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05-03-2025 | Original Paper

How are Ambulatory Treatment and Personalised Care Being Implemented in Psychiatry? An Analysis of Eight Years of Activity Records of a Belgian Mobile Crisis Team Developed in the Context of the ‘Psy 107’ Reform

Author: Sophie Pesesse

Published in: Community Mental Health Journal

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Abstract

Since 2009, the ‘Reform 107’ has been carrying out a substantial transformation of mental healthcare in Belgium, underpinned by two high ideals: ambulatory treatment and personalised care. Whilst there is broad support for the reform, its implementation is not without its problems and little data exists as to its effects. With that in mind, this article endeavours to assess the care provided by a Brussels-based mobile crisis team. Established by funding generated for the reform, this team has taken these ideals fully on board and, as a crisis response measure providing intensive and short-term care, is playing a central role in the organisation and management of mental healthcare across its territory. Therefore, with an approach at the intersection of the sociology of health and the sociology of public action, this article asks the following question: how are these ambitions– ambulatory treatment and personalised care– enacted in concrete terms in this mobile crisis team’s care provision practices? The analysis, based on eight years of activity records of this team, has brought to light that, on the one hand, the care interventions provided and patient referrals, when they occur, are for the most part ambulatory, but that hospitalisations still play a prominent role. On the other hand, this mobile team’s care provision is personalised, in particular regarding its duration. It emerges that this duration is correlated with certain individual characteristics, but the analyses nevertheless highlight the presence of other circumstantial determinants, calling for more research to be carried out as to their impact.
Footnotes
1
All quotations originally in French are my translations.
 
2
The author would like to express her sincere thanks to this person (whose name cannot be mentioned for ethical reasons) for all the help and time spent on the coding the data.
 
3
The concept of a network needs to be clarified in that it is both an emic term, used by both policy makers and carers in their professional practice, and a social science concept used to analyse developments and practices in the world of mental health. In the analyses, the term ‘network’ is used in its sociological meaning, referring not only to the formal organisation of healthcare in the Brussels area as planned by the reform, but it also refers to the informal contacts and interactions between practitioners and actors of the mental healthcare services (Marquis et al., 2010; Thunus & Lorquet, 2014).
 
4
See in particular the directory produced by the Plateforme Bruxelloise pour la Santé Mentale (online: https://​santementale.​brussels).
 
5
As the researcher points out, the period studied contains a significant bias, given that it corresponds to a lockdown period following the Covid-19 pandemic. As the mental health services which took part in the study confirm, this period is marked by a reduced number of requests. The results pertaining to the saturation of services is thus underestimated in comparison with the situation when there was no lockdown in place.
 
6
As a reminder: in the database the following figures are found: 40.3% provision of care, 23.6% requests referred after the case file has been assessed and 36.1% for immediate referrals.
 
7
Of these enforced hospitalisations, 62.6% were at the request of the MCT’s care providers and 23.1% at the request of third parties (other than the patients’ family and friends).
 
8
Its mission is similar to the MCT whose data we have analysed, and its conclusion is based on an analysis of seven years of activity (from 2013 to 2019).
 
9
The occasions where care provision lasts for less than a day are few in number (6 out of the 685), and involve situations which are very urgent and/or not very suitable for the MCT, as the data indicates that in the end the patient is hospitalised in two-thirds of the cases (4 situations out of 6).
 
10
These statistical analyses are Kruskall-Wallis tests. For each of them the confidence level is established at 95%.
 
11
For greater clarity, details of the results of the multiple comparisons of this variable are presented in the table in Fig. 4.
 
12
It is important to here underline that the list of variables which can lead to significant variations in the durations of the MCT’s care interventions is probably not exhaustive, given that they are sourced from data encoded at the request of SPF Santé.
 
Literature
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Metadata
Title
How are Ambulatory Treatment and Personalised Care Being Implemented in Psychiatry? An Analysis of Eight Years of Activity Records of a Belgian Mobile Crisis Team Developed in the Context of the ‘Psy 107’ Reform
Author
Sophie Pesesse
Publication date
05-03-2025
Publisher
Springer US
Published in
Community Mental Health Journal
Print ISSN: 0010-3853
Electronic ISSN: 1573-2789
DOI
https://doi.org/10.1007/s10597-025-01457-w