The patient care philosophy discussed in the sources emphasizes a community-oriented, holistic, and prevention-focused approach, fundamentally opposing the increasing economization of healthcare.
Key tenets of this philosophy include:
- Focus on the Neglected and Vulnerable: Dr. Saameli was initially drawn to social psychiatry because of the opportunity to build and expand services for patients who were often „neglected,“ specifically chronically psychotic, substance addicts, and those who are chronically ill. His aim was to work „bottom-up“ to serve the „poorest of the poor and neglected“. This highlights a core philosophy of prioritizing the most challenging and marginalized patient populations.
- Decentralized and Community-Based Care: A central tenet is that psychiatric care should be decentralized and brought closer to where people live and work, integrating the social environment into treatment. This involved establishing outpatient services (Ambulatorien) and day clinics in various locations across the canton, a vision Dr. Saameli passionately advocated for and a reason he left Königsfelden when it was not initially implemented. The aim is to make care accessible in the patient’s immediate surroundings.
- Prevention of Hospitalization and Early Intervention: A crucial aspect of this philosophy is to prevent unnecessary psychiatric hospitalizations. This is best achieved through integrated psychiatric emergency services within general hospitals, where psychiatric professionals can quickly intervene at the emergency department. This allows for early clarification and utilization of existing resources to avoid inpatient admission. The goal is to catch patients at an outpatient level rather than sending them to a clinic. There is a strong belief that significant financial savings could be made through earlier intervention in acute cases.
- Vocational and Social Reintegration: The philosophy strongly advocates for active professional integration (berufliche Eingliederung) and rehabilitation. This includes training long-term patients for office work and computer skills to facilitate their entry into the job market, moving beyond traditional workshop employment to integration into the „service industry“ and the „free economy“. The hospital itself should serve as a model for this, creating training positions and even employing former patients in administration.
- Systemic Thinking and Workplace Intervention: Patient care should adopt a systemic approach, meaning that the interaction between the patient and their social environment, including the workplace, must be considered, rather than treating the patient in isolation with only medication or individual techniques. For conditions like burnout, early interventions at the workplace to address conflicts and stress are seen as far more effective than prolonged sick leaves or hospitalizations in specialized clinics. The philosophy emphasizes avoiding „too long sick leaves and too early invalidization“ by supporting reintegration and part-time positions.
- Prioritizing Need Over Profit: A fundamental critique against current trends is the economization of medicine, which has led to institutions needing patients to be profitable, rather than patients solely needing the institution for help and protection. The philosophy vehemently rejects the idea that care should be expanded or focused on generating revenue. Instead, it asserts that resources must be directed towards the „severely ill and disturbed individuals and family systems“ who are most in need, focusing on what is „necessary“ rather than what is „commercially profitable“. The shift to referring to patients as „customers“ is criticized as revealing a „seller“ mentality.
- Maintaining Connection to Medicine and Broader Perspectives: While acknowledging the value of psychotherapy, Dr. Saameli stresses the importance of psychiatry retaining its connection to medicine and the understanding of disease processes. He also suggests that effective psychiatrists benefit from a „wide horizon“ derived from broader interests beyond medicine, such as literature and humanities, which enables them to „endure and effect change“.
- Addressing the „Salonfähige Depression“ (Socially Acceptable Depression) of Burnout: While recognizing that burnout reduces the stigma associated with psychological illness, the philosophy cautions against it becoming an „honorable retreat option“. Despite the reduced stigma and the emergence of „luxury clinics“ for burnout, it is crucial to remember that individuals suffering from burnout are „suffering people,“ not merely „consumers,“ and require genuine and effective intervention.
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