First experience in Hamm (Germany) , by Laélia Cômes (Lyon, France) – 18-31 May 2015
LWL- University Clinic for child and adolescent psychiatry
Trainee in child & adolescent psychiatry (correspondent, organisation): Dr. SARAH MARIA BIRKLE
Clinic Supervisior: Professor Dr. Dr. MARTIN HOLTMANN
At the first glance, and unto the end, I was astonished by the way I was welcomed in this university clinic: Sarah Birkle had organised a full and interesting programme, so that I could each day discover one or two of the different services of this clinic. She had also dealed with all her colleagues who have taken part in this adventure. Professor Holtmann was also very present, we met several times to discuss about the specificities of the therapeutical work in the clinic, the differences with my country, and whatever we wanted to share from our jobs in these relaxed conversations.
Also noticable was the material possibilities of the clinic. Its 110 inpatient beds are only dedicated to children and teenagers with psychic difficulties or diseases, with a specific service for emergencies and unplanned consultations. Three wards for children one for patiens from 6-9 years and the two others for the 10-13 year old patients can handle with different pathologies. The other services for the adolescent patients are mainly specialized: three services for drugs addicted teenagers (sevrage, comorbidities diagnostic, rehabilitation); one service for anorexia; one service for personnality disorders, mainly borderline patients, where the specific “dialectical behavioral therapy” is dispended and several acute wards. But these units are not close on themselves and on the troubles they heal: most of them also deal with patients who are coming for a different reason (general psychiatry). I found really interessant how the doctors and teams are, in this way, both specialized and generalists! Several transversal stations offer therapeutical possibilities for all the patients, after medical indication: diagnostical tests, work therapy, pedagogic and ergotherapie, psychomotoric, animals therapy and, of course, the clinic’s school and the social service. This organisation is quite exceptional in Germany. Talking about the material possibilities, I would like to show you some pictures.
The playroom and playground of the children’s service
Each teenager’s service has its own livingroom
The kitchens are really welcoming – and can also be a place for therapeutical interventions. No single portions for the anorexic persons, who are taught how to prepare a sustainable plate, adapted to their caloric needs, out of “family” dishes.
Nevertheless, and even if this welcoming environment sustains grandly the therapies, we do not take part to an exchange program only to visit great buildings! I would also like to talk you about what I understood from the therapy itself.
First, I noticed that the therapeutical relationship was very open. Doctors (or psychologists) and the patient and its familiy sit around a table, often with support documents, such as questionnaries, therapeutical educations sheets, contracts. Added to the language-based therapies, differents tools are often used: games, trainings, symbolic examples. Unless when it is not adequate, cognitive behavioral therapy is mainly used. The patient, and his family, sign thus a contract linking him to the therapeutist (or the service). In the drug addiction programme, exclusion can easily be used when the contract is not fullfilled and that the therapeutist understand that the patient is not ready for the treatment. He can of course register for a later hospitalization when needed. In the therapeutical sessions the patiens, will be asked this central question: “What is your goal? For the hospitalization, for this week, in this area?”.For example in the children’s service, each week begins by the “points round”, where each child tell how great he thinks he achieved his last week’s goal and what he wants for the coming week.
Furthermore, I was interessed by the nightwards’ organisation, also talking about the team’s spirit and the cooperation between the different therapeutists and professionals. Every friday, the “Assistenzärzte” (trainees), psychologists and the “Fachärzte” (consultants) meet to prepare the difficulties which may arrive during the week-end: each doctor or psychologists tells, in his service, which patients are in intensive state, need to be evaluated, at risk to pass by an acute state during the coming days. The emergencies and planned admissions are also presented.
The wards are insured by the interns, and a specialist doctor can be joined by phone.
As a conclusion, I would say that I have discovered in Hamm how clinical interventions can really involve the patient and his family, how this large pannel of possibilities and multidisciplinary work can be used, and how general psychiatry practices and specialized interventions are greatly allied.
I would like to thank “herzlich” Sarah, Professor Holtmann and all the therapeutists who have offered me to enter for a while their daily and so interesting practice.