Gunilla Svedstr\u00f6m, verksamhetschef f\u00f6r psykiatrin p\u00e5 Akademiska sjukhuset i Uppsala, informerar om nyt\u00e4nkandet inom psykiatrin. Den stora reformen \u00e4r h\u00e4lsocentraler \u2013 v\u00e5rd i samverkan med prim\u00e4rv\u00e5rd, kommun och specialistpsykiatrin. Planer finns \u00e4ven f\u00f6r egenv\u00e5rd och social tr\u00e4ning p\u00e5 v\u00e5ning 5 i Psykiatrins hus.<\/em><\/p><\/blockquote>\n\n\n\n
\u2013 V\u00e5r st\u00f6rsta utmaning, som jag ser det, \u00e4r hur vi kan g\u00f6ra det s\u00e5 bra som m\u00f6jligt f\u00f6r v\u00e5ra patienter och att utveckla v\u00e5rden p\u00e5 det s\u00e4ttet med mindre antal personer oavsett ekonomi, s\u00e4ger Gunilla. <\/p>\n\n\n\n
Gunilla har en vision om att utveckla fl\u00f6dena fr\u00e5n psykiatrin till prim\u00e4rv\u00e5rden. Bland annat vill psykiatrin g\u00f6ra v\u00e5ning 5 i huset till ett aktivitetsplan, d\u00e4r det \u00e4ven ska finnas ett antal h\u00e4lsocoacher. Hon menar att psykiatrins patienter i m\u00e5nga fall \u00e4r ensamma och lever oh\u00e4lsosamt. P\u00e5 v\u00e5ning 5 skulle patienterna d\u00e5 kunna f\u00e5 social tr\u00e4ning. Just nu p\u00e5g\u00e5r ett projekt inom psykosv\u00e5rden som har verksamhet med statsbidrag. <\/p>\n\n\n\n
Gunilla anser att de st\u00f6rsta utmaningarna de nu st\u00e5r inf\u00f6r \u00e4r besparingar och personalbrist samt inf\u00f6randet av h\u00e4lsocentraler. <\/p>\n\n\n\n
\u2013 Utmaningarna g\u00f6r att personalen blir mer kreativ. Ekonomin g\u00f6r att vi m\u00e5ste hitta nya l\u00f6sningar. Ett s\u00e4tt \u00e4r att i st\u00f6rre utstr\u00e4ckning digitalisera v\u00e5rden. <\/p>\n\n\n\n
N\u00e4rhetsprincipen<\/strong><\/h3>\n\n\n\n
Hur ska psykiatrin bem\u00f6ta utmaningarna som \u00e4r politiska beslut som inneb\u00e4r att patienter ska f\u00e5 v\u00e5rd enligt n\u00e4rhetsprincipen – h\u00e4lsocentraler? Vad inneb\u00e4r det f\u00f6r specialistpsykiatrin? Det har man resonerat mycket kring. Tanken \u00e4r att personalen ska kunna vara n\u00e5gon form av konsulter och vissa dagar i veckan vara ute p\u00e5 en v\u00e5rdcentral. Hur de ska organisera detta, det vill s\u00e4ga samarbetet mellan prim\u00e4rv\u00e5rden, kommunen och specialistpsykiatrin, m\u00e5ste de utreda mer s\u00e5 att de g\u00f6r r\u00e4tt saker. <\/p>\n\n\n\n
H\u00e4lsocentral eller specialistpsykiatri?<\/strong><\/h3>\n\n\n\n
Psykatrin funderar ocks\u00e5 p\u00e5 hur man i framtiden kan remittera patienter till r\u00e4tt v\u00e5rdniv\u00e5. Till exempel om en patient med ADHD-diagnos inte har behov av specialistpsykiatrin, utan endast beh\u00f6ver sin medicinering, s\u00e5 skulle patienten ist\u00e4llet kunna v\u00e4nda sig till en H\u00e4lsocentral som ligger n\u00e4ra. <\/p>\n\n\n\n
\u2013 Med tanke p\u00e5 de resurser och pengar vi blir tilldelade i framtiden m\u00e5ste vi fundera p\u00e5 hur vi ska prioritera och hur vi ska m\u00f6ta v\u00e5ra patienter p\u00e5 andra s\u00e4tt, s\u00e4ger Gunilla. <\/p>\n\n\n\n
Vilka projekt \u00e4r p\u00e5 g\u00e5ng?<\/strong><\/h3>\n\n\n\n
Inom heldygnsv\u00e5rden p\u00e5g\u00e5r just nu n\u00e5got som kallas f\u00f6r \u201dSM\u00c5\u201d- projektet. Det inneb\u00e4r beteendeaktivering inom heldygnsv\u00e5rden. Projektet startades inom psykosv\u00e5rden men nu har beslut tagits om att inf\u00f6ra det p\u00e5 samtliga avdelningar. Ett annat p\u00e5g\u00e5ende jobb \u00e4r att utveckla brukarr\u00e5dsstrukturen, vilket betyder att \u00f6ka patientinflytandet. Man har \u00e4ven sett att behov av att utveckla anh\u00f6rigperspektivet och barnperspektivet finns. Diskussioner f\u00f6rs om digitalisering inom psykiatrin, till exempel hur mycket av v\u00e5rden som skulle kunna ske hemifr\u00e5n via webbm\u00f6ten? <\/p>\n\n\n\n
\u2013 Det \u00e4r en j\u00e4tteviktig fr\u00e5ga. Vad kan vi anv\u00e4nda digitaliseringen till? Vad kan patienten g\u00f6ra sj\u00e4lv och vad kan sjukv\u00e5rden g\u00f6ra? <\/p>\n\n\n\n
Standardiserade v\u00e5rdprocesser<\/a> \u00e4r n\u00e5got som psykiatrin just nu jobbar intensivt med.<\/p>\n\n\n\n
V\u00e5rdens prioriteringar<\/strong><\/h3>\n\n\n\n
\u2013 Vi f\u00f6rs\u00f6ker naturligtvis arbeta s\u00e5 effektivt som m\u00f6jligt. Vi har ju k\u00f6er p\u00e5 vissa delar, s\u00e4ger Gunilla. F\u00f6r att avlasta psykiatrin s\u00e5 finns LOVEN- lagen om offentlig upphandling<\/a> och privata psykoterapeuter p\u00e5 stan som vi remitterar patienter till. Nu pratar vi ocks\u00e5 om vad n\u00e5gon annan akt\u00f6r kan g\u00f6ra f\u00f6r att f\u00e5 bort vissa k\u00f6er. I dagsl\u00e4get \u00e4r det ju att man m\u00e5ste prioritera det akuta och det f\u00f6rsta steget, det som ocks\u00e5 kallas f\u00f6r \u201dstegvis v\u00e5rd<\/a>\u201d. F\u00f6rst \u00e4r det behandling i grupp och sist individuell v\u00e5rd. <\/p>\n\n\n\n
Brukarinflytande<\/strong><\/h3>\n\n\n\n
\u2013 V\u00e5rden idag byggs ju mer och mer upp genom integration och dialog med brukarna, eller snarare patienterna. Det \u00e4r sv\u00e5rt att veta p\u00e5 vilken niv\u00e5 man ska l\u00e4gga det. Vi och brukarrepresentanterna har funderat p\u00e5 att hitta ett bra s\u00e4tt under flera \u00e5r. Vi tittar p\u00e5 m\u00f6jligheten att ha brukar- eller patientinflytande i mindre grupper utifr\u00e5n speciella fr\u00e5gest\u00e4llningar, ber\u00e4ttar Gunilla. <\/p>\n\n\n\n
Samarbetet med kommunen<\/strong><\/h3>\n\n\n\n
\u2013 I stort tycker jag att vi har ett bra samarbete, s\u00e4ger hon.<\/p>\n\n\n\n
Ibland kan det naturligtvis handla om ekonomi och d\u00e5 kan det emellan\u00e5t bli sv\u00e5rt, speciellt nu d\u00e5 b\u00e5da parter g\u00e5r mot tuffare ekonomiska tider. De m\u00e5ste titta p\u00e5 om verksamheten de har tillsammans \u00e4r tillr\u00e4ckligt bra. Utnyttjas resurserna p\u00e5 r\u00e4tt s\u00e4tt? <\/p>\n\n\n\n
PEER Support och framtiden<\/strong><\/h3>\n\n\n\n
Gunilla s\u00e4ger att hon definitivt tror p\u00e5 Peer Support som roll.<\/p>\n\n\n\n
\u2013 Jag tror att det \u00e4r j\u00e4tteviktigt. Jag tror att det \u00e4r v\u00e4ldigt v\u00e4sentligt, om man ligger p\u00e5 en heldygnsv\u00e5rdavdelning att f\u00e5 m\u00f6ta n\u00e5gon som har \u00e5terh\u00e4mtat sig. Fr\u00e5gan \u00e4r bara hur man organisatoriskt ska f\u00e5 till det, menar Gunilla.<\/p>\n\n\n\n
Uppsala beh\u00e5ller r\u00e4ttspsykiatrin<\/strong><\/h3>\n\n\n\n
Tidigare fanns det planer p\u00e5 att r\u00e4ttspsykiatrin skulle flytta fr\u00e5n Uppsala till Sala. Men nu har beslut tagits att r\u00e4ttspsykiatrin blir kvar i Uppsala och det finns en tomt i J\u00e4lla d\u00e4r man ska bygga nytt med ytterligare en avdelning. <\/p>\n\n\n\n
<\/p>\n\n\n\n
Text: Karin Olin Knutsson och Petra Rohrer
Foto: Karin Olin Knutsson
<\/strong>
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