Indirect forms of psychiatric care


Environmental therapy - team for environmental therapy

Support of the healing process after a schizophrenic episode requires:

  • collaboration of the patient, his/her family and a multi-professional therapeutic team,
  • accompaniment of the patient in his/her real life,
  • collaboration with extra-medical institutions which provide support to patients (social care, local government institutions, non-governmental organisations).


All this is possible only in the natural environment of the patient, therefore, various forms of environmental therapy are preferred in psychiatric therapy, with a tendency to limit inpatient treatment to a necessary minimum.

Stock photo. Posed by model.

Therapy in the patient's environment is conducted by a team of environmental therapy. The team includes psychiatric doctors, clinical psychologists, psychotherapists, environmental therapists and nurses. Care is provided to patients with mental disorders and conditions, demonstrating functional problems outside of hospital and thus at risk of re-hospitalisation. The rules of the team activity:

  • multi-professional approach,
  • combination of medical and psychosocial impacts,
  • changeability of roles,
  • joint establishment of an individual therapeutic programme for a given patient,
  • frequent contacts with the patient (on the average, once or twice a week),
  • providing services at the patient's home (at least a half of all provided services).

Every patient has his/her own therapist with whom he/she designs an individual therapeutic programme.

It is worth knowing that...

Emphasis is put on the patient's participation in selection of therapeutic goals and in the design of the plan of therapy, as well as on setting personal life goals by the patient, increased self-control of his/her life and taking more and more responsibility for their own destiny.

If necessary and possible, the care is also extended onto the patient's close, family-home environment. The services of the team of environmental therapy are provided acc. to the contract with the National Health Fund. These include:

  • home (environmental) visit,
  • counselling at the team's office (medical counselling: diagnostic, therapeutic and follow up, psychological counselling: diagnostic and standard),
  • sessions: psychotherapy, family therapy and support sessions.

Also non-standard services are provided in mediations and assistance in obtaining due rights and social and health benefits, in psychoeducation, meetings with a dietician, club meetings, excursions and special events. The most common work methods of the team include:

  • diagnostics: psychiatric, general medical, psychological, referring to consultations and specialised examinations / tests;
  • pharmacotherapy;
  • monitoring of mental and somatic condition;
  • psychotherapy: cognitive-behavioural, psychodynamic, systemic;
  • training of: basic life skills, social skills, coping with disease, cognitive functions;
  • psychoeducation of the patient and his/her family, counselling, crisis interventions, mediations, psychological support and help: group and individual;
  • club activities, excursions,
  • help to find a job;
  • collaboration with other units: health care units, social units, non-governmental organisations, local government, units involved in occupational readaptation.

How are admission to and discharge from the team arranged?

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The patient may come to the team of environmental therapy by himself/herself or a meeting may be initiated by the patient's family. No referral is necessary.

However, patients are often referred by psychiatric doctors from outpatient clinics of mental health, from 24-h and day-care wards, as well as by GPs. The care of the environmental therapy team is provided when the team analyses the patient's needs with regards to medical and psychosocial services and after establishment and mutual acceptance of the principles on which these services are provided.

A condition to cover the patient by the care of the team is the patient's consent in writing and signature of a consent to inform an indicated close person about his/her health condition and to disclose medical documentation. The duration of care by the team of environmental therapy is not predetermined. The patient may be discharged by his/her request - also oral. When the set therapeutic goals are achieved, the patient - in agreement with the team - may be transferred to an outpatient clinic of mental health for less intensive care.

When the patient's mental condition deteriorates, it may be necessary to refer the patient to a day-care ward or a 24-h care-ward for further treatment. Therefore, a close collaboration is important of all these units, within the local centre of mental health.

Day Care Department

It is a site of treatment of mental disorders in day-care system. The patient stays at the ward from 8:00 a.m. to 3:00 p.m. and the rest of the day and night spends at home. At the day-care ward, the patient has access to a psychiatric doctor, a psychologist and a nurse.

Occupational therapists, a psychotherapist and a social worker are also employed at the ward. A day-care ward provides: medical diagnosis (of mental and somatic state), psychological diagnosis, social diagnosis and therapy is planned and administered. The therapy includes pharmacological treatment of mental and somatic disorders and various forms of non-pharmacological therapy, especially:

  • individual and group psychotherapy,
  • sociotherapy,
  • occupational therapy,
  • art therapy (therapy by arts – music, dancing, drawing, painting),
  • bibliotherapy,
  • therapy with motion,
  • training of life skills (hygienic, cooking, budget),
  • training of social skills (communications, interpersonal skills, problem solutions, coping with emotions),
  • cognitive training sessions,
  • psychoeducation.

It is worth knowing that...

In many cases, mental disorders can be diagnosed and treated at a day-care ward, which is a good alternative to 24-h inpatient therapy at psychiatric ward - as it does not take the patient away from his/her home environment.

In other cases, it is possible to reduce hospitalisation periods by transfer of the patient from the 24-h department (after remission of acute symptoms) to a day-care ward to carry on the therapy.

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Day-care wards are general psychiatric (diagnostic-therapeutic) wards in character, where all types of mental disorders can be diagnosed and treated.

There are also specialised day-care wards:

  • rehabilitation day-care departments with psychotherapeutic and training programmes for persons after the first episode or with chronic or recurrent course of psychotic events (especially schizophrenia);
  • for persons with neurotic disorders, personality disorders and eating problems (these departments offer extensive programmes of individual and group psychotherapy),
  • for persons with depression or persons with affective disorders (depressions and bipolar disorders),
  • for persons in senile age (psychogeriatric),
  • for alcohol addicted persons,
  • for psychoactive substance addicted persons.

How is admission arranged?

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Admission to a day-care ward is possible by referral, issued by a psychiatrist (at a mental health outpatient clinic, a team of environmental therapy, a hospital or any other medical unit) and after qualification of the patient by a therapeutic team at the day-care ward.

The therapy at a day-care ward is free of charge. The patient should be insured. Employed patients are on sick-leave during the therapy period at a day-care ward.  On admission to a day-care ward, the patient provides a written consent to treatment and a separate consent to inform a definite close person about his/her health condition and disclose medical documentation.

Therapeutic hostel or flat

Therapeutic (training) hostels and flats are areas of temporary residence (from several months to one, two years) - under care of therapists - for few to several young persons with serious mental disorders, which make difficult everyday functions and preclude social roles.

A stay at a hostel may be especially needed during the period next to hospital discharge. It applies especially to persons which have not yet achieved or lost their full independence in life and their family environment is not supportive but internally conflicted, facing their own problems and only provides additional stress.

Hostel inhabitants work themselves on their basic subsistence needs - do shopping, cook meals, take of personal hygiene and cleanliness of their rooms, as well as monitor the adherence to medication regimens.

It is worth knowing that...

Living together and sharing the household by hostel's inhabitants has a socio-therapeutic aspect and gives a chance to train daily-living and social skills in natural conditions of daily life.

Before noon, all the residents should systematically (every day) go out for outdoor activities, such as, for example:

  • school education,
  • further education courses,
  • therapy at a day-care ward,
  • rehabilitation at workshop of occupational activities,
  • searching for or working in gainful employment.

These activities should provide a staged preparation to full independence in life. In the afternoon, individual meetings should be organised at the hostel, involving a therapist, a psychologist, a doctor plus meetings of the community, sometimes group or family therapy session. Living together and joint attempts for outdoor (outside of the hostel) activities plus in-house individual and group contacts with the therapist allow to diagnose in natural conditions the resources and deficits of daily-living and social skills in hostel residents.

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Based on the diagnosis, the therapist, together with the hostel resident, determine further therapeutic objectives and develop an individual therapeutic plan, which then verified and corrected in the course of implementation.

The plans are oriented towards strengthening of healing and recovery by addition of individual resources and competences. The stay and therapy in hostel (therapeutic flat) environment may also be helpful in processing and solving the patient's family conflicts, supporting his/her individuation and separation from his/her parents, completion of studies, finding a job.

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After completion of hostel therapy, patients return to their families and, sometimes, become independent by finding a flat and gainful employment.

Hostels (protected training flats) are organised within psychiatric hospitals and also at environmental self-help homes or as independent units of the local government of a town, a commune or a district.

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