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Integrated Working Group "Mental Health

In the Integrated Working Group Mental Health*, we implement theory-building, applied, and method-reflexive research projects. We use the term health* in the plural and with an asterisk to include physical, emotional, mental, social, spiritual, and other forms of well-being as well as their impairments, and to question the associated sick/healthy binary.

We have diverse personal, disciplinary, and professional backgrounds of knowledge and experience. This diversity enables research across perspectives and methods. In most of the projects, scientific staff members work who have experience with mental crises, impairments, illnesses, or deviations from the norm. Thus, they contribute a variety of experiences, e.g. with the care system, with recovery or dealing with complaints, as well as self-help and self-advocacy work. In the following, these researchers are called researchers with experiential expertise.

Our projects are set up in different ways: some are participatory in nature, others are primarily collaborative in their approach, meaning a collaboration between researchers with and without experiential expertise on the level of a research team (a weaker form of co-production). Other projects are user/survivor-controlled, meaning that researchers with experiential expertise work independently on the design, methods, or theory, drawing on their reflexive positionality. Some projects focus on epistemological and theoretical issues in the field of mental health*, others deal with questions of psychiatric and psychosocial care or alternatives to it.

All projects involving researchers with experiential expertise are pooled within our IAG as the Mental Health Co-Lab*. This includes joint scientific projects, e.g. methodological research, but also other activities, e.g. networking within the IAG or beyond.

For more information, please use our German website.

Coordination

Prof. Dr. med. MPhil.

Sebastian von Peter

Professor für Psychiatrische Versorgungsforschung, Oberarzt an der Hochschulklinik für Psychiatrie und Psychotherapie; Leiter IAG Psychische Gesundheiten* Universitätsklinikum Immanuel Klinik Rüdersdorf

Studies and Projects

PsychCare Study

As a result of a law passed in 2013 (§64b Social Code Book V), various model projects have been established in Germany to improve psychiatric hospital care. They aim at a stronger ambulantization, continuity and flexibility of treatment models, which is mainly achieved by a budgetary kind of financing (clinic-related total budget).

The PsychCare study is based on comparing the benefits, costs and efficiency of model projects with standard care. Methodologically, a controlled, prospective, multi-centre cohort study with two follow ups will be conducted. The study follows various research questions and includes a cost-effectiveness analysis, the identification of quality indicators and a data linkage of primary and secondary data.

Under the leadership of the Technical University Dresden, the MHB is also involved as a consortium partner. Based on the preliminary study EvaMode64 (see completed projects), a participatory-collaborative process evaluation is being conducted at the MHB in cooperation with researchers with and without own experiential experience. This evaluation aims at enabling a differentiated perspective on the treatment quality at the different locations of the care model.

The project is funded by the Innovation Fund and lasts from 2017 to 2021. The contact person at the MHB is Sebastian von Peter.

AktiV- Study

While in many countries, such as the Netherlands, in Australia and in the UK, acute psychiatric treatment is mainly provided by community psychiatric teams, in Germany it largely takes place on hospitals wards. Since 2017, there a law (§115d Social Code V) allows for home treatment as a substitute for inpatient treatment, known as “inpatient-equivalent treatment” (=StäB).

The AktiV study investigates the type of implementation, treatment processes, clinical effec-tiveness, inpatient readmission rates, and costs of inpatient-equivalent treatment compared to conventional inpatient treatment. The suitability of inpatient-equivalent treatment for different target groups, care settings, and care regions will be examined. The central hypothesis is that inpatient readmission rates will be lower within twelve months of inpatient-equivalent treat-ment, compared to usual inpatient treatment.

The study is led by Urban Hospital in Berlin and the MHB. At the MHB, a participatory-collaborative process evaluation is being conducted by researchers with and without their own experiential expertise. This evaluation will examine the value of inpatient equivalent treatment from the perspective of the users.

The project is funded by the Innovation Fund and lasts from 2020 to 2023. The contact person at the MHB is Julian Schwarz.

ImpPeer Psy5 Study

For about 20 years, people with own experiences of mental health crises and recovery from them (peers) have been working as peer support in mental health care settings. Reviews of in-ternational studies show that peer support can improve self-empowerment, self-efficacy and recovery of mental health users. At the same time, there are only few scientific findings and data on peer support in German regular care.

The research project ImpPeer-Psy5 collects and evaluates experiences with peer work nation-wide and analyses the needs of the involved actors. It examines the conditions under which peer workers are employed and their cooperation with other professional groups and users, and tests the transferability of international study results. A standardized survey is addressed to peer counsellors, peers in training, employees and managers from institutions with and without peer counselling, as well as users with and without contact to peers. In addition, actors from these target groups, in dialogues with researchers, explore their experiences in more detail in discus-sion groups and interviews.

The study is led by the MHB and conducted together with staff of the University Hospital Eppen-dorf, and the peer support association ExIN Germany. The project will be collaborative and par-ticipatory in all phases, i.e. in cooperation of researchers and practice experts with and without experiential expertise.

The project is funded by the Innovation Fund, it lasts from 2020 to 2023. Contact person at the MHB is Sebastian von Peter.

PazAng

Psychiatric care often focuses the dyadic doctor-user relationship, which makes caregivers a largely disregarded group in the treatment situation. Their systematic exclusion is often seen as a requirement and/or therapeutic necessity. Recently, there has been a renewed interest in the group of caregivers: On the one hand, there is a clear tendency to pathologize this group (as "co-sufferers"), on the other hand, psychiatry increasingly demands the inclusion of caregivers as so-called "co-therapists".

In a collaborative-participative cooperation, a proposal was formulated that aims to investigate the possibilities for participation of caregivers in psychiatric treatment, beyond this dichotomy. The application was submitted to the German Research Foundation. Members of the Berlin Association of Caregivers of Mentally Ill People (ApK e.V.), employees of the University Clinic for Psychiatry and Psychotherapy Leipzig and employees of the MHB participated in the development of the application. The project aims to develop an intervention to improve the integration of caregivers into the psychiatric treatment situation.

Contact person at the MHB is Sebastian von Peter.

PatB-Inst

Participation in Health Policy Institutions

In addition to the institutions that are obligated to involve patient representatives according to § 140 f of the German Social Code V, there are other institutions that infrequently involve patients without a formalized legal basis. There is a multitude of possibilities for participation, but the access and type of participation are difficult to recognise (not only) for those affected who want to get involved.

The project aims at an inventory and needs analysis of patient participation in health policy institutions in Germany at the federal level. For this purpose, different methods of analysis are combined (legal analysis, systematic literature research, document analysis, qualitative survey). In the area of the qualitative survey, semi-structured, guideline-supported individual interviews with representatives of health policy institutions and with patient representatives, as well as focus groups will be conducted. The aim of the study is to gain insights into the group of people involved, the recruitment of patient representatives, the institutional participation formats and the factors that constitute them. In this context, the perspectives of patient and other representatives will be investigated and how they experience the implementation of patient participation in institutions and which concrete needs for further development are seen.

The project is carried out in cooperation with the Center for Health Services Research Brandenburg (ZVF-BB) of the MHB (link), the duration is from 2020 to 2021. Contact person is Eva Buchholz.

SiSi

SiSi Study/Subproject Mad Studies

The project investigates the interplay of thing-meanings and agency in extreme mental crises, in madness experiences and psychiatric reactions to them. It is assumed that the boundaries be-tween man and thing are renegotiated precisely when we leave the territory of self-evident routines and the everyday. Following the method of "photo-elicitation", "object-elicited inter-views" are conducted. Things - either materially available or described from memory - are a third party between the interviewer and the interviewee. The preoccupation with their materi-ality, with the actions and meanings associated with them, allows a joint exploration of the sub-ject matter. The result is a scientific work and a website as a digital museum. This wants to make the knowledge of psychiatry-experienced about crises and their overcoming more publicly known.

It is a stakeholder-controlled project in which (a) the people who make the decisions and (al-most) all those who collaborate in it are relevantly experienced; b) interpretations are based on a hermeneutic circle of "mad wisdom": different texts of psychiatry-experiencers open up new horizons of understanding for each other; c) The "digital museum" will be designed with the participation of the "donors".

The project is funded by the BMBF (duration 2018-2021). It was conceived by Elena Demke and is being implemented by her together with other collaborators. Martin Heinze is in charge of the application.

Evaluation of Crisis Support in the Bochum Crisis Respite

In this research project, the crisis support of the Bochum Crisis Respite, an peer-organized sup-port by the Landesverband Psychiatrieerfahrener NRW (North Rhine-Westphalia Association of People Experiencing Psychiatric Disorders), was examined. The main research interest was to evaluate the specificities of a self-help-organized crisis support, the investigation of its central components, effective factors and effects. Methods of qualitative health research were used and the approach was strictly collaborative-participative, meaning that the research team consisted of employees with and without experiential expertise (collaboration), and that employees and, in some cases, former users of the Bochum crisis support were involved in central decisions in all phases of the research process (participation).

The project was funded by Stiftung Wohlfahrtspflege and lasted from 2017 to 2020.

Recovery-oriented Group Work

The term Recovery originates from the critical self-help and historically turned against the pessimism of employees in psychiatric institutions. Followingly, the term was adopted by reform-oriented professionals, gradually incorporating into various health policy concepts and demands, which also led to a major change in the concept.

Since 2014, participatory-collaborative work has been underway on a group concept for the implementation of Recovery-oriented principles for people with psychosis experiences. This concept has also been published in the meantime. Based on this, researchers with and without psychiatric experience are currently have been working on a brochure, which will present different recovery groups and discuss the underlying concepts in comparison.

The current project is funded by Aktion Mensch and lastet from 2020 to 2021.

Hope’nDialogue

Open Dialogue and its predecessors have been practiced and developed in some Scandinavian countries since the early 1980s. A number of principles have been described (such as immediate and mostly outreach help; team-based work; systemic orientation; presence of users during dis-cussion of all concerns; continuity of care; flexible treatment design; mediation of individual psychotherapy when needed; low-dose neuroleptics), not all of which can be easily translated to the German care situation. Nevertheless, Open Dialogue is now being implemented at about 42 locations in Germany, both in clinics and outpatient facilities. So far, there has been no system-atic evaluation of these services.

Based on a study with high methodological requirements in Great Britain (ODESSSI - link), an international cohort study has been in preparation since 2018, which will systematically investi-gate the effects of care through Open Dialogue in more than 10 countries over the long term. The research design for this international study is currently being implemented in the Nether-lands and in three locations in Germany. At the MHB, the study activities for the sites in Germa-ny are being coordinated.

The overall study receives funding from the Foundation for Excellence in Mental Health Care. It is planned to last for 7 years, 2019-2026. Contact person is Kolja Heumann.

CHIMPS

Children and adolescents who witness parents in mental health crisis are statistically at increased risk of experiencing a mental health crisis themselves at some point. Currently, there is a lack of low-threshold, family-oriented care services to respond to this need.

With the new form of care "CHIMPs-Net", a family-therapeutic offer is to be established in Germany, which is designed between therapy and prevention, depending on the needs of the family. Within the framework of a qualitative process and outcome evaluation, the MHB caries out the implementation process at various centres in Germany. This project also includes a critical examination of the concept of medical-psychiatric prevention of mental crises.

The project is implemented within the framework of the Innovation Fund. Duration: 2019-2022. Contact persons is Timo Beeker.

EKBM

The project investigates the interplay of thing-meanings and agency in extreme mental crises, in madness experiences and psychiatric reactions to them. It is assumed that the boundaries be-tween man and thing are renegotiated precisely when we leave the territory of self-evident routines and the everyday. Following the method of "photo-elicitation", "object-elicited inter-views" are conducted. Things - either materially available or described from memory - are a third party between the interviewer and the interviewee. The preoccupation with their materi-ality, with the actions and meanings associated with them, allows a joint exploration of the sub-ject matter. The result is a scientific work and a website as a digital museum. This wants to make the knowledge of psychiatry-experienced about crises and their overcoming more publicly known.

It is a stakeholder-controlled project in which (a) the people who make the decisions and (al-most) all those who collaborate in it are relevantly experienced; b) interpretations are based on a hermeneutic circle of "mad wisdom": different texts of psychiatry-experiencers open up new horizons of understanding for each other; c) The "digital museum" will be designed with the participation of the "donors".

The project is funded by the BMBF (duration 2018-2021). It was conceived by Elena Demke and is being implemented by her together with other collaborators. Martin Heinze is in charge of the application.

Reduction and Discontinuation of Psychotropic Drugs

Users and related associations have long criticized the strong reliance on psychopharmacothera-py as a primary means of treatment. They cite side effects and long-term consequences of taking both antipsychotics and antidepressants. Long-term and high-dose use of antipsychotics and an-tidepressants can lead to significant side effects, tolerance development and irreversible late effects. What is desired instead is a structured approach to reducing and/or discontinuing psy-chotropic medications. To date, there is little substantiated knowledge on this.

Thus, in 2018, a trialogue was founded in Berlin, in which psychiatric patients, their relatives and staff, exchange knowledge about the reduction and discontinuation of psychotropic drugs. In addition, the current procedures and attitudes of prescribing physicians with regard to the reduction and discontinuation of antidepressants and antipsychotics in Berlin and Brandenburg will be investigated within the framework of a doctoral project and an online survey.

The project is being implemented as part of a doctoral project. Duration: 2018-2021. Contact person is Sebastian von Peter.

Project description "Psychiatrization of society"

Over the last decades, psychiatry as an institution, science and practice has continuously gained importance in society. More and more people have received a psychiatric diagnosis, have been prescribed psychotropic drugs or have taken advantage of other psychiatric or psychotherapeutic treatment. In complex interactions with this development, psychiatrically influenced thinking in concepts and language is increasingly permeating our everyday life and various areas of life. Whether learning difficulties in elementary school or aggressiveness in a nursing home: problems are increasingly interpreted psychiatrically and are then primarily to be solved psychiatrically.

The project critically examines these phenomena and understands them as part of an overarching development process towards an increasing psychiatrization of society. It focuses on possible risks and damages for individuals (e.g. by low-threshold diagnoses and ineffective treatments) and society (e.g. if social grievances are not to be solved politically but medically-psychiatrically). The approach to the object of research is both empirical, using the methods of mental health care research, and conceptual, through continuous theory development along the lines of philosophy and the critical social sciences. Because of this theoretical reference, there is a close cooperation with the WG Paradigms of Psychiatry and Psychotherapy (Head: Prof. Heinze).

Project duration: open. Contact person: Timo Beeker.

EvaMod64b study

Internationally, there is a broad spectrum of team-based and inpatient care models, while in Germany many users are treated exclusively in the full inpatient setting. Since 2013, the possi-bilities for integrative forms of treatment according to §64b SGB V have been expanded: Through a clinic-related total budget across all treatment settings (inpatient, day-care, outpa-tient) these model projects aim to provide more flexible, needs-based care. As a result of the framework conditions of § 64b, the health insurance associations issued a Europe-wide invita-tion to tender for accompanying research in 2015. This is based on the analysis of routine data available from the health insurance funds.

This study design cannot answer qualitative questions, in particular the assessment of the model care by users, relatives and employees. It is also not possible to investigate how the individual clinics structure the model care. For these reasons, a group of model clinics decided to conduct their own study (Akronym EvaMod64b). Data collection has already been completed. The study results will be published starting in 2018.

The project was supported by funding from the consortium of participating clinics and lasted from 2016 to 2018.

© 2023 MEDIZINISCHE HOCHSCHULE BRANDENBURG Theodor Fontane
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