Jules Tielens is a Psychiatrist. His interest has always been on the treatment of people with schizophrenia and severe personality disorders as well as the development of alternative perspectives and a new language in respect to psychosis. He gives frequent workshops and lectures on this subject in addition to work as a psychiatrist at the care farm Bij Bram. From 1998 to 2010 he was Psychiatrist to the Rehabteam; outreach care for psychotic homeless people in Amsterdam, and he was a Psychiatrist in Early Intervention Psychoses at the Amsterdam Medical Centre. Between 2011-2016 he worked at The Brewery, a centre for recovery of Psychosis in Amsterdam. As of 2018 he has been working as a Psychiatrist at the care farm Bij Bram (at Bram’s place) Jules has authored 2 books in the Netherlands – "Assertive in Care" and "In conversation with Psychosis".

1. De Brouwerij
Hoogte Kadijk 61hs
1018 BE Amsterdam
Tel: 088 - 020 1350
Fax: 088 - 020 1351

2. DSM IV-TR: schizophrenia and
other psychotic ilnesses
• A majority of individuals with schizophrenia have poor insight
regarding the fact that they have a psychotic illness. Evidence
suggests that poor insight is a manifestation of the illness
rather than a coping strategy. It may be comparable to the
lack of awareness of neurological deficits seen in stroke,
termed anosognosia. This symptom predisposes the
individual to non-compliance with treatment and has been
found to be predictive of higher relapse rates, increased
number of involuntary hospital admissions, poorer
psychosocial functioning, and a poorer course of illness
Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, APA, 2000

3. When anosognosia:
• The patient will not trust the doctor
• No conventional psycho-education!
• Go around (our medical) insight of sickness.
• Connective Talking Technique.

4. Minister Luns and psychosis

5. ‘The Dutch are always right, but seldom relevant’.
(English Minister of Foreign affairs to our minister of Foreigns
affairs.
What is a psychosis?

6. A psychosis is:
• A serious and long-lasting problem in
interpretation (of non-verbal information).
• A serious problem of perception/hallucination.
• Some cognitive deficits.
– Filter en flexibility
– Face recognition
– Tone recognition
– Problems with abstractions
• Apathy (negative symptoms).

7. A psychosis is:
A disturbance in information processing.

8. In Gesprek met Psychose, 2012

9. We are a social species

10. The circle of destruction
Psychosi
s
Isolation
Loneliness
Los of trust and self-efficacy
Bad prognisis of outcome
Social malfuctioning
In Gesprek met Psychose, 2012

11. What is motivating?

12. Anosognosia:
‘No motivation without connection’
‘No treatment without motivation’
Connection

Motivation

Treatment

13. The conversation

14. Reflective listening
Start like a detective!
In Gesprek met Psychose, 2012

15. The Brewery
Center for Connection

16. View of the patient on psychosis?
'Not me bro!'
Ok than….. I have problems with burn-out,
hypersensitivity, social isolation, demotivation,
study problems, concentration, too much
weight, nothing to do, no hobbies, housing,
partner-relations, relations with friends, etc…

17. So what will be our focus?
Burn-out, hypersensitivity, social isolation,
demotivation, study problems, concentration,
too much weight, nothing to do, no hobbies,
housing, partner-relations, relations with
friends!!!!

18. What is de Brouwerij?
A cooperation of
1.Excellent professionals
2.Clients (members)
3.Family members
4.Volunteers

19. Professionals do:
• Assertive (seduce to) care
• Connective Talking Therapy
• Prepared for a longlasting relationship with
the patient
• Shared decision making
• Make extensive use of the volunteers

20. Health

21. with..

22. by all members & almost 30
volunteers

23. …next to treatment by a team of
highly skilled craftsmen…..
Community mental health nurses, home care nurses,
psychologists, social worker, legal expert,
psychiatrists…

24. Wat doen de vrijwilligers?
• Daily lunch
• Twice a week diner
• Yoga with Pim
• Courses in communication styles
• Holidays, going out
• Guitarlesson with Dominik
• Madstudies
• Michaja, Sacha at the telephone
• Running with Johanne
• Fitness with Bert and Jules
• Welcome by Frans en Ajay
• Young Ones with Bert and Marije
• Artclub with Riek
• Improvisationtheater by Alessandra
• Blogging with Evelyne
• Aikido with Jan
Nothing for nothing!

25. Continuity of care
• Handling of crisis at home
• Trans-mural treatment when hospitalized
• partial recovery: no transferal but low
maintenance membership at the Brewery by:
– Peer to peer
– Support by family and volunteers

26. Current care for psychosis

27. Nieuwe psychosezorg

28. Inloop
Ambulante
outreachende
zorg
Sociaal contact
Scholing
Sport
Lunchgroep
Muziekles
Werk
Mantelzorg
ondersteuning
Bibliotheek
/kenniscentrum
Dagbesteding
Yoga
Ei-complex
Windroos
Sens catering
Loenatix
Waterheuvel
de Prael
enz…
Ypsilon
Anoiksis
Werkgevers via
Ypsilon familienetwerk
Werkgevers in
de buurt
Sportschool
en zwembad
in de buurt
Vrijwilligers
Vrijwilligers
Vrijwilligers
Vrijwilligers
Vrijwilligers
Vrijwilligers

29. And…
• Advise by telephone until 10 PM
• If necessary prolonged treatment in the weekend
• Peer to peer (USA inspiration) and ‘union of members'
• Family is very welcome
• In future:
– Collaboration with entrepreneurs in the neighborhood
– Entrepreneurs in the building
– Flexible workplaces for members in the Brewery

30. The Brouwerij Effect
• Honos en Mansa scores
• Client and familymember Evaluation
iROC based questionnaire (measuring recovery)”
• Days of hospilization
(during MT and the years before MT)
• Costs per day
• Costs for society and client
• DBC minutes (time spend with client)
Quality of treatment
Relevance to society
Cohort N = 42: patiënts > 3 years in treatment at bij MT
A.Galli, J.A.E. Tielens, J. van Os sept 2016

31. N = 42 >3 DBC years in treatment ( 2012 t/m 2015 )
0
200
400
600
800
1000
1200
1400
1600
1800
Vóór MT TijdensMT
Aantalopnamedagenover3jaar
Gedwongen
Vrijwillig
* p = 0.053
Het Brouwerij Effect
Resultaten opnames
A.Galli, J.A.E. Tielens, J. van Os sept 2016

32. Het Brouwerij Effect
Resultaten DBC minuten
N = 42
0
1000
2000
3000
4000
5000
6000
7000
Jaar 1 Jaar 2 Jaar 3
gemiddeldeDBCminuten *** p < 0.001
A.Galli, J.A.E. Tielens, J. van Os sept 2016
N = 42 >3 DBC years in treatment ( 2012 t/m 2015 )

33. De Brouwerij
Hoogte Kadijk 61hs
1018 BE Amsterdam
Tel: 088 - 020 1350
Fax: 088 - 020 1351
molemanntielens.amsterdam@molemann.nl