1. Clinical and Social Factors of Compulsory Psychiatric Treatment in Moscow Prof. Tsygankov Boris, MD, PhD Chief Psychiatrist of Moscow City, Head of the Department of Psychiatry, Addiction and Psychotherapy, Moscow State University of Medicine and Dentistry Dr. Saveliev Dmitri, MD, PhD Department of Psychiatry, Station of Ambulance and Emergency Medical Service named after A.S. Puchkov, Moscow, Russia & Dr. Yaltonskaya A., MD, PhD

2. Prevalence of mental disorders in Moscow Показатель 20102011Trend Prevalence of mental disorders (per 100 thousands people) 455,3 0% Incidence of mental disorders (per 100 thousands people) Including children (0-14 years old) 9,9 2,3 11,6 2,7 Increased by 17,1% Increased by 17,4% Number of cases schizophrenia Number of cases of disability due to mental disorders (schizophrenia) 47105 33626 47152 34036 Increased by 0,01% Increased by 1,2% Prevalence of hospitalizations due to schizophrenia (per 100 thousands people) 232,2232,3Increased by 0,4% Mean number of days spent in-patiently due to schizophrenia 79,490,3Increased by 13,7% Re-hospitalizations (% from a total number of hospitalizations) 29,332,5Increased by 10,9%

3. Mental Health Care System in Moscow Outpatient service – Psychiatric Dispensaries Inpatient service – Psychiatric Hospitals Emergency service - Station of Ambulance and Emergency Medical Service named after Puchkov Number of psychiatrists working in Moscow: 1466 – total amount of full time positions 1198 – number of occupied positions

4. Number of beds in mental hospitals (1981-2014) Total: 1981 – 16 565 2009 - 13 857 2013 - 12 309 2014 - 10 499

5. Reform in Mental Health Care System in Moscow since 2012 Main purpose is to develop better connection between outpatient and inpatient psychiatric services Focus on providing more help out-patiently through the active work of dispensaries (Day/Night Hospital, House Calls) Focus on inclusion families into help (through education and increasing the level of legal responsibilities)

6. Preliminary results of the reform Local Emergency Psychiatric Service in each dispensary was organized. -Main purpose – to provide help to patients with relapses of psychotic disorders at evening/night time -Includes: House Calls, Day/Night Hospitals, Local Intensive Care/Emergency Services with further referral to a local psychiatrist As a result significant decrease the amount of calls into Emergency Psychiatric Services (after first 2 moths) that allowed to decrease the amount of beds into psychiatric hospitals by 40%.

7. Emergency Psychiatric Service Part of General Emergency Service provided by Station of Ambulance and Emergency Medical Service named after Puchkov 24 hours Receiving and reacting to a phone calls Service provided by psychiatrists. They make decision about necessary actions and provide consultations to a) staff from hospitals and other medical settings, b) ambulances c) people

8. Emergency Psychiatric Service (2) 24 emergency psychiatric medical teams (1 psychiatrist + 2 psychiatric paramedics) 12 emergency psychiatric paramedical teams (for transporting psychiatric patients) (2 psychiatric paramedics) 8 stations located in the different areas of Moscow Each team uses fully equipped modern ambulance car (Mercedes) with GPS navigation, on-line connection with the head office, medical equipment necessary for providing intensive care.

9. Territory

10. Location of stations in different areas of Moscow

11. Steps after arrival of psychiatric team to a patient Sometimes in difficult cases Emergency Nursing Teams provide transportation of psychiatric patients (for example, to Intensive Care Department of General Hospitals). Upon arrival psychiatrist makes a decision about the necessity to provide psychiatric examination (art. 23, 24 «Psychiatric Assistance and Civil Rights Act») Reasons for psychiatric examination EXIST (voluntary or non-voluntary examination) Reasons for psychiatric examination DO NOT EXIST - Hospitalization in Psychiatric Clinic (voluntary or non-voluntary art. 28, 29) - Hospitalization in General Hospital (Psychosomatic ward) Provide medical help Provide consultation Refer to a local psychiatrist (active referral to a dispensary)

12. Main indicators of performance 39% - receives help during 20 minutes 68% - during 30 minutes 95% - during 60 minutes

13. Number of attendances and hospitalizations Number of attendance emergency psychiatric team Number of hospitalization% 2010376852161758% 2011 419002584162% 2012 474182953562%

14. Conclusion Reform of mental care system has a positive effect: -Decrease loading on psychiatric hospitals and Emergency Psychiatric Service -Increase in number of staff and material well-being Problems: - Poorly developed connection of outpatient and inpatient service