regional resolution is attached, which determines the opening of the SIM 12 hours giorno.Con this decision will change anything.
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Decision of the Regional March 25, 2010, No 916
Regional Law 26/2006 "Interventions in health, art. 9. Health Plan 2008-2010 ". Opening h. 12 of the Mental Health Centres.
The Assessor of Health, based on the investigation carried out by service area, psychiatry and addiction, and confirmed by the Executive Office of the Director of Planning, Assistance and Regional Prevention, reports that:
The DPR 07.04.1994 Project-Goal Protection of Mental Health 1994-96 ", in the network department of mental health services, gives a central role in the mental health center (MSC) recognizes as the coordination point area of \u200b\u200bprevention, treatment, rehabilitation and reintegration into society and, in the same time, the need for openness of the CSM for at least 12 hours a day, 6 days a week, and by listing the functions and tasks.
Regional Law No 30/98 "rules and principles for the operation of the Mental Health Department under the Regional Law 28 December 1994, n. 36 ", confirming the central role of the CSM within the Department of Mental Health, it covers a catchment area of \u200b\u200b75 thousand to 120 thousand inhabitants, determined in relation to the concentration of the population of the territory, and it allows for the ' allocation in the opening outside the hospital for 12 hours a day, six days a week, attributing functions of medical care, social psychology, nursing and education are guaranteed through outpatient activities, house and land.
So much is confirmed in the next Presidential 10/11/1999 "Project-Goal Environment Mental Health 1998-2000". The minimum structural and organizational features, including the opening for 12 hours a day, are best defined in the DPR 14.1.1997 on "structural, technological and organizational requirements for the exercise of health activities by the public and private ".
At regional level, with EC Regulation 3 / 2005, it was decided to supplement these minimum requirements and to define the additional requirements accreditation, in relation to specific local needs and local regulations.
Regional Law No 26/2006 "Interventions in health", Article 9, reiterated the requirement for ASL to take all actions necessary to complete implementation of the Mental Health Department, in compliance with Law 30/98, as well as the prescribing reinforcement of CSM beyond the opening for 12 hours a day, with the establishment of MSM working experimentally 24 hours on 24 and 7 / 7.
the guidelines of the National Mental Health, approved by the Joint Conference at its meeting on March 20, 2008, indicate what objectives to be pursued, the promotion of services targeted to the paths of recovery and the promotion of mental health in communities, also emphasize the need to relaunch the objective of taking over by the services of people with mental disorder, based on criteria of timeliness, promotion and developing the potential of life, continuity of care, empowerment.
The Multi-Annual Programme for absorption of EU funds 2007-2013 - Priority III, approved by DGR 1401/2009 provides that the line 3.1 will be dedicated to the improvement of health infrastructure planning and, specifically, restructuring, expansion and / or adaptation departmental structures, with reference to the Department of Prevention, addiction, mental health, and to the strengthening and modernization of the technological equipment of the same locations.
Under that framework, the Regional Council, in Resolution No. 1400/07 (DEHP 2007) has identified the minimum staffing for an "CSM - type" with a catchment area of \u200b\u200b100,000 inhabitants required to open the CSM for 12 hours a day, with resolution no 95/08 (DEHP 2008), has also ordered that the General Managers of the priority actions related to the hiring plans, should activate the procedures for the recruitment of CSM.
Given the above, it should be noted that the existing network of MSM in the region still has obvious problems, also identified in the Regional Health Plan 2008-2010, and that spending on mental health care is represented by over 50% of the purchase of private health care.
These problematic issues have been, however, useful because of regional monitoring conducted in December 2009, which covered the 48 Mental Health Centres active in the area and the 60 campuses. As mentioned
monitoring shows that:
1. the majority of the MSM is still open only six hours a day, No 15 CSM ensure the opening 12 h, according to the following geographical distribution:
2. remains the severe shortage of personnel: the personnel serving in the 48 CSM operators amounted to 775 compared with a minimum total requirement of 1392 units (DGR 1400/2007) with a difference of 617 units or 44% compared to requirements. In particular, the survey are lacking some specific professions, such as professional educators (only 15 units compared to 144) nurses (295 units on 480) the rehabilitation technicians (only 5 units compared to 96) psychiatrists ( 186 to 288) Psychologists (103 to 144). In addition, several professionals in service are not evenly distributed in the CSM and the distribution of the staff does not take sufficient account of the particular geo-morphological characteristics of individual territories.
3. the opening hours of weekly users are not provided adequate standards: survey conducted there are 2 users CSM opening up for less than 6 days a week and no CSM plans to open 7 days on 7.
4. in infrastructure, finally, it must register a widespread inadequacy of the premises of the CSM compared to the standard required and the activities being conducted related to the displacement device too, the structural deficiencies, poor accessibility, lack of respect for privacy. The quality of the physical structure in which the seats are allocated by the CSM (registered Main offices and other outpatient) was self-evaluated, with reference to the requirements of the Reg Reg No 3 / 2005:
• Good: No 32
• Adequate: No 36
• Poor, poor: No 18
• Not suitable: No 20
• Not Rated: No 2
also emerge deficiencies relating to furniture, equipment, materials, and the severe depreciation of vehicles park. It should be noted that, to guarantee the multiple functions of the CSM and the multidisciplinary nature of the interventions, the premises must meet at least the minimum requirements of the Reg Reg No 3 / 2005, with particular attention to the role of acceptance in respect spaces (which should be bright, spacious, well ventilated and air conditioned) and furniture (comfortable and functional). The CSM must be equipped with medicines, medical devices and the psycho-diagnostic, risocializzanti material activities and rehabilitation, information technology and audiovisual equipment, fax, copier, adequacy of service vehicles in relation to the characteristics of the area served and other facilities of the Department functionally related to it.
Therefore, a gradual resolution of deficiencies identified, the regional government, starting in 2009, took steps to set aside a share of the FSR of current expenditure, amounting to € 2.2 million per year, enough to adapt the staffing of the CSM that already provide coverage h/12 \u200b\u200b- in accordance with the form-type-approved by DGR 1400/2007 and to implement the adjustment h/12 \u200b\u200ball other CSM, by the end of 2011.
Regarding the structural adjustment of seats, also includes equipment and furnishings, it is necessary that the General Managers, assisted by the sole blame of Procedure for the use of Community funds already signed on as the above-Disciplinary regulating the relationship between Puglia Region and the ASL for the use of ERDF funds to the 20072013 period-since I now identify and propose actions to be implemented in programming of the second period, given that the essential requirements for eligibility for Community funding are:
- final design
- immediate cantierabilità
- consistency with the priorities already outlined by the Regional Health
- consistent with their PAL.
It is therefore proposed to adopt the work plan in the following phases:
by May 2010:
Presentation by the Managing Directors of ASL in a report that will contain analysis and evaluation of the organizational situation of the CSM and the preparation of a business plan to decline priorities and objectives of intervention, temporal phases and timing, in order to arrive by May 2011, opening h/12 \u200b\u200band proper operation of at least two thirds of MSM in each ASL and by December 2011, the remaining third. A scheme for the recruitment of personnel required to implement this measure will fall within the annual term employment plans of the ASL. The report should include proposals
:
I. reconnaissance "weighted" (hours actually performed in the month for each professional category) in each of the staff in CSM;
II. the actions that the ASL is committed to put in place to balance the presence of staff in between CSM and integrating their own resources, based on the catchment and the index of spatial dispersion, including the activation, whereas in the presence of excess personnel, procedures for internal mobility. The standard of personal respect for each professional category, scheduled for the CSM from DGR 1400/07, is intended as a minimum standard, regardless of the catchment area of \u200b\u200bthe CSM itself;
III. the criteria for identifying the CSM to make it operational on h/12 \u200b\u200bfor each phase;
IV. the shortage of staff compared to the standard expected, that remains after activating the procedures set out in section II;
V. an estimate of planned spending for the recruitment of personnel necessary to achieve the objective, resulting in request for funding to cover costs related to a year of operation.
The report, prepared with the support of the Sole of Procedure for the use of EU funds, will also contain a list of infrastructure projects to be implemented in accordance with the above defined, according to the time schedule for the use of structural funds .
June 2010
Assessment reports by the Regional Policies of Health and provision of funding current spending to open up and proper operation h/12 \u200b\u200bat least two thirds of the CSM
July 2010 - May 2011
Realization the first phase and the report on achievements ASL
June 2011
ASL Assessment reports and disburse funds for the adaptation of the remaining MSM
luglio - December 2011
Construction of the second phase and final reports ASL.
It considers it essential to implement the opening of h12 CSM, so that they are able to adequately ensure all tasks assigned by law, often only partially implemented or even completely disregarded.
activities attributed to the CSM needs to be enhanced, if already underway, or implemented according to the care needs assessed, and implemented within the span of all 12 hours of operation of the CSM.
Since the Regional Plan Health Centers Mental Health characterizes as "community service" a strong interaction with the local community, multi-professional and multi-dimensional action for the protection of mental health, prevention and education to health care for citizens of all ages and social condition, the reinforcement of CSM must ensure in particular the following objectives to be considered a priority.
1) timely and adequate emergency management, emergency psychiatric admissions to filter activities, collaboration with SPDC during periods of hospitalization and agreed to resign.
2) Increase home care, home maker services and, in the territory of structured activities to support families, including through initiatives of self / mutual help, based on estimated needs.
3) Development of the work towards social inclusion through the employment of people with mental health problems in loading to the CSM, as required by the regional guidelines approved by DGR 471 / '10.
4) Increase in integrated health care activities through continuous collaboration with general practitioners, the District's social, health and other health services of the DSM and external to it, with special reference to neuropsychiatry of childhood and adolescents and to pathological addiction.
5) Specific initiatives for the identification and early intervention in serious mental disorders and for recovery of dropouts.
6) Increase social care integration activities through a significant presence and a continuing collaboration with the bodies of territorial limits for the Area Plans, is being co-design of effective implementation
7) Definition of individual treatment plans for each patient load, formalized and shared with the patient, timed, created in collaboration with other health agencies and social and monitored regularly, and who pay attention to the different sizes in need of overall health, including physical health.
8) For each patient, which is necessary for a rehabilitation program, rehabilitation projects definition of custom, signed by the patient, made in the territory directly from the CSM, or in the context of semi-residential rehabilitation facilities. In the latter case, the CSM must ensure that they share the project with the operators of facilities, periodic checks of the development of the project and the quality and effectiveness of interventions, outcome evaluation, coordination and supervision of the actions to discharge and appropriate reintegration in the context of origin. Implementation of appropriate actions for a gradual reduction in the use of residential, by creating alternative forms of land rehabilitation to ensure greater proximity to the usual conditions of life and habits of each user in their context.
9) Testing Day-care self-management by users and groups of self-help.
10) offer appropriate assistance in relation to psychiatric patients stabilized, hosted by the facilities provided by the Regional Regulation No. 4 of 2007, including the "Case for Life" in Article. 70 of the Convention itself.
11) The assumption of full responsibility for the protection of and assistance to mental health in prisons psychiatric offenders, in prison or under alternative measures to imprisonment.
12) Increase in primary prevention activities, information, awareness and promotion of mental health in the community, targeting the general population and particularly to the disadvantaged and at-risk groups.
13) Timely identification of emerging mental health needs (which is constantly changing), including the protection of the mental health of migrants is not fully integrated into the social fabric.
FINANCIAL COVERAGE - LR 16 November 2001 N. 28 and subsequent amendments and additions.
The costs arising from this measure for an amount of € 2,200,000.00 will be in charge of share 711033 - 2010-UPB 5.7.1 competence of the budget for the year 2010 budget, approved by LR No 35 of 31 December 2009. Stood, also, that the said expenditure is within the FSR shares or more of the state and community-related assignments allocated or earmarked to be allocated to local health authorities, and is excluded under article 4 of LR 4.5. 1999, No. 17, as amended by Article 13 of LR13 in December 1999, n. 32, any additional burden.
The Executive Service PATP
Dr. Fulvio Longo
Councillor rapporteur on the basis of the results of the investigation as explained before, the Board proposes the adoption of the resulting Final Act under Article 4, paragraph 4, letter a) of the LR No 7 / 97.
• The Board heard the report of the Directorate of Health Policy, prof. Tommaso Fiore;
• Having regard to the subscription at the footnote of this measure by the Officer Instructor, Director of the Office of the Director of Service and the Acting Director of Area;
• a unanimous vote cast in accordance with the law;
acting for the reason given in the narrative, which here means full below:
- to approve the decisions, programmatic for the protection of mental health, for the adjustment of the CSM that already provide coverage h/12 \u200b\u200b- in accordance with the standard form approved by DGR 1400/2007-el 'h/12 implementation of all the other MSM, according to the following Timetable:
by May 2010: Presentation by
of Managing Directors of ASL in a report that will contain analysis and evaluation of the organizational situation of the CSM and the preparation of a business plan priorities and objectives to decline intervention phases time and timing, in order to arrive by May 2011, opening h/12 \u200b\u200band proper operation of at least two thirds of MSM in each ASL and by December 2011, the remaining 1 / 3. A scheme for the recruitment of personnel required to implement this measure will fall within the annual term employment plans of the ASL. The report should include proposals:
I. reconnaissance "weighted" (hours actually performed in the month for each professional category) in each of the staff in CSM;
II. the actions that the ASL is committed to put in place to balance the presence of staff in between CSM and integrating their own resources, based on the catchment area and the index of dispersion, including activation, whereas in the presence of excess personnel, procedures for mobility inside. The standard of personal respect for each professional category, scheduled for the CSM from DGR 1400/07, is intended as a minimum standard, regardless of the catchment area of \u200b\u200bthe CSM itself;
III. the criteria for identifying the CSM to make it operational on h/12 \u200b\u200bfor each phase;
IV. the shortage of staff compared to the standard expected, that remains after activating the procedures set out in section II;
V. an estimate of planned spending for the recruitment of personnel necessary to achieve the objective, resulting in a request for funding to cover costs related to a year of operation.
The report, prepared with support of the Sole Procedure for the use of EU funds, will also contain a list of infrastructure projects to be implemented in accordance with the above defined, according to the time schedule for the use of structural funds.
June 2010
Assessment reports by the Regional Policies of Health and provision of funding current spending to open up and proper operation h/12 \u200b\u200bat least two thirds of the CSM.
July 2010 - May 2011
the first stage and the report on achievements ASL
June 2011
Assessment reports ASL and disburse funds for the adaptation of the remaining MSM
luglio - December 2011
Realization of the second phase and final reports ASL.
- to delegate to the Manager of Planning and Regional Assistance Prevention implementing any performance;
- to arrange the publication of this decision in the Official Bulletin of the Region of Puglia.
The Secretary of the Executive Board President Dr. Romano
Donno Dr. Nichi Vendola
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