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Institute of Mental Health – past, present, future Prof. Dusica Lecic Tosevski, MD, Ph. Institute of Mental Health – past, present, future Prof. Dusica Lecic Tosevski, MD, Ph. D 11 July 2016 www. imh. org. rs

Content §Past – beginning §Present – profile and activities §Future plans Content §Past – beginning §Present – profile and activities §Future plans

Past § Past § "What’s past is prologue" – W. Shakespeare, The Tempest, Act 2, Scene I § Pioneer beginnings of our founders and teachers determined our present

Beginning § 14 April 1963 § Prof. Slavka MorićPetrović Beginning § 14 April 1963 § Prof. Slavka MorićPetrović

History § § § § Big changes in psychiatry at 50 -ies of the History § § § § Big changes in psychiatry at 50 -ies of the last century Requests of societies for the more humane approach to psychiatric patients and their inclusion into community New discoveries in pharmacotherapy Group of psychiatrists around Prof. Slavka Morić-Petrović decided to undertake a pioneer work of inclusion of world trends in psychiatry . . . …and open the first socio-psychiatric institution, not only in Yugolasvia but in the whole Balkan The project of the architect Vladeta Stojković accepted and on 5 June 1960 the foundation stone was laid Institute of Mental Health officially opened on 14 April 1963

History, 2 § § § Accent to treatment and support of patients put to History, 2 § § § Accent to treatment and support of patients put to social community New social and psychologial methods of treatment introduced During following 15 years the IMH became one of the most eminent psychiatric insitution in SFRY and doubled its professional staff Among the first in the country – day hospitals as partial psychiatric treatment, as well as individual and group psychotherapeutic methods 1969 – the journal „Annals of the Institute of Mental Health” – in 1975 „Psychiatry Today “ – the oldest psychiatric journal in the country Increase of doctors with Ph. D and teachers of a few faculties – new name on 20 November 1978 – Institute of Mental Health

Founders and teachers § Prof. Dr Dušan Petrović § Prof. Dr Miroslav Antonijević § Founders and teachers § Prof. Dr Dušan Petrović § Prof. Dr Miroslav Antonijević § Prof. Dr Milan Popović § Prof. Dr Predrag Kaličanin § And others

Institute of Mental Health § In the centre of the city § The first Institute of Mental Health § In the centre of the city § The first psychiatric institution in the Balkans with comprehensive psychosocial approach § “Open doors”, treatment in the community, mobile teams § French model (sectorial approach) § Education of staff – Salpetriere, Tavistock, etc.

Directors § Slike Directors § Slike

Present Present

Three principles §Treatment §Education §Research Three principles §Treatment §Education §Research

Activites – 10 points 1) Improvement of treatment of mental 2) 3) 4) 5) Activites – 10 points 1) Improvement of treatment of mental 2) 3) 4) 5) disodrers Prevention of mental disorders and mental health promotion Application of highest ethical standards in psychiatric practice Destigmatisation of persons with mental disodrers, psychiatry and pscyhiatrists CME of psychiatrists, health workers and primary care physicians

Activities, 2 6) Continuous education of young collaborators 7) 8) 9) 10) (graduate, postgraduate, Activities, 2 6) Continuous education of young collaborators 7) 8) 9) 10) (graduate, postgraduate, study visits) – national and international schools Research International collaboration (Maudsley, WPA, EPA, WFMH, PAEEB, ICPCM) National and international congresses and symposia (IMH Forums, WPA co-sponsored international congresses, regional PAEEB congresses - Belgrade, 2008, 2012, 2016) – Psychiatry in social transition, Person oriented psychiatry, Pathways and Crossroads of Psychiatry, 2016) Collaboration with WHO

Organizational structure § § 3 Clinics (inpatients): for adults, for chidren and adolescents, for Organizational structure § § 3 Clinics (inpatients): for adults, for chidren and adolescents, for substance abuse Outpatient department 8 day hospitals (for adolescents, adults – affective, psychotic and neurotic and PD disorders, children, alcoholics – 2 (1 in the community), for young substance abusers Departments: § § § Medical genetics Couple and family Reproductive psychiatry Third age Child abuse prevention Psychotherapy Clinical neurophysiology and epilepsies Forensic psychiatry Research and education Clinical studies and medical laboratory Administration

New names of departments – in honour of teachers § § § Dept. for New names of departments – in honour of teachers § § § Dept. for Medical Genetics “Prof. Dr Slavka Morić-Petrović” Research Department „Prof. Dr Predrag Kaličanin“ Day Hospital for children „Prof. Dr Svetomir Bojanin“ Day Hospital for Alcoholics “Dr Branko Gacic “ Dept. for Clinical Neurophysiology and Epilepsies “Prof. dr Dragan Ercegovac “

Clinic for children and adolescents § § § Dr Nataša Stanojević, Prof. Dr Nevenka Clinic for children and adolescents § § § Dr Nataša Stanojević, Prof. Dr Nevenka Tadić, Prof. Dr Svetomir Bojanin – founders of child psychiatry in the country Modern principles of comprehensive psychiatric care Prof. Dr Veronika Išpanović Prof. Dr. Smiljka Popović Deušić Psychiatrists, psychologists, special pedagogues, nurses

Day hospital for adolescents § § § § In the past decade – Idea Day hospital for adolescents § § § § In the past decade – Idea for the Centre for children and families - „mission impossible“ La masion de Solenne, Pariz 2005 – 2007 Ministry of Health, Caritas Italiana, Fund of Princess Catherine Karadjordjević Two stores, 2007 Eighth IMH day hospital, link that was missing Help to young people between 15 - 24 years Supervision (Prof. Michel Botbol, France)

Day hospital for adolescents (opening, 26 December 2007) Day hospital for adolescents (opening, 26 December 2007)

IMH patients § 120 beds § 180 places in day hospitals § 200 -300 IMH patients § 120 beds § 180 places in day hospitals § 200 -300 outpatients daily § All mental disorders – severe, moderate, mild, life problems § All ages

Treatment §Team approach §Multidimensional, biopsychosocial, patient centred §Integrative (pharmacotherapy, psychotherapy, individual and group) Treatment §Team approach §Multidimensional, biopsychosocial, patient centred §Integrative (pharmacotherapy, psychotherapy, individual and group)

Patients’s clubs § § § § For ex-alcoholics – 53 years at the IMH Patients’s clubs § § § § For ex-alcoholics – 53 years at the IMH and community “Peacock’s garden” Wednesday Club – chronic psychiatric patients Third age Passage (adolescents and their parents) Occupational and art therapy, exhibitions Maintenance of remission, relapse prevention, rehabilitatiom of healthy capacities, recovery Mental health promotion

Wednesday culture circle § Mozart effect § Classical and modern § § 22 music, Wednesday culture circle § Mozart effect § Classical and modern § § 22 music, poetry evenings, dances, etc. Cammerata Serbica (Mozart, Bach), choirs „Smoking Forbidden“, Orthodox Kelts, Baiaga, etc. Meetings with eminent public figures Summer mental cinemania

Education § Teaching hospital for few faculties: § Medicine, Political Sciences, High School for Education § Teaching hospital for few faculties: § Medicine, Political Sciences, High School for Special Education, Psychology, High school for nurses § IMH Friday „Lessons“ § 28 CME courses (for doctors and health workers) § 20 doktoral studies § 10 subspecializations § Specialization of nurses § Journal Club § Summer schools, congresses

Education, 2 § § § Primary care physicians in mental health issues – IMH, Education, 2 § § § Primary care physicians in mental health issues – IMH, Public Health Institute, Sarajevo, Committee for Human Rights, Norwegian Medical Association 2002 -2011 (WHO) In regions of Serbia Schools, social workers, legal institutions, etc.

Education of young collaborators § § § § Winter School, Mećavnik, decembar 2004 WPA Education of young collaborators § § § § Winter School, Mećavnik, decembar 2004 WPA Zonal School, Belgrade, 2008, 2012 Study visits Berlin Summer School EPA – Strasbourg ECNP - Oxford Florence, Minsk, etc.

IMH Forums IMH Forums

XIV National Congress and III Congress of Eastern Europe and the Balkans, 2012 XIV National Congress and III Congress of Eastern Europe and the Balkans, 2012

International collaboration § Maudsley, London - 2009§ Louisville University, USA § Athens University, Greece International collaboration § Maudsley, London - 2009§ Louisville University, USA § Athens University, Greece § Psychiatric Hospital, Attica, Greece § International College for Person Centred Medicine § Guests, visiting professsors § Northwestern University, Chicago, USA, July 2016

Collaboration - national § Psychiatric Clinic, Kragujevac § Clinic for Neurology, Clinical Centre of Collaboration - national § Psychiatric Clinic, Kragujevac § Clinic for Neurology, Clinical Centre of Serbia § Other clinics § First Prosecutor’s Office (domestic violence)

Research – international § § § Multicentric, international study on longterm cilinical and social Research – international § § § Multicentric, international study on longterm cilinical and social consequences after war experiences in ex-Yugoslavia - “CONNECT” project (2004 -2008), 8 medical faculties, FP 6, FW 6 Genetic basis of autism and schizophrenia (FP 7, EU – 2009 -2012) – 8 countries ROAMER project, FP 7 – Multicentric, international study, FP 7 s/l polymorphism of the serotonin transport gene and MRI changes in depressed patients with or without comorbidity with anxiety disorder (IMH, Milan, Italy) AIDA – Identity of adolescents – Multicentric study – 2011 - Depression and diabetes – SASA, IMH, Clinic for Endocrinology, CCS – 17 countries (2013 -2016)

National studies § PTSD after delivery (SASA, 2010 -2013) § Temperament and structure of National studies § PTSD after delivery (SASA, 2010 -2013) § Temperament and structure of symptoms of personality disorders, Ministry of Science, 2011 -2016 § Transgenerational transmission of trauma, Ministry of Science, 2006 -2010 § Psychological and psychosomatic consequences of stress, 2006 -2010

Prevention § Stress in refugees - UNHCR – 1994 -1998 § Torture consequnces (Norwegian Prevention § Stress in refugees - UNHCR – 1994 -1998 § Torture consequnces (Norwegian Committee for Human Rights, 2000) § Alcoholism (2008 -2013) § Collaboration with NGOs (UNHCR, UNICEF, Save the Children, Caritas Italiana, Swiss Disaster Relief, IOM, International Red Cross, etc. )

Prevention of suicide üWHO – December 2005 - January 2006 § In schools § Prevention of suicide üWHO – December 2005 - January 2006 § In schools § For primary care physicians § In primary health care § For prison officers § For media professionals § Survivor groups

Prevention – children and adolescents § Violence, Ministry of § § § Health “Schools Prevention – children and adolescents § Violence, Ministry of § § § Health “Schools without violence“, with Unicef Suicide, Ministry of Health Child abuse (UNICEF, IMH, 20112016)

Destigmatisation and mental health promotion § “United colours of souls”, 2004 § “Open doors”, Destigmatisation and mental health promotion § “United colours of souls”, 2004 § “Open doors”, WPA § „I also have rights“, 2008

National guidelines of good clinical practice § Depression, 2011 § Schizophrenia, 2013 § Alcoholism, National guidelines of good clinical practice § Depression, 2011 § Schizophrenia, 2013 § Alcoholism, 2013 § Ministry of Health

National committee for mental health ü Stability Pact for SEE ü “Enhancing social cohesion National committee for mental health ü Stability Pact for SEE ü “Enhancing social cohesion through strengthening community mental health care”, 2003 -2008 (8 countries) ü Strategy for development of mental health care, 2007 ü Law for protection of rights of mentally ill persons, 2013 ü Centres for community mental health care

Publications § More than 100 books § Papers in JCR list, Pubmed, international books Publications § More than 100 books § Papers in JCR list, Pubmed, international books § Psychiatry Today (journal, 47 years)

Human behavior during war Human behavior during war

Serbian experience Serbian experience

WHO books www. imh. org. rs ICD-10 Classification of mental dsorders, 1992 Mental health WHO books www. imh. org. rs ICD-10 Classification of mental dsorders, 1992 Mental health care of refugees – guidlines for field work, 1993 Pszchosocial consequences of disasters, 1993 Guidelines for daignostics and management of mental disorders in primary health care – ICD-10, 1996 ICD-10 Classification of mental disorders, Diagnostic criteris for research, 1998 World Health report 2001 - Mental health – New Understanding, New Hope, 2003 Prevention of Suicide, six books, 2003

Institute of Mental Health WHO Collaborating Centre for Mental Healthcare Workforce Development 24 September Institute of Mental Health WHO Collaborating Centre for Mental Healthcare Workforce Development 24 September 2009

Future steps § Collaboration with WHO and other organisations § New European Action Plan Future steps § Collaboration with WHO and other organisations § New European Action Plan for Mental Health („Health § § § 2020“) – 2012 ICD-11 Classification of PDs – 2010 -2016 Stability pact for SEE: „Strengthening Capacity of the Mental Health Professionals and of the Users Associations“ Research (regional, European) Young collaborators and their CME (Young IMH) National Institute for Mental Health

Photogallery Photogallery

Past – morning meeting in day hospital Past – morning meeting in day hospital

Meeting of therapists in day hospital Meeting of therapists in day hospital

Laboratory for cytogenetics Laboratory for cytogenetics

Seminar for the staff Seminar for the staff

Education of nurses Education of nurses

Sociotherapeutic club for alcoholics and their families Sociotherapeutic club for alcoholics and their families

Lessons, supevision Lessons, supevision

Department For Medical Genetics Department For Medical Genetics

Third Age Department Third Age Department

Day hospital for adolescents, first supervision, April 2007 Day hospital for adolescents, first supervision, April 2007

Club for patients and staff Club for patients and staff

Patients’s exhibition Patients’s exhibition

Antistress club Antistress club