care and primary care. People admitted to the hospital suffer from a lack of outpatient follow-up after discharge, and people suffering from MD in the community have difficulty accessing appropriate mental health care. Finally, in the Sint-Truiden region, the historical presence of Asster, a major psychiatric institution, has led to the settlement in the community of a large population of people suffering from mental vulnerability. Asster therefore joined forces with a local primary care practice and decided to develop an innovative initiative, the "Halmaal Home" (HH).
Methods: HH is guided by a steering committee made up of several stakeholders, such as representatives of all the mental health care organizations in the region, primary care organizations, the chief executive and medical director of the psychiatric hospital, and representatives of the local council and patient organizations. The initiative is recognized and financially supported by the Flemish government. Finally, the initiative is being supported by a consultancy agency in the development of its mission, vision, and action plan.
Results: The initiative is currently under construction and should start in April 2024. We want to focus particularly - but not exclusively - on people with severe long-term mental vulnerability. As such, we aim to position HH as an 'intermediary' point of care between the psychiatric hospital and the outpatient primary care environment, to strengthen and facilitate mutual collaboration. The interdisciplinary care team will comprise street nurses, practice nurses, physiotherapists, general practitioners, primary care psychologists, psychiatrists, and social workers. The street nurses will actively seek out homeless people in need of care. HH will also act as a 'hub' for referrals to other health and social care providers. Our service to primary care providers (GPs, nurses,...) will consist of advising on how to treat people with (severe) mental health problems and, if necessary, facilitating direct communication with and access to specialist mental health care. Our service to social and municipal services will involve facilitating communication with specialist mental health care and the timely provision of care appropriate to the situation and its urgency. Finally, we will also organize preventive activities on topics such as smoking cessation, healthy eating, and mindfulness. HH will also work closely with the neighborhood through initiatives such as neighborhood solidarity and quartering.