1. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 1 EMERGING SERVICE MODELS IN MENTAL HEALTH AND INTELLECTUAL DISABILITY IN THE CITY OF VIENNA Ernst Berger > UNIVERSITY OF VIENNA < > NEUROLOGICAL HOSPITAL ROSENHUEGEL < > COMMUNITY MENTAL HEALTH SERVICES VIENNA <

2. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 2 VIENNA CAPITAL OF AUSTRIA 1,6 MIO INHABITANTS 1977 MORE THAN 2500 IN-PATIENTS IN PSYCHIATRIC HOSPITAL  START OF REFORM OF PSYCHIATRIC CARE

3. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 3 TARGET PLAN FOR PSYCHIATRIC CARE 1979 HOUSING PROGRAM FOR DISABLED PEOPLE 1986 DEINSTITUTIONALISATION PROGRAM 1996

4. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 4 TARGET PLAN for PSYCHIATRIC CARE 1979 DECLARATION: „NORMALISATION OF LIVING CONDITIONS OF DISABLED PEOPLE...“ REALITY: NO CHANGES IN THE NEXT YEARS FOR ABOUT 500 DISABLED PEOPLE IN PSYCHIATRIC HOSPITAL OF VIENNA

5. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 5 FIRST STEPS of CHANGE 1984 - 93 N = 22 (7f / 15m) Age 16;0 - 30;2 years (BERGER 1995) MODEL PROJECT OF 1984: (COMMUNITY MENTAL HEALTH SERVICES VIENNA) THE FIRST GROUP-HOME FOR DISABLED PEOPLE AFTER LONGTIME HOSPITALISATION

6. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 6 HOUSING PROGRAM FOR DISABLED PEOPLE 1986 1000 NEW LIVING PLACES IN GROUP HOMES OUTSIDE THE HOSPITAL

7. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 7 DEINSTITUTIONALISATION PROJECT 1996 THE LAST STEPS: GROUP HOMES FOR TWO GROUPS OF SEVERE DISABLED IN-PATIENTS: A) PEOPLE WITH MULTIPLE HANDICAP B) PEOPLE WITH DUAL DIAGNOSIS

8. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 8 DEINSTITUTIONALISATION PROJECT 1996 INTERIM REPORT JUNE 2000 RETROSPECTIVE INVESTIGATION ABOUT PERIOD 1986 – 98 N = 135 CLIENTS Mean age = 40 y (17 - 73 y) Mean hospitalisation period = 23,45 y

9. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 9 CLUSTERS OF CLIENTS DEINSTITUTIONALISATION PROJECT 1996

10. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 10 CLUSTERS TYPE 1....„SEVERE DISABILITY“ TYPE 2....„HIGH COMPETENCE“ TYPE 3....„DUAL DIAGNOSIS“

11. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 11 PROCESS OF DEINSTITUTIONALISATION and TYPES OF CLIENTS DEINSTITUTIONALISATION PROJECT 1996

12. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 12 BASIC CONDITIONS IN ORGANISATION OF PSYCHIATRIC CARE FOR DOUBLE DIAGNOSED PEOPLE IN VIENNA NO MEDICAL SPECIALISATION ON DUAL DIAGNOSIS > SMALL KNOWLEDGE OF PSYCHIATRISTS ABOUT INTELLECTUAL DISABILITY > PREDOMINANCE OF MEDICAL CONCEPTS VERY DIFFERENT LIVING SITUATIONS OF CLIENTS

13. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 13 SOME RELEVANT POINTS IN THE DEINSTITUTIONALISATION PROJECT HIGH RATE (> 50%) OF AGGRESSIVE BEHAVIOUR HIGH RATE ( 45%) OF SEVERE SPEECH DISTURBANCES BUT REMARKABLY BETTER (TWICE) RESSOURCES FOR CARE

14. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 14 NO CLEAR LEGAL RULES ABOUT THE USE OF COERCION AND FORCE IN THE EVERYDAY CARE OUTSIDE OF HOSPITALS THE RESPONSIBILITY OF PSYCHIATRIC INSTITUTIONS FOR PEOPLE WITH DUAL DIAGNOSIS IS DIMINISHING SOME ACTUAL PROBLEMS IN THE CARE OF PEOPLE DUAL DIAGNOSED

15. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 15 MODEL OF PSYCHIATRIC CARE FOR PEOPLE WITH INTELLECTUAL DISABILITY AREAS OF DAILY LIFE OUTPATIENT CARE INPATIENT CARE DIFFERENT LEVELS

16. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 16 LIVING AREAS OF PEOPLE WITH INTELLECTUAL DISABILITY HOUSING WORKING LEISURE TIME PROFESSIONAL CARE FULLYPARTIALLY PRIVATE CARE FULLYPARTIALLY INDEPENDENT

17. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 17 OUTPATIENT CARE FOR PEOPLE WITH INTELLECTUAL DISABILITY PSYCHIATRISTS IN PRIVATE PRACTICES GENERAL PSYCHIATRIC OUTPATIENT CARE FACILITIES + EMERGENCY CARE PRIVATE SECTOR COMMUNITY MENTAL HEALTH CARE TEAM OF SPECIALISTS FOR DOUBLE DIAGNOSIS

18. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 18 OUTPATIENT CARE TEAM OF SPECIALISTS MULTIPROFESSIONAL TEAM SPECIALLY TRAINED PSYCHIATRIST SPECIALLY TRAINED PSYCHOLOGIST SOCIAL WORKER SPECIALLY TRAINED PSYCHOTHERAPIST

19. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 19 INPATIENT SERVICES FOR PEOPLE WITH INTELLECTUAL DISABILITY GENERAL PSYCHIATRIC HOSPITAL UNIT PSYCHIATRIC HOSPITAL UNIT FOR DUAL DIAGNOSIS

20. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 20 INPATIENT SERVICE SPECIALISED UNIT FOR DUAL DIAGNOSIS FUNCTIONS CRISIS INTERVENTION PSYCHIATRIC THERAPY PSYCHOTHERAPY PLANNING OF REHABILITATION TEAM PSYCHIATRISTS PSYCHOLOGISTS NURSING PERSONS PSYCHOTHERAPISTS PEDAGOGUES

21. Double Diagnosis /da Vinci / Biomed /VIENNA 2000 21 HOUSING GENERAL PSYCHIATRIC HOSPITAL UNIT WORKINGLEISURE TIME PSYCHIATRISTS IN PRIVATE PRACTICES GENERAL PSYCHIATRIC OUTPATIENT CARE STATION + EMERGENCY CARE TEAM OF SPECIALISTS FOR DOUBLE DIAGNOSIS HOSPITAL UNIT FOR DUAL DIAGNOSIS WAYS OF CLIENTS LIAISON - SERVICES NETWORKS