Israel's mental health services in general and its psychiatric hospitals in particular have been undergoing substantial structural change.A specific instance of the changes is the merging of the Be'er Ya'akov, the Ness Tziona and the Israel Prisons Service mental health centers. This is the first such successful merger in Israel and has became a model for merging other mental health facilities. Directed by the Ministry of Health, the merger was protracted over many phases and highly complex consultations with the various service-provider bodies and the managements of the three institutions. Numerous steering committee meetings reviewed the merged center's operational model and long negotiations took place with the trades unions involved.Selected clinical disciplines benefited from an extensive retraining program and both inpatient and outpatient services were reinforced with new specialist staff and other resources.The merger was driven by structural, economic, therapeutic and ethical considerations, among them efficient resource use, increased cooperation within and between service systems, reinforcing and enriching human capital, providing a comprehensive response to consumer needs and optimal continuity of care.The merger phases included: (a) establishing a unified management, (b) creating a new organizational structure (c) creating and implementing a new staff placement and mobility mechanism.The presentation will set out the benefits of the merger to staff and clients, the structural outcomes, and the lessons learnt. The early experience of the merged center is offered for the benefit of other organizations considering a similar step.
Beds in Israel's private psychiatric hospitals, where the standard of care is markedly lower than in state-run facilities, are being closed down. Their patients - many hospitalized for years - are being re-assessed and those still needing inpatient care transferred to state hospitals. The aim is to give a better quality of life, conduct a thorough psychiatric reappraisal and offer the latest therapeutic options.The merged Be'er Ya'akov-Ness Ziona- Israel Prisons Service Mental Health Center set up a multidisciplinary team to conduct a coordinated process of reappraisal, preparation, reorganization and admission for these patients and their families. We found in the patients complex self-management problems, a high level of dependency, severe neglect, a range of tendencies to violence, and mistrust of the staff. The family members revealed high levels of anxiety and fear. Given this situation, a nursing staffer was appointed to liaise with the families, be freely available for consultation and act as patient advocate.In this presentation we describe the core principles for this multidisciplinary reassessment and re-placement process, which began by assessing the patients in their setting of origin. We report on the planning of new interventions incorporating the latest therapeutic advances, exceptional incidents, changing the profile of the psychogeriatric ward, etc. We offer the conclusions and recommendations drawn from this change process, undergone equally by patients, family members and staff, and report on its results, which for many of the patients led to a more open care-setting in the community and for some a return home.
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