Improving long-term clinical psychiatric care: implementation of a method for renewed diagnosis and treatment (DITSMI

Lianne SANDERS2, M HELLEMAN2, Lisette VAN DER MEER2,3, C WUNDERINK2,4, I BERG2, T VAN BROUWERSHAVENA2

1Universitair Hoofddocent, Groningen, Netherlands
2Lentis Psychiatric Institute, Department of Rehabilitation, Zuidlaren, Netherlands
3University of Groningen, Department of Clinical and Developmental Neuropsychology, Groningen, Netherlands
4Hanze University of Applied Sciences, Centre of Expertise Healthy Ageing, Groningen, Netherlands
5GNet Community Mental Health Center, Warnsveld, Netherlands

Background

The DITSMI method (Diagnose, Indicate and Treat Severe Mental Illness) involves diagnosis or re-diagnosis and appropriate treatment for persons with severe mental illness (SMI) in need of longer term clinical psychiatric care. In the current project, we aim to implement the DITSMI method in four organizations providing long-term care for persons with SMI throughout the Netherlands.



Methods

The DITSMI method is based on providing a holistic diagnosis including psychiatric, somatic and social functioning for each participating individual. Subsequently, a multidisciplinary treatment proposal according to treatment guidelines is formulated and adhered to. In the current implementation study, we will measure potential adaptations in diagnosis, treatment indications, medication use, and use of psychiatric care services, as well as potential changes in somatic and psychosocial functioning.



Results

In the original study (Veereschild et al., 2020) 83 persons with SMI (mean age 49±11.8y; 31% female; mean duration of care history 21±8.9y; 53% DSM-IV classification Schizophrenia) were evaluated over a three-year period. After DITSMI, 49% of the DSM-IV classifications changed; 67% of the treatment proposals changed; medication prescriptions changed for 67% of patients; time spent by professionals in face-to-face contact as well as administrative time lowered with 20-29%; bed utilization lowered with 44%. Preliminary results from the implementation study will be presented at the conference. 



Discussion

The DITSMI method was previously found to lead to changes in diagnosis and treatment indication, resulting in improved medication use and psychosocial functioning and less utilization of psychiatric care services in persons with SMI within a long-term clinical psychiatric facility. While the clinical validity of DITSMI is considered high, factors complicating daily health care for persons with SMI on a provider and organizational level will need to be carefully investigated for a successful implementation of DITSMI on a larger scale.