Time for something new
The history of PSC illustrates the evolution of psychiatry over the last decades. When it started in 1978, there was no Supported housing, there were no mobile teams... There were hospitals (psychiatric wards or PAAZ units), with open and closed wards, admission and treatment units, acute and chronic wards – but beyond that: nothing. A patient was either admitted or living at home. There was no form of community care.
PSC arose from the urgent need to provide something 'different' – a need felt in the psychosis care units of the former Sint-Jozef clinic in Kortenberg. Experience there showed that the follow-up and support for patients who, after a first psychotic crisis and a hospital stay of several months, returned home or went to live alone, were insufficient. The unfortunate consequence was relapse, more often than not. It was precisely at the moment the patient left the hospital that the greatest challenge awaited them: finding a new impetus and a new structure, building up a new life, picking up the thread that had often been brutally broken by the psychotic crisis.
The new initiative took the form of a centre for partial night hospitalisation. Partial hospitalisation was and is mainly used in the form of day hospitalisation. The reasoning in 1978 was, however: if patients, after their admission, have to find their way back into society and rebuild a life, it makes little sense to bring them to the hospital during the day and send them home in the evening. Let us reverse it. We try to support them so that, during the day, they can again take up a role in society – studying, following a training course, working, possibly in a sheltered workplace – by accompanying them in the evening hours, within a supportive framework.
The Brussels context
For a long time, PSC was closely linked in its work to UPC Sint-Jozef. Almost all patients were referred from the psychosis care units there. Gradually, however, PSC increasingly found its place within the Brussels context. Today, most patients come for intake from Brussels hospitals: Brugmann, Sans Souci, Fond'Roy, Titeca, UZ Jette. The latter is, alongside PSC, the only hospital in Brussels with psychiatric beds recognised as Flemish.
PSC has therefore found its place in the complex Brussels context – where it is part of the South Care Zone – but over the years it has also helped to develop and shape that context itself. For example, in 1999 it participated, together with all Dutch-speaking services in Brussels, in the creation of the day activity centre Den Teirling, a place that has played and still plays an important role for many of our patients.
More recently, the reform of mental health care through Article 107 and the mandatory development of networks per region has boosted cooperation with other care institutions in Brussels.
Working in the Brussels context remains a challenge, also because of the issues that are inherent to working in a large city, where the refugee situation, drug use, homelessness, etc. are felt more acutely than in more rural areas. In this respect, there has been a major evolution since the early years.
Creation of PSC
Start of Supported housing
Supported housing gains official recognition
Beds are converted into chairs.
Start of psychiatric home care, with staff from PSC and VDAB.
Opening of the Den Teirling day activity centre
trACTor becomes a fully-fledged mobile team
Creation of the HerstelAcademie
A network with a 'mother house'
PSC started in 1978 as a night hospital, but it did not stop there. In 1995, beds were converted into chairs. Due to the development of Supported housing, there was gradually less demand for night hospitalisation and more demand for daytime activities for the residents.
PSC has taken on a (pioneering) role in the development of Supported housing and later of home care/mobile teams. The projects Supported housing and trACTor grew out of PSC, from where they were once launched as pilot projects, long before they could be officially recognised. Supported housing started in 1981 and was recognised in 1990 – psychiatric home care started in 1997 with staff made available by PSC and by VDAB, before trACTor became a fully-fledged mobile team in 2011. Both Supported housing and trACTor therefore have a historical bond with PSC and, in day-to-day practice, cooperation and interaction continue.
PSC is and remains, to some extent, a 'mother house' that also provides services to patients from Supported housing and trACTor. This can range from administering depot medication, using the café and garden, participating in certain activities, 24/7 on-call availability, cake on Sundays, to a bed on prescription for residents in crisis...
A new spirit of the times
Combating stigma is something we at PSC consider very important. We see it as our task not only to provide good care for our patients and residents, but also to take up a responsibility towards society: to counter misunderstandings about people with psychological vulnerabilities and to value their contribution to society.
Since the early days of PSC, the spirit of the times has evolved considerably. Patients are no longer merely ill people who are expected to submit meekly to treatment by an expert. They are also citizens with rights and talents. They are people with a vulnerability who can work on their own recovery and, through their experiential expertise, help others. Staff from PSC have been closely involved in the development and operation of the HerstelAcademie in this region.
This is one of the ways in which PSC seeks to achieve what it stands for, and to realise its mission: "PSC is a low-threshold place where adults with a psychotic vulnerability can find support to work on their recovery in a creative environment." Innovation, independence (and the related small scale) and patient participation have been guiding principles from the very beginning.