51
|
Byrne S, Kotze B, Ramos F, Casties A, Starling J, Harris A. Integrating a Mobile Health Device Into a Community Youth Mental Health Team to Manage Severe Mental Illness: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e19510. [PMID: 33136053 PMCID: PMC7669449 DOI: 10.2196/19510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Symptoms of mental illness are often triggered by stress, and individuals with mental illness are sensitive to these effects. The development of mobile health (mHealth) devices allows continuous recording of biometrics associated with activity, sleep, and arousal. Deviations in these measures could indicate a stressed state requiring early intervention. This paper describes a protocol for integrating an mHealth device into a community mental health team to enhance management of severe mental illness in young adults. OBJECTIVE The aim of this study is to examine (1) whether an mHealth device integrated into a community mental health team can improve outcomes for young adults with severe mental illness and (2) whether the device detects periods of mental health versus deterioration. METHODS This study examines whether physiological information from an mHealth device prevents mental deterioration when shared with the participant and clinical team versus with the participant alone. A randomized controlled trial (RCT) will allocate 126 young adults from community mental health services for 6 months to standard case management combined with an integrated mHealth device (ie, physiological information is viewed by both participant and case manager: unWIRED intervention) or an unintegrated mHealth device (ie, participant alone self-monitors: control). Participants will wear the Empatica Embrace2 device, which continuously records electrodermal activity and actigraphy (ie, rest and activity). The study also examines whether the Embrace2 can detect periods of mental health versus deterioration. A variety of measurements will be taken, including physiological data from the Embrace2; participant and case manager self-report regarding symptoms, functioning, and quality of life; chart reviews; and ecological momentary assessments of stress in real time. Changes in each participant's Clinical Global Impression Scale scores will be assessed by blinded raters as the primary outcome. In addition, participants and case managers will provide qualitative data regarding their experience with the integrated mHealth device, which will be thematically analyzed. RESULTS The study has received ethical approval from the Western Sydney Local Health District Human Research Ethics Committee. It is due to start in October 2020 and conclude in October 2022. CONCLUSIONS The RCT will provide insight as to whether an integrated mHealth device enables case managers and participants to pre-emptively manage early warning signs and prevent relapse. We anticipate that unWIRED will enhance early intervention by improving detection of stress and allowing case managers and patients to better engage and respond to symptoms. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000642987; https://www.anzctr.org.au/ACTRN12620000642987.aspx. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/19510.
Collapse
Affiliation(s)
- Simon Byrne
- Western Sydney Local Health District Mental Health Service, Sydney, NSW, Australia.,Westmead Institute for Medical Research, Sydney, Australia
| | - Beth Kotze
- Rivendell Child Adolescent and Family Unit, Sydney, Australia
| | - Fabio Ramos
- School of Computer Science, University of Sydney, Sydney, Australia
| | - Achim Casties
- Westmead Institute for Medical Research, Sydney, Australia
| | - Jean Starling
- Concord Centre for Mental Health, Sydney, Australia.,Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Anthony Harris
- Western Sydney Local Health District Mental Health Service, Sydney, NSW, Australia.,Westmead Institute for Medical Research, Sydney, Australia.,Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| |
Collapse
|
52
|
Antoine B, Nicolas D, Laurent D. Reshaping Community Mental Health Services during the COVID-19 Epidemic - Report from the 59G21 Service in Lille, France. Health Serv Insights 2020; 13:1178632920954876. [PMID: 32973373 PMCID: PMC7495522 DOI: 10.1177/1178632920954876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic led to a rapid transformation of the health care system to cope with the risk of contamination and of developing a severe form of the infection. Although it is an international crisis, strategies have been decided nationally. In France, priority was given to hospital reorganization, especially intensive care units. Reorganization of primary health and mental health services took place with late and inadequate national guidelines or coordination. For mental health services, lack of visibility on the crisis impact on mental health, and difficulties in defining their place in the overall health strategy appeared as the main challenges to overcome. These rapid transformations impacted the whole organization of community mental health care. Any strategies developed must ensure that every person enjoys the highest attainable standard of physical and mental health. Using a systemic approach, it has been necessary to identify both status and risk factors of communities, and to implement appropriate and efficient health promotion and crisis resolution actions. These theoretical issues and their practical impact are discussed using the field strategy developed during the first 28 days of confinement by the 59G21 service in Lille, France.
Collapse
Affiliation(s)
- Baleige Antoine
- Mental health service of the municipalities of Mons-en-Barœul, Hellemmes, Lezennes, Ronchin, Faches-Thumesnil, Lesquin (59G21); EPSM Lille-Métropole, WHO Collaborating Centre; Ronchin, France
| | - Daumerie Nicolas
- Mental health service of the municipalities of Mons-en-Barœul, Hellemmes, Lezennes, Ronchin, Faches-Thumesnil, Lesquin (59G21); EPSM Lille-Métropole, WHO Collaborating Centre; Ronchin, France
| | - Defromont Laurent
- Mental health service of the municipalities of Mons-en-Barœul, Hellemmes, Lezennes, Ronchin, Faches-Thumesnil, Lesquin (59G21); EPSM Lille-Métropole, WHO Collaborating Centre; Ronchin, France
| |
Collapse
|
53
|
Yamaguchi S, Kawasoe Y, Nayuki K, Aoki T, Fujii C. Is intensive case management screening sheet score associated with service intensity? Neuropsychopharmacol Rep 2020; 40:302-306. [PMID: 32672008 PMCID: PMC7722654 DOI: 10.1002/npr2.12126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Since April 2020, the new Japanese mental health system has used the Intensive Case Management Screening Sheet (ICMSS) to identify patients' needs for case management services. This study aimed to examine the association between ICMSS score and service intensity and compare the magnitude of association between ICMSS score and service intensity with other scales. METHODS We recruited patients who received case management services from a staff member in a psychiatric outpatient service, psychiatric day-care program, or outreach team based at one psychiatric hospital. Case management service needs and functioning were assessed using ICMSS, Global Assessment Functioning (GAF), and Personal and Social Performance (PSP). The case manager also documented all services received by the participant for 2 months. The association between each scale and service duration was examined. Furthermore, the magnitude of the association between each scale and service intensity was compared. RESULTS Overall, 138 participants were included in the analysis. The most common diagnosis was schizophrenia. Mean total service duration was weakly but significantly correlated with ICMSS (Spearman's ρ = 0.320), GAF (ρ = -0.198), and PSP (ρ = -0.275) scores. Poisson's regression models and postestimation testing showed that the coefficient for ICMSS score (B = 0.144; 95% CI = 0.141, 0.148) was significantly larger than the coefficients for GAF (B = -0.017, 95% CI = -0.017, -0.016, χ2 = 15.70, P < 0.001) and PSP (B=-0.016, 95% CI = -0.017, -0.016, χ2 = 14.64, P < 0.001) scores. CONCLUSION ICMSS may provide preliminary information on case management service needs, but the level of service should be based on the individual needs of each patient and shared decision-making between the patient and case manager.
Collapse
Affiliation(s)
- Sosei Yamaguchi
- Department of Community Mental Health & LawNational Institute of Mental HealthNational Center of Neurology and PsychiatryKodairaJapan
| | | | - Kazumi Nayuki
- Department of Health and Welfare for Persons with Disabilities, Social Welfare and War Victims' Relief BureauMinistry of Health Labour and WelfareChiyoda‐kuJapan
| | | | - Chiyo Fujii
- Department of Community Mental Health & LawNational Institute of Mental HealthNational Center of Neurology and PsychiatryKodairaJapan
| |
Collapse
|
54
|
Bertulies-Esposito B, Nolin M, Iyer SN, Malla A, Tibbo P, Otter N, Ferrari M, Abdel-Baki A. Où en sommes-nous? An Overview of Successes and Challenges after 30 Years of Early Intervention Services for Psychosis in Quebec: Où en sommes-nous? Un aperçu des réussites et des problèmes après 30 ans de services d'intervention précoce pour la psychose au Québec. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:536-547. [PMID: 31910659 PMCID: PMC7492883 DOI: 10.1177/0706743719895193] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Over the last 30 years, early intervention services (EIS) for first-episode psychosis (FEP) were gradually implemented in the province of Quebec. Such implementation occurred without provincial standards/guidelines and policy commitment to EIS until 2017. Although the literature highlights essential elements for EIS, studies conducted elsewhere reveal that important EIS components are often missing. No thorough review of Quebec EIS practices has ever been conducted, a gap we sought to address. METHODS Adopting a cross-sectional descriptive study design, an online survey was distributed to 18 EIS that existed in Quebec in 2016 to collect data on clinical, administrative, training, and research variables. Survey responses were compared with existing EIS service delivery recommendations. RESULTS Half of Quebec's population had access to EIS, with some regions having no programs. Most programs adhered to essential components of EIS. However, divergence from expert recommendations occurred with respect to variables such as open referral processes and patient-clinician ratio. Nonurban EIS encountered additional challenges related to their geography and lower population densities, which impacted their team size/composition and intensity of follow-up. CONCLUSIONS Most Quebec EIS offer adequate services but lack resources and organizational support to adhere to some core components. Recently, the provincial government has created EIS guidelines, invested in the development of new programs and offered implementation support from the National Centre of Excellence in Mental Health. These changes, along with continued mentoring and networking of clinicians and researchers, can help all Quebec EIS to attain and maintain recommended quality standards.
Collapse
Affiliation(s)
- Bastian Bertulies-Esposito
- Department of Psychiatry, Université de Montréal, Montreal, Quebec,
Canada
- Centre de recherche du Centre hospitalier de l’Université de
Montréal, Montreal, Quebec, Canada
| | - Marie Nolin
- Hôpital Pierre-Le Gardeur, Terrbonne, Quebec, Canada
| | - Srividya N. Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP),
Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec,
Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP),
Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec,
Canada
| | - Phil Tibbo
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nicola Otter
- Canadian Consortium for Early Intervention in Psychosis, Hamilton,
Ontario, Canada
| | - Manuela Ferrari
- Department of Psychiatry, McGill University, Montreal, Quebec,
Canada
- Douglas Mental Health University Institute, Montreal, Quebec,
Canada
| | - Amal Abdel-Baki
- Department of Psychiatry, Université de Montréal, Montreal, Quebec,
Canada
- Centre de recherche du Centre hospitalier de l’Université de
Montréal, Montreal, Quebec, Canada
- Clinique Jeunes adultes psychotiques, Centre hospitalier de
l’Université de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
55
|
Gaebel W, Kerst A, Janssen B, Becker T, Musalek M, Rössler W, Ruggeri M, Thornicroft G, Zielasek J, Stricker J. EPA guidance on the quality of mental health services: A systematic meta-review and update of recommendations focusing on care coordination. Eur Psychiatry 2020; 63:e75. [PMID: 32703326 PMCID: PMC7443789 DOI: 10.1192/j.eurpsy.2020.75] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The quality of mental health services is crucial for the effectiveness and efficiency of mental healthcare systems, symptom reduction, and quality of life improvements in persons with mental illness. In recent years, particularly care coordination (i.e., the integration of care across different providers and treatment settings) has received increased attention and has been put into practice. Thus, we focused on care coordination in this update of a previous European Psychiatric Association (EPA) guidance on the quality of mental health services. METHODS We conducted a systematic meta-review of systematic reviews, meta-analyses, and evidence-based clinical guidelines focusing on care coordination for persons with mental illness in three literature databases. RESULTS We identified 23 relevant documents covering the following topics: case management, integrated care, home treatment, crisis intervention services, transition from inpatient to outpatient care and vice versa, integrating general and mental healthcare, technology in care coordination and self-management, quality indicators, and economic evaluation. Based on the available evidence, we developed 15 recommendations for care coordination in European mental healthcare. CONCLUSIONS Although evidence is limited, some concepts of care coordination seem to improve the effectiveness and efficiency of mental health services and outcomes on patient level. Further evidence is needed to better understand the advantages and disadvantages of different care coordination models.
Collapse
Affiliation(s)
- W Gaebel
- Department of Psychiatry, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.,WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| | - A Kerst
- Department of Psychiatry, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.,WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| | - B Janssen
- LVR-Klinik Langenfeld, Langenfeld, Germany
| | - T Becker
- Department of Psychiatry II, University of Ulm, Bezirkskrankenhaus Günzburg, Germany
| | - M Musalek
- Anton Proksch Institute, Vienna, Austria
| | - W Rössler
- Department of Psychiatry and Psychotherapy, Charité, Universitätsmedizin Berlin, Berlin, Germany.,Psychiatric University Hospital, University of Zurich, Zurich, Switzerland.,Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of Sao Paulo; Sao Paulo, Brazil
| | - M Ruggeri
- Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - G Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology &Neuroscience, King's College, London, United Kingdom
| | - J Zielasek
- LVR-Institute for Healthcare Research, Cologne, Germany
| | - J Stricker
- Department of Psychiatry, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.,WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| |
Collapse
|
56
|
Imai H, Takamatsu T, Mitsuya H, Yoshizawa H, Mitsuya H, Furukawa TA. The Characteristics and Social Functioning of Pathological Social Withdrawal, "Hikikomori," in a Secondary Care Setting: a One-Year Cohort Study. BMC Psychiatry 2020; 20:352. [PMID: 32631267 PMCID: PMC7336612 DOI: 10.1186/s12888-020-02660-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pathological social withdrawal, named "Hikikomori," is a Japanese culture-bound syndrome and a serious social problem in Japan. The number of Hikikomori cases in Japan was estimated at about 563,000 in 2016 according to governmental surveys. However, no studies have reported how many people with Hikikomori have access to community-based psychiatry clinics, and how different they are from non-Hikikomori patients regarding their baseline characteristics and outcomes. The aim of the present study is to evaluate the baseline characteristics, clinical attendance, and social functioning of community psychiatric clinic patients treated for social withdrawal at one-year follow-up. METHOD Participants (n = 304) were all patients (aged under 65) of a psychiatric clinic in a one-year period. Baseline patient characteristics were compared among "current" Hikikomori patients, "past" Hikikomori," and "other" patients. Logistic regression analysis of clinic attendance status and social functioning at one-year follow-up was used to assess patient outcomes. Independent variables were age, gender, Hikikomori status, and support from clinical staff. RESULTS Numbers of "current", "past" Hikikomori, and "other" patients were 60 (19.7%), 81 (26.6%), and 163 (53.6%), respectively. The percentage of "current" Hikikomori who attended in person (56.7%) was significantly smaller than for "past" (92.6%) and "other" (92.6) (p < .001). The age distribution of "current" Hikikomori patients was bimodal, peaking at 20 and 40-45 years. The "current" state predicted significantly fewer regular visits (OR = 0.43; 95% CI = 0.22-0.83; p = .012); support from psychiatric social workers increased visits (OR = 2.35; 95% CI = 1.14-4.86; p = .021). Among the "current" Hikikomori patients, first visit attendance in person predicted regular attendance; no factor consistently predicted working/schooling status. CONCLUSION A sizable percentage of community clinic patients experienced Hikikomori. The "current" Hikikomori state corresponded with low clinic attendance and social function; "support from clinical staff" may increase visit regularity; no factors consistently improved social functioning. Further multi-site study is warranted to examine the generalizability of the findings from the current single-center study.
Collapse
Affiliation(s)
- Hissei Imai
- Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan. .,Ohashi Psychiatric Clinic, Kyoto, Japan.
| | | | | | | | | | - Toshi A. Furukawa
- grid.258799.80000 0004 0372 2033Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501 Japan
| |
Collapse
|
57
|
Di Lorenzo R, Montardi G, Panza L, Del Giovane C, Saraceni S, Rovesti S, Ferri P. Retrospective Analysis of Factors Associated with Long-Stay Hospitalizations in an Acute Psychiatric Ward. Risk Manag Healthc Policy 2020; 13:433-442. [PMID: 32547274 PMCID: PMC7245472 DOI: 10.2147/rmhp.s238741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/14/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the longest hospitalizations in an acute psychiatric ward [Service of Psychiatric Diagnosis and Treatment (SPDT)] and the related demographic, clinical and organizational variables to understand the factors that contribute to long-stay (LOS) phenomenon. The term “long stay” indicates clinical, social and organizational problems responsible for delayed discharges. In psychiatry, clinical severity, social dysfunction and/or health-care system organization appear relevant factors in prolonging stays. Patients and Methods We divided all the SPDT hospitalizations from 1 January 2010 to 31 December 2015 into two groups based on the 97.5th percentile of duration: ≤36 day (n=3254) and >36 day (n=81) stays, in order to compare the two groups for the selected variables. Comparisons were made using Pearson’s chi-square for categorical data and t-test for continuous variables, the correlation between the LOS, as a dependent variable, and the selected variables was analyzed in stepwise multiple linear regression and in multiple logistic regression models. Results The longest hospitalizations were significantly related to the diagnosis of “schizophrenia and other psychosis” (Pearson Chi2=17.24; p=0.045), the presence of moderate and severe aggressiveness (Pearson chi2=29; p=0.000), compulsory treatment (Pearson Chi2=8.05; p=0.005), parenteral or other route administration of psycho-pharmacotherapy (Pearson Chi2=12.91; p=0.007), poli-therapy (Pearson Chi2=6.40; p=0.041), complex psychiatric activities (Pearson Chi2=12.26; p=0.002) and rehabilitative programs (Pearson Chi2=37.05; p=0.000) during the hospitalization and at discharge (Pearson Chi2=29.89; p=0.000). Many demographic and clinical variables were statistically significantly correlated to the LOS at our multiple linear and logistic regression model. Conclusion In our sample, clinical illness severity and need for complex therapeutic and rehabilitative treatments were associated with prolonged psychiatric hospitalizations. Understanding this phenomenon can have not only economic but also clinical, ethical and social relevance.
Collapse
Affiliation(s)
- Rosaria Di Lorenzo
- Psychiatric Intensive Treatment Facility, Department of Mental Health and Drug Abuse, Az-USL Modena, Modena 41122, Italy
| | - Giulia Montardi
- School of Specialization in Psychiatry, University of Modena and Reggio Emilia, Modena 41124, Italy
| | - Leda Panza
- School of Nursing, University of Modena and Reggio Emilia, Modena 41124, Italy
| | - Cinzia Del Giovane
- Head of Statistics and Methodology, Institute of Primary Health Care (BIHAM), Bern, Switzerland
| | - Serena Saraceni
- School of Specialization in Psychiatry, University of Modena and Reggio Emilia, Modena 41124, Italy
| | - Sergio Rovesti
- General and Applied Hygiene, Department of Biomedical, Metabolic and Neural Sciences, Modena 41125, Italy
| | - Paola Ferri
- Nursing, Department of Biomedical, Metabolic and Neural Sciences, Modena 41125, Italy
| |
Collapse
|
58
|
Díaz-Fernández S, Frías-Ortiz DF, Fernández-Miranda JJ. Suicide attempts in people with schizophrenia before and after participating in an intensive case managed community program: A 20-year follow-up. Psychiatry Res 2020; 287:112479. [PMID: 31377009 DOI: 10.1016/j.psychres.2019.112479] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 01/22/2023]
Abstract
Lack of treatment compliance in patients with schizophrenia is a risk factor that leads to illness-relapse, hospitalization and potentially strengthens suicidal behavior. The purpose of this investigation was to assess treatment adherence, reasons for treatment discharge, suicidal behaviour and impact of route of antipsychotics administration in a group of patients with schizophrenia treated in a comprehensive, community-based, intensive case managed program for people with severe mental illness. And to compare it to previous standard treatment received in mental health units (MHU). An observational, longitudinal, mirror-image study of patients with severe schizophrenia (N = 344) was carried out: ten years of follow-up (Program) and ten years retrospective (MHU). Reasons for treatment discharge, suicide attempts and antipsychotic (AP) medication were recorded. Treatment adherence during the Program was higher than in MHU (abandonment of treatment: 12.2% vs. 84.3% of patients). Forty patients died during follow-up, five of them due to suicide. Suicidal attempts significantly decreased during Program treatment compared to the standard one (7.6% vs. 38.9% of patients). Long-acting injectable (LAI) AP medication was significantly related to this outcome. A combination of intensive case-managed and LAIAP treatment helped to improve compliance and to reduce suicidal behavior compared to standard treatment in patients with severe schizophrenia.
Collapse
Affiliation(s)
- Sylvia Díaz-Fernández
- Centro de Tratamiento Integral-AGC SM-HUCAB-SESPAsturian Mental Health Service, Gijón, Spain; Health Sciences Dt. Camilo J Cela University, Madrid, Spain
| | - Danny F Frías-Ortiz
- Centro de Tratamiento Integral-AGC SM-HUCAB-SESPAsturian Mental Health Service, Gijón, Spain; Health Sciences Dt. Camilo J Cela University, Madrid, Spain
| | - Juan J Fernández-Miranda
- Centro de Tratamiento Integral-AGC SM-HUCAB-SESPAsturian Mental Health Service, Gijón, Spain; Health Sciences Dt. Camilo J Cela University, Madrid, Spain.
| |
Collapse
|
59
|
Shoemaker ES, Kendall CE, Mathew C, Crispo S, Welch V, Andermann A, Mott S, Lalonde C, Bloch G, Mayhew A, Aubry T, Tugwell P, Stergiopoulos V, Pottie K. Establishing need and population priorities to improve the health of homeless and vulnerably housed women, youth, and men: A Delphi consensus study. PLoS One 2020; 15:e0231758. [PMID: 32298388 PMCID: PMC7162520 DOI: 10.1371/journal.pone.0231758] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 04/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background Homelessness is one of the most disabling and precarious living conditions. The objective of this Delphi consensus study was to identify priority needs and at-risk population subgroups among homeless and vulnerably housed people to guide the development of a more responsive and person-centred clinical practice guideline. Methods We used a literature review and expert working group to produce an initial list of needs and at-risk subgroups of homeless and vulnerably housed populations. We then followed a modified Delphi consensus method, asking expert health professionals, using electronic surveys, and persons with lived experience of homelessness, using oral surveys, to prioritize needs and at-risk sub-populations across Canada. Criteria for ranking included potential for impact, extent of inequities and burden of illness. We set ratings of ≥ 60% to determine consensus over three rounds of surveys. Findings Eighty four health professionals and 76 persons with lived experience of homelessness participated from across Canada, achieving an overall 73% response rate. The participants identified priority needs including mental health and addiction care, facilitating access to permanent housing, facilitating access to income support and case management/care coordination. Participants also ranked specific homeless sub-populations in need of additional research including: Indigenous Peoples (First Nations, Métis, and Inuit); youth, women and families; people with acquired brain injury, intellectual or physical disabilities; and refugees and other migrants. Interpretation The inclusion of the perspectives of both expert health professionals and people with lived experience of homelessness provided validity in identifying real-world needs to guide systematic reviews in four key areas according to priority needs, as well as launch a number of working groups to explore how to adapt interventions for specific at-risk populations, to create evidence-based guidelines.
Collapse
Affiliation(s)
- Esther S. Shoemaker
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- Institute of Clinical and Evaluative Sciences, Toronto, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Claire E. Kendall
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- Institute of Clinical and Evaluative Sciences, Toronto, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Institute du Savoir Montfort, Ottawa, ON, Canada
| | | | | | - Vivian Welch
- Bruyère Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Anne Andermann
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- St Mary’s Research Centre, St Mary’s Hospital, Montreal, QC, Canada
| | - Sebastian Mott
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | | | - Gary Bloch
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Inner City Health Associates, Toronto, ON, Canada
| | | | - Tim Aubry
- School of Psychology and Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada
| | - Peter Tugwell
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Vicky Stergiopoulos
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addictions and Mental Health, Toronto, ON, Canada
| | - Kevin Pottie
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- * E-mail:
| |
Collapse
|
60
|
Briscoe S, Bethel A, Rogers M. Conduct and reporting of citation searching in Cochrane systematic reviews: A cross-sectional study. Res Synth Methods 2020; 11:169-180. [PMID: 31127978 PMCID: PMC7079050 DOI: 10.1002/jrsm.1355] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/04/2019] [Accepted: 05/14/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The search for studies for a systematic review should be conducted systematically and reported transparently to facilitate reproduction. This study aimed to report on the conduct and reporting of backward citation searching (ie, checking reference lists) and forward citation searching in a cross section of Cochrane reviews. Citation searching uses the citation network surrounding a source study to identify additional studies. METHODS Cochrane reviews were identified by searching the Cochrane Database of Systematic Reviews using the wildcard symbol and date limiting to the 3-month period November 2016 to January 2017. Cochrane reviews thus identified were screened for mention of citation searching. Descriptive detail on the conduct and reporting of citation searching was captured in data extraction forms and described and evaluated. RESULTS Two hundred fifteen Cochrane reviews were identified. One hundred seventy-two reviews reported backward citation searching, and 18 reviews reported forward citation searching. Web of Science was the most frequently reported citation index. The studies used for backward citation searching consisted mainly of studies meeting the inclusion criteria. One-third of reviews that reported forward citation searching used selected studies of importance. Reporting of citation searching was compliant with the Methodological Expectations of Cochrane Intervention Reviews (MECIR) standards, but full transparency requires additional detail that only a minority of reviews reported. CONCLUSION The conduct of backward citation searching was more uniform than forward citation searching. This might be due to lack of MECIR guidance for forward citation searching. Reporting was generally compliant with MECIR, but this is not always sufficient to ensure full transparency.
Collapse
Affiliation(s)
- Simon Briscoe
- Exeter HS&DR Evidence Synthesis Centre, College of Medicine and HealthUniversity of ExeterExeterUK
| | - Alison Bethel
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula, College of Medicine and HealthUniversity of ExeterExeterUK
| | - Morwenna Rogers
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula, College of Medicine and HealthUniversity of ExeterExeterUK
| |
Collapse
|
61
|
Dalton-Locke C, Marston L, McPherson P, Killaspy H. The Effectiveness of Mental Health Rehabilitation Services: A Systematic Review and Narrative Synthesis. Front Psychiatry 2020; 11:607933. [PMID: 33519552 PMCID: PMC7838487 DOI: 10.3389/fpsyt.2020.607933] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/30/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction: Mental health rehabilitation services provide essential support to people with complex and longer term mental health problems. They include inpatient services and community teams providing clinical input to people living in supported accommodation services. This systematic review included international studies evaluating the effectiveness of inpatient and community rehabilitation services. Methods: We searched six online databases for quantitative studies evaluating mental health rehabilitation services that reported on one or both of two outcomes: move-on to a more independent setting (i.e. discharge from an inpatient unit to the community or from a higher to lower level of supported accommodation); inpatient service use. The search was further expanded by screening references and citations of included studies. Heterogeneity between studies was too great to allow meta-analysis and therefore a narrative synthesis was carried out. Results: We included a total of 65 studies, grouped as: contemporary mental health rehabilitation services (n = 34); services for homeless people with severe mental health problems (n = 13); deinstitutionalization programmes (n = 18). The strongest evidence was for services for homeless people. Access to inpatient rehabilitation services was associated with a reduction in acute inpatient service use post discharge. Fewer than one half of people moved on from higher to lower levels of supported accommodation within expected timeframes. Conclusions: Inpatient and community rehabilitation services may reduce the need for inpatient service use over the long term but more high quality research of contemporary rehabilitation services with comparison groups is required. Review registration: This review was prospectively registered on PROSPERO (ID: CRD42019133579).
Collapse
Affiliation(s)
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Peter McPherson
- Division of Psychiatry, University College London, London, United Kingdom
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, United Kingdom.,Camden and Islington National Health Service Foundation Trust, London, United Kingdom
| |
Collapse
|
62
|
Clausen H, Ruud T, Odden S, Benth JŠ, Heiervang KS, Stuen HK, Landheim A. Improved Rehabilitation Outcomes for Persons With and Without Problematic Substance Use After 2 Years With Assertive Community Treatment-A Prospective Study of Patients With Severe Mental Illness in 12 Norwegian ACT Teams. Front Psychiatry 2020; 11:607071. [PMID: 33424668 PMCID: PMC7785822 DOI: 10.3389/fpsyt.2020.607071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/11/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Persons with severe mental illness often face difficulties in accessing and receiving adequate services enabling them to live independently. Many have co-occurring substance use problems that increase the risk of adverse outcomes. Community-based service models have been implemented around the world, including assertive community treatment (ACT), but the knowledge of rehabilitation outcomes in different subgroups is limited. We aimed to explore rehabilitation outcomes among patients suffering severe mental illness with and without substance use problems who had received ACT services for at least 2 years. Additionally, we compared differences in changes between the two groups. Methods: A total of 142 patients who received services for 2 years from the first 12 Norwegian ACT teams were included. Eighty-four (59%) had problematic substance use, while 58 (41%) did not. Data regarding housing, activity, symptoms, functioning, and subjective quality of life were collected upon enrollment into ACT and at 2 years of follow-up. Clinician-rated scales and self-report questionnaires were used. Changes within the two groups and differences in change between the groups were assessed using generalized linear mixed models. Results: Both groups were more likely to have good housing, higher level of functioning, and less anxiety and depressive symptoms after 2 years. The odds of good housing among participants with problematic substance use increased only after adjusting for age and gender. Participants with problematic substance use had less severe symptoms, particularly negative and manic symptoms, while participants without problematic substance use reported improved satisfaction with life in general. Neither group experienced a change in having a meaningful daily activity, positive symptoms, practical and social functioning, or subjective quality of life. The reduction of manic symptoms in the substance use group was the only difference between the groups. Conclusion: After 2 years, patients with and without problematic substance use experienced improvements in several important domains. Furthermore, the improvements were similar in both groups for most outcomes. This may suggest that ACT has a place in the continued effort toward integrated and comprehensive community services empowering patients with severe mental illness to achieve and sustain an independent life, including marginalized groups with severe substance use.
Collapse
Affiliation(s)
- Hanne Clausen
- Department of Research and Development, Division of Mental Health Services, Akerhus University Hospital, Lørenskog, Norway.,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Torleif Ruud
- Department of Research and Development, Division of Mental Health Services, Akerhus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sigrun Odden
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Kristin Sverdvik Heiervang
- Department of Research and Development, Division of Mental Health Services, Akerhus University Hospital, Lørenskog, Norway.,Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hanne Kilen Stuen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| |
Collapse
|
63
|
Hunt GE, Siegfried N, Morley K, Brooke‐Sumner C, Cleary M. Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2019; 12:CD001088. [PMID: 31829430 PMCID: PMC6906736 DOI: 10.1002/14651858.cd001088.pub4] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Even low levels of substance misuse by people with a severe mental illness can have detrimental effects. OBJECTIVES To assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. SEARCH METHODS The Information Specialist of the Cochrane Schizophrenia Group (CSG) searched the CSG Trials Register (2 May 2018), which is based on regular searches of major medical and scientific databases. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing psychosocial interventions for substance misuse with standard care in people with serious mental illness. DATA COLLECTION AND ANALYSIS Review authors independently selected studies, extracted data and appraised study quality. For binary outcomes, we calculated standard estimates of risk ratio (RR) and their 95% confidence intervals (CIs) on an intention-to-treat basis. For continuous outcomes, we calculated the mean difference (MD) between groups. Where meta-analyses were possible, we pooled data using a random-effects model. Using the GRADE approach, we identified seven patient-centred outcomes and assessed the quality of evidence for these within each comparison. MAIN RESULTS Our review now includes 41 trials with a total of 4024 participants. We have identified nine comparisons within the included trials and present a summary of our main findings for seven of these below. We were unable to summarise many findings due to skewed data or because trials did not measure the outcome of interest. In general, evidence was rated as low- or very-low quality due to high or unclear risks of bias because of poor trial methods, or inadequately reported methods, and imprecision due to small sample sizes, low event rates and wide confidence intervals. 1. Integrated models of care versus standard care (36 months) No clear differences were found between treatment groups for loss to treatment (RR 1.09, 95% CI 0.82 to 1.45; participants = 603; studies = 3; low-quality evidence), death (RR 1.18, 95% CI 0.39 to 3.57; participants = 421; studies = 2; low-quality evidence), alcohol use (RR 1.15, 95% CI 0.84 to 1.56; participants = 143; studies = 1; low-quality evidence), substance use (drug) (RR 0.89, 95% CI 0.63 to 1.25; participants = 85; studies = 1; low-quality evidence), global assessment of functioning (GAF) scores (MD 0.40, 95% CI -2.47 to 3.27; participants = 170; studies = 1; low-quality evidence), or general life satisfaction (QOLI) scores (MD 0.10, 95% CI -0.18 to 0.38; participants = 373; studies = 2; moderate-quality evidence). 2. Non-integrated models of care versus standard care There was no clear difference between treatment groups for numbers lost to treatment at 12 months (RR 1.21, 95% CI 0.73 to 1.99; participants = 134; studies = 3; very low-quality evidence). 3. Cognitive behavioural therapy (CBT) versus standard care There was no clear difference between treatment groups for numbers lost to treatment at three months (RR 1.12, 95% CI 0.44 to 2.86; participants = 152; studies = 2; low-quality evidence), cannabis use at six months (RR 1.30, 95% CI 0.79 to 2.15; participants = 47; studies = 1; very low-quality evidence) or mental state insight (IS) scores by three months (MD 0.52, 95% CI -0.78 to 1.82; participants = 105; studies = 1; low-quality evidence). 4. Contingency management versus standard care We found no clear differences between treatment groups for numbers lost to treatment at three months (RR 1.55, 95% CI 1.13 to 2.11; participants = 255; studies = 2; moderate-quality evidence), number of stimulant positive urine tests at six months (RR 0.83, 95% CI 0.65 to 1.06; participants = 176; studies = 1) or hospitalisations (RR 0.21, 95% CI 0.05 to 0.93; participants = 176; studies = 1); both low-quality evidence. 5. Motivational interviewing (MI) versus standard care We found no clear differences between treatment groups for numbers lost to treatment at six months (RR 1.71, 95% CI 0.63 to 4.64; participants = 62; studies = 1). A clear difference, favouring MI, was observed for abstaining from alcohol (RR 0.36, 95% CI 0.17 to 0.75; participants = 28; studies = 1) but not other substances (MD -0.07, 95% CI -0.56 to 0.42; participants = 89; studies = 1), and no differences were observed in mental state general severity (SCL-90-R) scores (MD -0.19, 95% CI -0.59 to 0.21; participants = 30; studies = 1). All very low-quality evidence. 6. Skills training versus standard care At 12 months, there were no clear differences between treatment groups for numbers lost to treatment (RR 1.42, 95% CI 0.20 to 10.10; participants = 122; studies = 3) or death (RR 0.15, 95% CI 0.02 to 1.42; participants = 121; studies = 1). Very low-quality, and low-quality evidence, respectively. 7. CBT + MI versus standard care At 12 months, there was no clear difference between treatment groups for numbers lost to treatment (RR 0.99, 95% CI 0.62 to 1.59; participants = 327; studies = 1; low-quality evidence), number of deaths (RR 0.60, 95% CI 0.20 to 1.76; participants = 603; studies = 4; low-quality evidence), relapse (RR 0.50, 95% CI 0.24 to 1.04; participants = 36; studies = 1; very low-quality evidence), or GAF scores (MD 1.24, 95% CI -1.86 to 4.34; participants = 445; studies = 4; very low-quality evidence). There was also no clear difference in reduction of drug use by six months (MD 0.19, 95% CI -0.22 to 0.60; participants = 119; studies = 1; low-quality evidence). AUTHORS' CONCLUSIONS We included 41 RCTs but were unable to use much data for analyses. There is currently no high-quality evidence to support any one psychosocial treatment over standard care for important outcomes such as remaining in treatment, reduction in substance use or improving mental or global state in people with serious mental illnesses and substance misuse. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high-quality trials are required which address these concerns and improve the evidence in this important area.
Collapse
Affiliation(s)
- Glenn E Hunt
- The University of SydneyDiscipline of PsychiatryConcord Centre for Mental HealthHospital RoadSydneyNSWAustralia2139
| | - Nandi Siegfried
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitTybergCape TownSouth Africa
| | - Kirsten Morley
- The University of SydneyAddiction MedicineSydneyAustralia
| | - Carrie Brooke‐Sumner
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitTybergCape TownSouth Africa
| | - Michelle Cleary
- University of TasmaniaSchool of Nursing, College of Health and MedicineSydney, NSWAustralia
| | | |
Collapse
|
64
|
Wang JZ, Mott S, Magwood O, Mathew C, Mclellan A, Kpade V, Gaba P, Kozloff N, Pottie K, Andermann A. The impact of interventions for youth experiencing homelessness on housing, mental health, substance use, and family cohesion: a systematic review. BMC Public Health 2019; 19:1528. [PMID: 31727031 PMCID: PMC6857126 DOI: 10.1186/s12889-019-7856-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/28/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Youth often experience unique pathways into homelessness, such as family conflict, child abuse and neglect. Most research has focused on adult homeless populations, yet youth have specific needs that require adapted interventions. This review aims to synthesize evidence on interventions for youth and assess their impacts on health, social, and equity outcomes. METHODS We systematically searched Medline, Embase, PsycINFO, and other databases from inception until February 9, 2018 for systematic reviews and randomized controlled trials on youth interventions conducted in high income countries. We screened title and abstract and full text for inclusion, and data extraction were completed in duplicate, following the PRISMA-E (equity) review approach. RESULTS Our search identified 11,936 records. Four systematic reviews and 18 articles on randomized controlled trials met the inclusion criteria. Many studies reported on interventions including individual and family therapies, skill-building, case management, and structural interventions. Cognitive behavioural therapy led to improvements in depression and substance use, and studies of three family-based therapies reported decreases in substance use. Housing first, a structural intervention, led to improvements in housing stability. Many interventions showed inconsistent results compared to services as usual or other interventions, but often led to improvements over time in both the intervention and comparison group. The equity analysis showed that equity variables were inconsistently measured, but there was data to suggest differential outcomes based upon gender and ethnicity. CONCLUSIONS This review identified a variety of interventions for youth experiencing homelessness. Promising interventions include cognitive behavioural therapy for addressing depression, family-based therapy for substance use outcomes, and housing programs for housing stability. Youth pathways are often unique and thus prevention and treatment may benefit from a tailored and flexible approach.
Collapse
Affiliation(s)
- Jean Zhuo Wang
- University of Ottawa Faculty of Medicine, Bruyere Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Sebastian Mott
- McGill University Faculty of Medicine, Montreal, QC Canada
| | - Olivia Magwood
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, ON Canada
| | | | - Andrew Mclellan
- University of Toronto, Faculty of Nursing, Toronto, ON Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON Canada
| | - Victoire Kpade
- McGill University Faculty of Medicine, Montreal, QC Canada
| | - Priya Gaba
- Department of Family Medicine, University of Ottawa, Ottawa, ON Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada
| | - Kevin Pottie
- Departments of Family Medicine and Epidemiology and Community Medicine, Bruyere Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Anne Andermann
- Department of Family Medicine and Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC Canada
| |
Collapse
|
65
|
Suzuki K, Yamaguchi S, Kawasoe Y, Nayuki K, Aoki T, Hasegawa N, Fujii C. Core services of intensive case management for people with mental illness: A network analysis. Int J Soc Psychiatry 2019; 65:621-630. [PMID: 31394969 DOI: 10.1177/0020764019867346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In intensive case management (ICM), users receive a wide variety of services of varying content, which makes it difficult to understand the global features of ICM programs. AIMS The aim of this study was to examine the features of ICM programs using network analysis. METHODS A total of 233 ICM users in two Japanese medical institutions were recruited to participate. All received services were recorded for 2 months. In the network analysis, nodes represented types of ICM services and edges between two nodes depicted when over 5% of participants received both types of services. RESULTS We found high centrality values for 'H5. Hospital-based counseling', 'O13. Outreach support for mental health medications', 'H13. Hospital-based support for mental health medication', 'T5. Counseling via telecommunication', 'H3. Hospital-based coordination of services in the medical institution' and 'T2. Coordination of services with other institutions via telecommunication'. These results indicated that these services were associated with various other types of services. Social functioning was related to 'O13. Outreach support for mental health medication', whereas need for ICM was related to 'H13. Hospital-based support for mental health medications', 'T5. Counseling via telecommunication' and 'T2. Coordination of services with other institutions via telecommunication'. CONCLUSION Based on these findings, we speculated that there are at least five types of core services in ICM: regular face-to-face contact, outreach services, hospital-based services, easy contacts and coordination. These findings clarified the features of ICM programs, which may help improve the understanding of case managers' practice.
Collapse
Affiliation(s)
- Kota Suzuki
- 1 Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan.,2 Faculty of Education, Shitennoji University, Habikino, Japan
| | - Sosei Yamaguchi
- 1 Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | | | | | | | - Naomi Hasegawa
- 4 Psychiatric Day Care & Clinic Hotto Station, Sapporo, Japan
| | - Chiyo Fujii
- 1 Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| |
Collapse
|
66
|
Kennedy HG, Simpson A, Haque Q. Perspective On Excellence in Forensic Mental Health Services: What We Can Learn From Oncology and Other Medical Services. Front Psychiatry 2019; 10:733. [PMID: 31681042 PMCID: PMC6813277 DOI: 10.3389/fpsyt.2019.00733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/12/2019] [Indexed: 12/11/2022] Open
Abstract
We propose that excellence in forensic and other mental health services can be recognized by the abilities necessary to conduct randomized controlled trials (RCTs) and equivalent forms of rigorous quantitative research to continuously improve the outcomes of treatment as usual (TAU). Forensic mental health services (FMHSs) are growing, are high cost, and increasingly provide the main access route to more intensive, organized, and sustained pathways through care and treatment. A patient newly diagnosed with a cancer can expect to be enrolled in RCTs comparing innovations with the current best TAU. The same should be provided for patients newly diagnosed with severe mental illnesses and particularly those detained and at risk of prolonged periods in a secure hospital. We describe FMHSs in four levels 1 to 4, basic to excellent, according to seven domains: values or qualities, clinical organization, consistency, timescale, specialization, routine outcome measures, and research. Excellence is not elitism. Not all centers need to achieve excellence, though all should be of high quality. Services can provide each population with a network of centers with access to one center of excellence. Excellence is the standard needed to drive the virtuous circle of research and development that is necessary for teaching, training, and the pursuit of new knowledge and better outcomes. Substantial advances in treatment of severe mental disorders require a drive at a national and international level to create services that meet these standards of excellence and are focused, active, and productive to drive better functional outcomes for service users.
Collapse
Affiliation(s)
- Harry G. Kennedy
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Alexander Simpson
- Division for Forensic Psychiatry—University of Toronto Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Quazi Haque
- Elysium Healthcare, London, United Kingdom
- Division for Forensic Psychiatry—University of Toronto Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health—University of Toronto, Toronto, ON, Canada
| |
Collapse
|
67
|
Odden S, Landheim A, Clausen H, Stuen HK, Heiervang KS, Ruud T. Model fidelity and team members' experiences of assertive community treatment in Norway: a sequential mixed-methods study. Int J Ment Health Syst 2019; 13:65. [PMID: 31636700 PMCID: PMC6796407 DOI: 10.1186/s13033-019-0321-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assertive community treatment (ACT) is an evidence-based treatment for people with severe mental illness, and this model is used widely throughout the world. Given the various adaptations in different contexts, we were interested in studying the implementation and adaptation of the ACT model in Norway. The first 12 Norwegian ACT teams were established between 2009 and 2011, and this study investigated the teams' model fidelity and the team members' experiences of working with ACT. METHODS To investigate implementation of the ACT model, fidelity assessments were performed 12 and 30 months after the teams started their work using the Tool for Measurement of Assertive Community Treatment (TMACT). Means and standard deviations were used to describe the ACT teams' fidelity scores. Cohen's effect size d was used to assess the changes in TMACT scores from the first to second assessment. Qualitative focus group interviews were conducted in the 12 teams after 30 months to investigate the team members' experiences of working with the ACT model. RESULTS The fidelity assessments of the Norwegian teams showed high implementation of the structural and organizational parts of the ACT model. The newer parts of the model, the recovery and evidence-based practices, were less implemented. Four of the six subscales in TMACT improved from the first to the second assessment. The team members experienced the ACT model to be a good service model for the target population: people with severe mental illness, significant functional impairment, and continuous high service needs. Team members perceived some parts of the model difficult to implement and that it was challenging to find effective ways to collaborate with existing health and social services. CONCLUSION The first 12 Norwegian ACT teams implemented the ACT model to a moderate degree. The ACT model could be implemented in Norway without extensive adaptations. Although the team members were satisfied with the ACT model, especially the results for their service users, inclusion of the ACT team to the existing service system was perceived as challenging.
Collapse
Affiliation(s)
- Sigrun Odden
- Norwegian National Advisory Unit On Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Anne Landheim
- Norwegian National Advisory Unit On Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Hanne Clausen
- Norwegian National Advisory Unit On Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
- Dept. of Research & Development, Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Hanne Kilen Stuen
- Norwegian National Advisory Unit On Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Kristin Sverdvik Heiervang
- Dept. of Research & Development, Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Torleif Ruud
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
68
|
Bosco A, Paulauskaite L, Hall I, Crabtree J, Soni S, Biswas A, Cooper V, Poppe M, King M, Strydom A, Crawford MJ, Hassiotis A. Process evaluation of a randomised controlled trial of PBS-based staff training for challenging behaviour in adults with intellectual disability. PLoS One 2019; 14:e0221507. [PMID: 31437228 PMCID: PMC6705827 DOI: 10.1371/journal.pone.0221507] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/08/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Positive Behaviour Support (PBS) for challenging behaviour is a complex intervention. Process evaluation is pivotal in fully understanding the mechanisms and contextual factors that impact on participant outcomes. AIMS To conduct a process evaluation of a national clinical trial investigating the impact of PBS-based staff training on the level of challenging behaviour in adults with intellectual disability. METHOD The Medical Research Council guidance for process evaluation of complex interventions was followed. Semi-structured interviews with 62 stakeholders from the intervention arm (service users, family and paid carers, service managers, staff who delivered the intervention and PBS trainers), quantitative data from the study database and an external evaluation of the quality of the PBS plans were used. RESULTS Twenty-one health staff volunteered to be trained in delivering PBS. Available log data from 17 therapists revealed that they worked with 63 participants a median of 11.50 hours (IQR 8-32). Only 33 out of 108 reports had included all elements of the intervention. Another 47 reports had some elements of the intervention. All PBS plans were rated weak, indicating insufficient quality to impact challenging behaviour. Stakeholders reported an appreciation of PBS and its potential to impact quality of care and engagement with the participant. However, they also identified important challenges including managing PBS-related caseloads, paid carer turnover and service commitment to the delivery of PBS. CONCLUSIONS PBS-based staff training was well received, but therapists found it difficult to undertake all the elements of the intervention in routine care. Implementing a workforce training strategy is important to better define the active components of PBS, and resource implications if the intervention is no better than usual care.
Collapse
Affiliation(s)
- Alessandro Bosco
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Laura Paulauskaite
- Division of Psychiatry, University College London, London, United Kingdom
| | - Ian Hall
- Community Learning Disability Service, Mile End Hospital, East London NHS Foundation Trust, London, United Kingdom
| | - Jason Crabtree
- Community Learning Disability Service, Mile End Hospital, East London NHS Foundation Trust, London, United Kingdom
| | - Sujata Soni
- Community Learning Disability Service, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Asit Biswas
- Leicestershire Partnership NHS Trust & University of Leicester, Leicester, United Kingdom
| | - Vivien Cooper
- Challenging Behaviour Foundation, the Old Courthouse, Chatham, Kent, United Kingdom
| | - Michaela Poppe
- Division of Psychiatry, University College London, London, United Kingdom
| | - Michael King
- Division of Psychiatry, University College London, London, United Kingdom
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
- South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | | | - Angela Hassiotis
- Division of Psychiatry, University College London, London, United Kingdom
- Community Learning Disability Service, Camden and Islington NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
69
|
de Jong MH, Wierdsma AI, Van Gool AR, Mulder CL. An intensive multimodal group programme for patients with psychotic disorders at risk of rehospitalization: a controlled intervention study. BMC Psychiatry 2019; 19:241. [PMID: 31382937 PMCID: PMC6683433 DOI: 10.1186/s12888-019-2229-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND On the basis of earlier experiences in Germany and England, we developed an intensive multimodal group programme (FACT Plus) for psychotic-spectrum patients. By combining it with regular Flexible Assertive Community Treatment (FACT) (care as usual), we intended to reduce psychiatric rehospitalizations and mental healthcare costs. METHODS We included adult patients (>18 years) with a psychotic spectrum disorder who had had at least one psychiatric admission in the 2 years before inclusion. FACT Plus was delivered weekly for 9 months. The intervention group was recruited in northern Rotterdam (the Netherlands), and the control group was recruited in southern Rotterdam. The primary outcome measure was length of stay (LOS) and the secondary outcome measures were mental healthcare costs and compulsory admissions. RESULTS We included 52 patients in the intervention group and 61 patients in the control group. During the 12-month observation period, the mean LOS per patient was 15.2 (intervention group) and 34.6 (control group). This represents a difference of 19.4 days (56.1%). This result was statistically significant (B = -.859, SE = .497, p = .042) in a regression model correcting for baseline differences between the groups. Mean total mental healthcare costs per patient were €21,098 in the intervention group) versus €25,054 in the control group, a difference of about €4000 per patient (16%). In addition, there were zero compulsory admissions in the intervention group and nine in the control group. CONCLUSIONS After the addition of FACT Plus to regular FACT, psychiatric LOS was substantially lower in the intervention group than in the control group. This result was accompanied by a limited reduction in mental healthcare costs.
Collapse
Affiliation(s)
- Mark H. de Jong
- Yulius Mental Health, PO Box 1001, 3300 BA Dordrecht, The Netherlands
| | - André I. Wierdsma
- 000000040459992Xgrid.5645.2Epidemiological and Social Psychiatric Research Institute (ESPRi), Department of Psychiatry, Erasmus University Medical Centre, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | | | - Cornelis L. Mulder
- 000000040459992Xgrid.5645.2Epidemiological and Social Psychiatric Research Institute (ESPRi), Department of Psychiatry, Erasmus University Medical Centre, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| |
Collapse
|
70
|
Suzuki K, Yamaguchi S, Kawasoe Y, Nayuki K, Aoki T, Hasegawa N, Fujii C. Development and evaluation of Intensive Case Management Screening Sheet in the Japanese population. Int J Ment Health Syst 2019; 13:22. [PMID: 30992714 PMCID: PMC6449981 DOI: 10.1186/s13033-019-0278-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 03/22/2019] [Indexed: 11/29/2022] Open
Abstract
Background In Japan, the mental health system has been shifting from hospitalization-based to community-based care; some organizations have gradually begun providing intensive case management (ICM) services. We developed an Intensive Case Management Screening Sheet (ICMSS) to screen for the need for ICM in people with mental illness. Methods The aim of this study was to examine the psychometric properties and discriminative ability of ICMSS. Subjects consisted of 911 people with mental illness. The ICMSS score was rated by a professional such as a nurse, social worker, or occupational therapist. Results Exploratory factor analysis showed a one-factor structure with 14 items. The factor structure was supported by confirmatory factor analysis (comparative fit index, 0.98; Tucker–Lewis index, 0.97; root mean square error test of close fit, 0.05). In the receiver operating characteristic analysis for discriminating between users and non-users of ICM services, the area under the curve (AUC) for ICMSS was significantly larger than for Global Assessment of Functioning and Personal and Social Performance Scale, indicating better discriminative ability. However, the AUC for ICMSS was moderate. Thus, we suggest that the need for ICM services is determined by quantitative assessment (i.e., ICMSS) and clinical judgment. Conclusion ICMSS is a brief tool for mental health professionals that will be useful in routine clinical practice. We expect that ICMSS will be used as a measure that reflects the views of professionals from various disciplines in Japanese institutions.
Collapse
Affiliation(s)
- Kota Suzuki
- 1Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawahigashi, Kodaira, Tokyo Japan
| | - Sosei Yamaguchi
- 1Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawahigashi, Kodaira, Tokyo Japan
| | | | | | - Tsutomu Aoki
- 2Asahi General Hospital, I 1326, Asahi, Chiba Japan
| | - Naomi Hasegawa
- Psychiatric Day Care & Clinic Hotto Station, Odori 5, Sapporo, Hokkaido Japan
| | - Chiyo Fujii
- 1Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawahigashi, Kodaira, Tokyo Japan
| |
Collapse
|
71
|
Luo X, Law SF, Wang X, Shi J, Zeng W, Ma X, Chow W, Liu S, Zhao W, Liu X, Yao S, Phillips MR. Effectiveness of an Assertive Community Treatment program for people with severe schizophrenia in mainland China - a 12-month randomized controlled trial. Psychol Med 2019; 49:969-979. [PMID: 29962366 DOI: 10.1017/s0033291718001629] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Assertive Community Treatment (ACT) is an evidence-based treatment program for people with severe mental illness developed in high-income countries. We report the first randomized controlled trial of ACT in mainland China. METHODS Sixty outpatients with schizophrenia with severe functional impairments or frequent hospitalizations were randomly assigned to ACT (n = 30) or standard community treatment (n = 30). The severity of symptoms and level of social functioning were assessed at baseline and every 3 months during the 1-year study. The primary outcome was the duration of hospital readmission. Secondary outcomes included a pre-post change in symptom severity, the rates of symptom relapse and gainful employment, social and occupational functioning, and quality of life of family caregivers. RESULTS Based on a modified intention-to-treat analysis, the outcomes for ACT were significantly better than those of standard community treatment. ACT patients were less likely to be readmitted [3.3% (1/30) v. 25.0% (7/28), Fisher's exact test p = 0.023], had a shorter mean readmission time [2.4 (13.3) v. 30.7 (66.9) days], were less likely to relapse [6.7% (2/30) v. 28.6% (8/28), Fisher's exact test p = 0.038], and had shorter mean time in relapse [3.5 (14.6) v. 34.4 (70.6) days]. The ACT group also had significantly longer times re-employed and greater symptomatic improvement and their caregivers experienced a greater improvement in their quality of life. CONCLUSION Our results show that culturally adapted ACT is both feasible and effective for individuals with severe schizophrenia in urban China. Replication studies with larger samples and longer duration of follow up are warranted.
Collapse
Affiliation(s)
- Xingwei Luo
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| | - Samuel F Law
- Department of Psychiatry,University of Toronto,Toronto, Ontario,Canada
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| | - Jingzheng Shi
- Xiangya School of Public Health, Central South University,Changsha, Hunan410078,China
| | - Wu Zeng
- Brandeis University,Waltham MA, 02454,USA
| | - Xiaoqian Ma
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| | - Wendy Chow
- Department of Psychiatry,University of Toronto,Toronto, Ontario,Canada
| | - Shiyan Liu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| | - Wei Zhao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| | - Xiaoli Liu
- Xiangya School of Public Health, Central South University,Changsha, Hunan410078,China
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University,Changsha, Hunan 410011,China
| | - Michael R Phillips
- Suicide Research and Prevention Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine,Shanghai,China
| |
Collapse
|
72
|
Almeda N, García-Alonso CR, Salinas-Pérez JA, Gutiérrez-Colosía MR, Salvador-Carulla L. Causal Modelling for Supporting Planning and Management of Mental Health Services and Systems: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030332. [PMID: 30691052 PMCID: PMC6388254 DOI: 10.3390/ijerph16030332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/19/2019] [Accepted: 01/19/2019] [Indexed: 12/17/2022]
Abstract
Mental health services and systems (MHSS) are characterized by their complexity. Causal modelling is a tool for decision-making based on identifying critical variables and their causal relationships. In the last two decades, great efforts have been made to provide integrated and balanced mental health care, but there is no a clear systematization of causal links among MHSS variables. This study aims to review the empirical background of causal modelling applications (Bayesian networks and structural equation modelling) for MHSS management. The study followed the PRISMA guidelines (PROSPERO: CRD42018102518). The quality of the studies was assessed by using a new checklist based on MHSS structure, target population, resources, outcomes, and methodology. Seven out of 1847 studies fulfilled the inclusion criteria. After the review, the selected papers showed very different objectives and subjects of study. This finding seems to indicate that causal modelling has potential to be relevant for decision-making. The main findings provided information about the complexity of the analyzed systems, distinguishing whether they analyzed a single MHSS or a group of MHSSs. The discriminative power of the checklist for quality assessment was evaluated, with positive results. This review identified relevant strategies for policy-making. Causal modelling can be used for better understanding the MHSS behavior, identifying service performance factors, and improving evidence-informed policy-making.
Collapse
Affiliation(s)
- Nerea Almeda
- Universidad Loyola Andalucía, Department of Psychology, C/ Energía Solar 1, 41014 Seville, Spain.
| | - Carlos R García-Alonso
- Universidad Loyola Andalucía, Department of Quantitative Methods, C/ Energía Solar 1, 41014 Seville, Spain.
| | - José A Salinas-Pérez
- Universidad Loyola Andalucía, Department of Quantitative Methods, C/ Energía Solar 1, 41014 Seville, Spain.
| | | | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, Australian National University, 63 Eggleston Rd, Acton ACT 2601, Australia.
| |
Collapse
|
73
|
Innovative Versorgungsmodelle für Menschen mit schizophrenen Erkrankungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:163-172. [DOI: 10.1007/s00103-018-2868-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
74
|
Zinkler M. Supported Decision Making in the Prevention of Compulsory Interventions in Mental Health Care. Front Psychiatry 2019; 10:137. [PMID: 30984038 PMCID: PMC6449721 DOI: 10.3389/fpsyt.2019.00137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 02/26/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Martin Zinkler
- Kliniken Landkreis Heidenheim gGmbH, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Teaching Hospital of Ulm University, Heidenheim, Germany
| |
Collapse
|
75
|
Vanderplasschen W, Rapp RC, De Maeyer J, Van Den Noortgate W. A Meta-Analysis of the Efficacy of Case Management for Substance Use Disorders: A Recovery Perspective. Front Psychiatry 2019; 10:186. [PMID: 31057432 PMCID: PMC6477913 DOI: 10.3389/fpsyt.2019.00186] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 03/14/2019] [Indexed: 11/21/2022] Open
Abstract
Background: Case management is a client-centered approach to improve the coordination and continuity of service delivery, especially for persons with substance use disorders (SUD) and multiple and complex support needs. This intervention supports individuals by helping them identify needed services, facilitate linkage with services, and promote participation and retention in services. However, it is questionable whether case management is equally effective in promoting recovery and aspects of personal functioning. The objective was to conduct an updated meta-analysis and to assess whether case management was more effective than treatment as usual (TAU) among persons with SUD for improving treatment-related (e.g., successful linkage with and retention in treatment) as well as personal functioning outcomes (e.g., substance use). Methods: This meta-analysis focuses on randomized controlled trials (RCTs) that included persons with alcohol or drug use disorders and compared case management with TAU. To be eligible, interventions had to meet core case management functions as defined in the literature. We conducted searches of the following databases to May 2017: the Cochrane Drugs and Alcohol Specialized Register, CENTRAL, PubMed, Embase, CINAHL, and Web of Science. Also, reference lists of retrieved publications were scanned for relevant (un)published studies. Results: The overall effect size for case management compared to TAU across all outcome categories and moments was small and positive (SMD = 0.18, 95% CI 0.07-0.28), but statistically significant. Effects were considerably larger for treatment tasks (SMD = 0.33, 95% CI 0.18-0.48) than for personal functioning outcomes (SMD = 0.06, 95% CI -0.02 to 0.15). The largest effect sizes were found for retention in substance abuse treatment and linkage with substance abuse services. Moderator effects of case management models and conditions were assessed, but no significant differences were observed. Conclusions: The primary results from earlier meta-analyses were supported: case management is more effective than TAU conditions for improving outcomes, but this effect is significantly larger for treatment-related tasks than for personal functioning outcomes. Case management can be an important supplement to available services for improving linkage and retention, although further research is needed to assess its potential for supporting recovery from a longitudinal perspective.
Collapse
Affiliation(s)
| | - Richard C Rapp
- Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Jessica De Maeyer
- Centre of Expertise on Quality of Life, University College Ghent, Ghent, Belgium
| | | |
Collapse
|
76
|
Complex Interventions and Interorganisational Relationships: Examining Core Implementation Components of Assertive Community Treatment. Int J Integr Care 2018; 18:11. [PMID: 30532665 PMCID: PMC6284138 DOI: 10.5334/ijic.3547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: There is increasing interest in implementing evidence-based integrated models of care in community-based mental health service systems. Assertive Community Treatment (ACT) is seen as an attractive, and at the same time challenging, model to implement in sectored service settings. This study investigates the implementation process of such an initiative. Methods: Interviews were conducted with ACT team members, the process leader, steering group members, and collaboration partners. The “Sustainable Implementation Scale” helped to identify critical implementation components, and these were further explored using the qualitative interview data. The “Tool for Measuring Assertive Community Treatment” addressed programme fidelity, and the initiative’s sustainability was assessed. Results: High-fidelity implementation of ACT in a sectored service setting is possible. Prominent components that facilitated implementation were careful preparations, team members’ characteristics, and efforts by the process leader and the steering group to improve networking. Implementation was hampered by conflicting goals among the involved authorities and a mismatch between the ACT model’s characteristics and existing organisational traditions and regulations. Discussion and Conclusions: Reducing the uncertainty caused by conflicting goals is an important step in improving the implementation of ACT. In order to facilitate implementation, the goals, regulations, and availability of resources should be aligned horizontally and vertically through the involved organisations.
Collapse
|
77
|
Anderson M, Revie CW, Quail JM, Wodchis W, de Oliveira C, Osman M, Baetz M, McClure J, Stryhn H, Buckeridge D, Neudorf C. The effect of socio-demographic factors on mental health and addiction high-cost use: a retrospective, population-based study in Saskatchewan. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2018; 109:810-820. [PMID: 29981109 PMCID: PMC6267642 DOI: 10.17269/s41997-018-0101-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/07/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE A small proportion of the population accounts for the majority of healthcare costs. Mental health and addiction (MHA) patients are consistently high-cost. We aimed to delineate factors amenable to public health action that may reduce high-cost use among a cohort of MHA clients in Saskatoon, Saskatchewan. METHODS We conducted a population-based retrospective cohort study. Administrative health data from fiscal years (FY) 2009-2015, linked at the individual level, were analyzed (n = 129,932). The outcome of interest was ≥ 90th percentile of costs for each year under study ('persistent high-cost use'). Descriptive analyses were followed by logistic regression modelling; the latter excluded long-term care residents. RESULTS The average healthcare cost among study cohort members in FY 2009 was ~ $2300; for high-cost users it was ~ $19,000. Individuals with unstable housing and hospitalization(s) had increased risk of persistent high-cost use; both of these effects were more pronounced as comorbidities increased. Patients with schizophrenia, particularly those under 50 years old, had increased probability of persistent high-cost use. The probability of persistent high-cost use decreased with good connection to a primary care provider; this effect was more pronounced as the number of mental health conditions increased. CONCLUSION Despite constituting only 5% of the study cohort, persistent high-cost MHA clients (n = 6455) accounted for ~ 35% of total costs. Efforts to reduce high-cost use should focus on reduction of multimorbidity, connection to a primary care provider (particularly for those with more than one MHA), young patients with schizophrenia, and adequately addressing housing stability.
Collapse
Affiliation(s)
- Maureen Anderson
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada.
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada.
| | - Crawford W Revie
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - Jacqueline M Quail
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada
- College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Walter Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada
- Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada
| | - Meriç Osman
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada
| | - Marilyn Baetz
- College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
- Saskatoon Health Region, #101-310 Idylwyld Drive North, Saskatoon, SK, S7L 0Z2, Canada
| | - J McClure
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - Henrik Stryhn
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE, C1A 4P3, Canada
| | - David Buckeridge
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Purvis Hall 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada
| | - Cordell Neudorf
- College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
- Saskatoon Health Region, #101-310 Idylwyld Drive North, Saskatoon, SK, S7L 0Z2, Canada
| |
Collapse
|
78
|
Malagón-Amor Á, Martín-López LM, Córcoles D, González A, Bellsolà M, Teo AR, Pérez V, Bulbena A, Bergé D. A 12-month study of the hikikomori syndrome of social withdrawal: Clinical characterization and different subtypes proposal. Psychiatry Res 2018; 270:1039-1046. [PMID: 29615267 DOI: 10.1016/j.psychres.2018.03.060] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 03/10/2018] [Accepted: 03/22/2018] [Indexed: 11/16/2022]
Abstract
Social withdrawal is a new mental health problem increasingly common, present in different cultures, whose psychopathology and treatment is not yet established. This study aims to determine the socio-demographic and clinical features and possible clinical subtypes that predict the 12-month outcomes of cases with hikikomori syndrome, a severe form of social withdrawal. Socio-demographic and clinical data at baseline were analysed as well as data obtained for 12 months after at-home treatment in 190 cases. The inclusion criteria were: spending all time at home, avoiding social situations and relationships, significant deterioration due to social isolation, with a minimum duration of 6 months. Six major diagnostic groups were identified: affective, anxiety, psychotic, drug use, personality and other Axis I disorders. The anxiety-affective subgroup demonstrated lower clinical severity, but worse evolution. Less than half of the cases were available for medical follow-up at 12-months. Subjects undergoing intensive treatment had a higher medical follow-up rate and better social networks at 12-months. Therefore, our findings provide data to reach consensus on the specific characteristics of social isolation hikikomori syndrome. The analysis demonstrated the fragility and tendency to relapse and have disengagement, particularly relevant in the anxiety-affective subgroup, suggesting that intensive treatments are more effective.
Collapse
Affiliation(s)
- Ángeles Malagón-Amor
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Luis Miguel Martín-López
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Spain; Neurosciences Research Programme, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - David Córcoles
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Spain
| | - Anna González
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
| | - Magda Bellsolà
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain
| | - Alan R Teo
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, USA; Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland, USA; School of Public Health, Oregon Health & Science University and Portland State University, Portland, USA
| | - Víctor Pérez
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Spain; Neurosciences Research Programme, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Antoni Bulbena
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Spain; Neurosciences Research Programme, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Daniel Bergé
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Spain; Neurosciences Research Programme, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| |
Collapse
|
79
|
Haddad PM, Correll CU. The acute efficacy of antipsychotics in schizophrenia: a review of recent meta-analyses. Ther Adv Psychopharmacol 2018; 8:303-318. [PMID: 30344997 PMCID: PMC6180374 DOI: 10.1177/2045125318781475] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/04/2018] [Indexed: 12/19/2022] Open
Abstract
Schizophrenia is the eighth leading cause of disability worldwide in people aged 15-44 years. Before antidopaminergic antipsychotics were introduced in the 1950s, no effective medications existed for the treatment of schizophrenia. This review summarizes key meta-analytic findings regarding antipsychotic efficacy in the acute treatment of schizophrenia, including clozapine in treatment-resistant patients. In the most comprehensive meta-analysis of randomized controlled trials conducted in multi-episode schizophrenia, antipsychotics outperformed placebo regarding total symptoms, positive symptoms, negative symptoms, depressive symptoms, quality of life and social functioning. Amongst these outcomes, the standardized mean difference for overall symptoms was largest, that is, 0.47 (95% credible interval = 0.42-0.51), approaching a medium effect size, being reduced to 0.38 when publication bias and small-trial effects were accounted for. A comparison of two meta-analyses indicated that first-episode patients, compared with multi-episode patients, were more likely to have at least minimal treatment response [⩾20% Positive and Negative Syndrome Scale (PANSS)/Brief Psychiatric Rating Scale (BPRS) score reduction: 81% versus 51%] and good response (⩾50% PANSS/BPRS score reduction: 52% versus 23%). In multi-episode schizophrenia, no response or worsening after 2 weeks of a therapeutic antipsychotic dose was highly predictive of not achieving a good response at endpoint (median treatment = 6 weeks: specificity = 86%; positive predictive value = 90%), suggesting a change in treatment should be considered in such cases. In first-episode psychosis, adequately dosed antipsychotic treatment trials for more than 2 weeks are recommended before using no response or worsening as a decision point for aborting a given antipsychotic. In clearly defined treatment-resistant schizophrenia, clozapine generally outperformed other antipsychotics, especially when dosed appropriately (target = 3-6 months' duration; trough clozapine level ⩾350-400 μg/L) with a response rate (⩾20% PANSS/BPRS) of 33% by 3 months of treatment. High antipsychotic doses and psychotropic combinations are unlikely to be superior to standard doses of antipsychotic monotherapy. Acute antipsychotic efficacy in schizophrenia depends on the targeted symptom domain (greater efficacy: total and positive symptoms, lesser efficacy: negative symptoms, depressive symptoms, social functioning and quality of life). Greater antipsychotic efficacy is associated with higher total baseline symptom severity, treatment-naïveté/first-episode status, shorter illness duration, and trials that are nonindustry sponsored and that have a lower placebo effect. The heterogeneity of antipsychotic response across individuals and key symptom domains, the considerable degree of nonresponse/treatment resistance in multi-episode patients, and the adverse effect potential of antipsychotics are major limitations, underscoring the need to develop new medications for the treatment of schizophrenia. Drug development should include matching patient subgroups, which are identified by means of clinical and biomarker variables, to mechanisms of action of novel medications, targeting specific symptom domains, and investigating mechanisms of action other than dopaminergic blockade.
Collapse
Affiliation(s)
- Peter M Haddad
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar. Neuroscience and Psychiatry Unit, University of Manchester, Stopford Building, Oxford Road, Manchester, UK
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Glen Oaks, NY, USA Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| |
Collapse
|
80
|
Stuen HK, Landheim A, Rugkåsa J, Wynn R. How clinicians make decisions about CTOs in ACT: a qualitative study. Int J Ment Health Syst 2018; 12:51. [PMID: 30258490 PMCID: PMC6151000 DOI: 10.1186/s13033-018-0230-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/16/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The first 12 Norwegian assertive community treatment (ACT) teams were piloted from 2009 to 2011. Of the 338 patients included during the teams' first year of operation, 38% were subject to community treatment orders (CTOs). In Norway as in many other Western countries, the use of CTOs is relatively high despite lack of robust evidence for their effectiveness. The purpose of the present study was to explore how responsible clinicians reason and make decisions about the continued use of CTOs, recall to hospital and the discontinuation of CTOs within an ACT setting. METHODS Semi-structured interviews with eight responsible clinicians combined with patient case files and observations of treatment planning meetings. The data were analysed using a modified grounded theory approach. RESULTS The participants emphasized that being part of a multidisciplinary team with shared caseload responsibility that provides intensive services over long periods of time allowed for more nuanced assessments and more flexible treatment solutions on CTOs. The treatment criterion was typically used to justify the need for CTO. There was substantial variation in the responsible clinicians' legal interpretation of dangerousness, and some clinicians applied the dangerousness criterion more than others. CONCLUSIONS According to the clinicians, many patients subject to CTOs were referred from hospitals and high security facilities, and decisions regarding the continuation of CTOs typically involved multiple and interacting risk factors. While patients' need for treatment was most often applied to justify the need for CTOs, in some cases the use of CTOs was described as a tool to contain dangerousness and prevent harm.
Collapse
Affiliation(s)
- Hanne Kilen Stuen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brummundal, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brummundal, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Jorun Rugkåsa
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Centre for Care Research, University of South-Eastern Norway, Porsgrunn, Norway
| | - Rolf Wynn
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Divison of Mental Health and Addictions, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
81
|
Kerkemeyer L, Wasem J, Neumann A, Brannath W, Mester B, Timm J, Wobrock T, Bartels C, Falkai P, Biermann J. Effectiveness and cost-effectiveness of an integrated care program for schizophrenia: an analysis of routine data. Eur Arch Psychiatry Clin Neurosci 2018; 268:611-619. [PMID: 28791485 DOI: 10.1007/s00406-017-0830-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/24/2017] [Indexed: 11/24/2022]
Abstract
In Germany, a regional social health insurance fund provides an integrated care program for patients with schizophrenia (IVS). Based on routine data of the social health insurance, this evaluation examined the effectiveness and cost-effectiveness of the IVS compared to the standard care (control group, CG). The primary outcome was the reduction of psychiatric inpatient treatment (days in hospital), and secondary outcomes were schizophrenia-related inpatient treatment, readmission rates, and costs. To reduce selection bias, a propensity score matching was performed. The matched sample included 752 patients. Mean number of psychiatric and schizophrenia-related hospital days of patients receiving IVS (2.3 ± 6.5, 1.7 ± 5.0) per quarter was reduced, but did not differ statistically significantly from CG (2.7 ± 7.6, 1.9 ± 6.2; p = 0.772, p = 0.352). Statistically significant between-group differences were found in costs per quarter per person caused by outpatient treatment by office-based psychiatrists (IVS: €74.18 ± 42.30, CG: €53.20 ± 47.96; p < 0.001), by psychiatric institutional outpatient departments (IVS: €4.83 ± 29.57, CG: €27.35 ± 76.48; p < 0.001), by medication (IVS: €471.75 ± 493.09, CG: €429.45 ± 532.73; p = 0.015), and by psychiatric outpatient nursing (IVS: €3.52 ± 23.83, CG: €12.67 ± 57.86, p = 0.045). Mean total psychiatric costs per quarter per person in IVS (€1117.49 ± 1662.73) were not significantly lower than in CG (€1180.09 ± 1948.24; p = 0.150). No statistically significant differences in total schizophrenia-related costs per quarter per person were detected between IVS (€979.46 ± 1358.79) and CG (€989.45 ± 1611.47; p = 0.084). The cost-effectiveness analysis showed cost savings of €148.59 per reduced psychiatric and €305.40 per reduced schizophrenia-related hospital day. However, limitations, especially non-inclusion of costs related to management of the IVS and additional home treatment within the IVS, restrict the interpretation of the results. Therefore, the long-term impact of this IVS deserves further evaluation.
Collapse
Affiliation(s)
- Linda Kerkemeyer
- Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Straße 9, 45127, Essen, Germany.
| | - Jürgen Wasem
- Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Straße 9, 45127, Essen, Germany
| | - Anja Neumann
- Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Straße 9, 45127, Essen, Germany
| | - Werner Brannath
- Competence Centre for Clinical Trials/Biometry, University of Bremen, Linzer Straße 4, 28359, Bremen, Germany
| | - Benjamin Mester
- Competence Centre for Clinical Trials/Biometry, University of Bremen, Linzer Straße 4, 28359, Bremen, Germany
| | - Jürgen Timm
- Competence Centre for Clinical Trials/Biometry, University of Bremen, Linzer Straße 4, 28359, Bremen, Germany
| | - Thomas Wobrock
- Centre of Mental Health, County Hospitals Darmstadt-Dieburg, Krankenhausstraße 7, 64823, Groß-Umstadt, Germany.,Department of Psychiatry and Psychotherapy, Georg-August University, von-Siebold-Straße 5, 37075, Göttingen, Germany
| | - Claudia Bartels
- Department of Psychiatry and Psychotherapy, Georg-August University, von-Siebold-Straße 5, 37075, Göttingen, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstraße 7, 80336, Munich, Germany
| | - Janine Biermann
- Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Straße 9, 45127, Essen, Germany
| |
Collapse
|
82
|
Bighelli I, Salanti G, Reitmeir C, Wallis S, Barbui C, Furukawa TA, Leucht S. Psychological interventions for positive symptoms in schizophrenia: protocol for a network meta-analysis of randomised controlled trials. BMJ Open 2018. [PMID: 29540411 PMCID: PMC5857696 DOI: 10.1136/bmjopen-2017-019280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION There is rising awareness that we need multidisciplinary approaches integrating psychological treatments for schizophrenia, but a comprehensive evidence based on their relative efficacy is lacking. We will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomised controlled trials (RCTs) to rank psychological treatments for schizophrenia according to their efficacy, acceptability and tolerability. METHODS AND ANALYSIS We will include all RCTs comparing a psychological treatment aimed at positive symptoms of schizophrenia with another psychological intervention or with a no treatment condition (waiting-list and treatment as usual). We will include studies on adult patients with schizophrenia, excluding specific subpopulations (eg, first-episode patients or patients with psychiatric comorbidities). Primary outcome will be the change in positive symptoms on a published rating scale. Secondary outcomes will be acceptability (dropout), change in overall and negative symptoms of schizophrenia, response, relapse, adherence, depression, quality of life, functioning and adverse events. Published and unpublished studies will be sought through database searches, trial registries and websites. Study selection and data extraction will be conducted by at least two independent reviewers. We will conduct random-effects NMA to synthesise all evidences for each outcome and obtain a comprehensive ranking of all treatments. NMA will be conducted in Stata and R within a frequentist framework. The risk of bias in studies will be evaluated using the Cochrane Risk of Bias tool and the credibility of the evidence will be evaluated using an adaptation of the Grading of Recommendations Assessment, Development and Evaluation framework to NMA, recommended by the Cochrane guidance. Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings. ETHICS AND DISSEMINATION No ethical issues are foreseen. Results from this study will be published in peer-reviewed journals and presented at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42017067795.
Collapse
Affiliation(s)
- Irene Bighelli
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technischen Universitat Munchen, Munchen, Germany
| | - Georgia Salanti
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Cornelia Reitmeir
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technischen Universitat Munchen, Munchen, Germany
| | - Sofia Wallis
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technischen Universitat Munchen, Munchen, Germany
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technischen Universitat Munchen, Munchen, Germany
| |
Collapse
|
83
|
Affiliation(s)
- Barbara A Coles
- a Department of Veteran Affairs, Veterans Health Administration , Keiser University , Fort Lauderdale , FL , USA ; American Public University Systems , Charles Town , WV , USA
| |
Collapse
|
84
|
Leach MJ, Jones M, Bressington D, Nolan F, Jones A, Muyambi K, Gillam M, Gray R. The association between mental health nursing and hospital admissions for people with serious mental illness: a protocol for a systematic review. Syst Rev 2018; 7:2. [PMID: 29316979 PMCID: PMC5759359 DOI: 10.1186/s13643-017-0658-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 12/05/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Relapse in individuals with severe mental illness (SMI) is a frequent occurrence and can add considerably to the burden of disease. As such, relapse prevention is an essential therapeutic outcome for people with SMI. Mental health nurses (MHNs) are well placed to support individuals with SMI and to prevent relapse; notwithstanding, there has been no synthesis of the evidence to date to determine whether MHNs prevent relapse in this population. METHODS Electronic databases will be systemically searched for observational studies and clinical trials that report the association between mental health nursing and the hospitalisation of persons living with an SMI. The search will be supplemented by reference checking and a search of the grey literature. The primary outcome of interest will be hospital admission rate. Screening of articles, data extraction and critical appraisal will be undertaken by two reviewers, independently, with a third reviewer consulted should disagreement occur between reviewers. The quality of studies will be assessed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool and the Cochrane Collaboration risk of bias tool. Depending on the number of studies and level of heterogeneity, the evidence may be synthesised using meta-analysis or narrative synthesis. DISCUSSION This review will explore for the first time the clinical potential of mental health nursing in preventing relapse in persons with SMI. The findings of this review will serve to inform future research and education in this area. The evidence may also help inform future policy, including decisions regarding future mental health workforce development and planning. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017058694 .
Collapse
Affiliation(s)
- Matthew J Leach
- Department of Rural Health, University of South Australia, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, North Terrace, Adelaide, South Australia, 5000, Australia.
| | - Dan Bressington
- Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, Special Administrative Region of China
| | - Fiona Nolan
- School of Health and Human Science, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, UK
| | - Adrian Jones
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, LL167TD, Wrexham, UK
| | - Kuda Muyambi
- Department of Rural Health, University of South Australia, 111 Nicholson Avenue, Whyalla Norrie, South Australia, 5608, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Richard Gray
- Department of Rural Health, University of South Australia, 111 Nicholson Avenue, Whyalla Norrie, South Australia, 5608, Australia.,La Trobe University, Bundoora, Victoria, 3086, Australia
| |
Collapse
|
85
|
Wullschleger A, Berg J, Bermpohl F, Montag C. Can "Model Projects of Need-Adapted Care" Reduce Involuntary Hospital Treatment and the Use of Coercive Measures? Front Psychiatry 2018; 9:168. [PMID: 29765339 PMCID: PMC5939233 DOI: 10.3389/fpsyt.2018.00168] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 04/12/2018] [Indexed: 11/13/2022] Open
Abstract
Intensive outpatient models of need-adapted psychiatric care have been shown to reduce the length of hospital stays and to improve retention in care for people with severe mental illnesses. In contrast, evidence regarding the impact of such models on involuntary hospital treatment and other coercive measures in inpatient settings is still sparse, although these represent important indicators of the patients' wellbeing. In Germany, intensive models of care still have not been routinely implemented, and their effectiveness within the German psychiatric system is only studied in a few pioneering regions. An innovative model of flexible, assertive, need-adapted care established in Berlin, Germany, in 2014, treating unselected 14% of the catchment area's patients, was evaluated on the basis of routine clinical data. Records of n = 302 patients diagnosed with severe mental disorders, who had been hospitalized at least once during a 4-year-observational period, were analyzed in a retrospective individual mirror-image design, comparing the 2 years before and after inclusion in the model project regarding the time spent in hospital, the number and duration of involuntary hospital treatments and the use of direct coercive interventions like restraint or isolation. After inclusion to the project, patients spent significantly less time in hospital. Among patients treated on acute wards and patients with a diagnosis of psychosis, the number of patients subjected to provisional detention due to acute endangerment of self or others decreased significantly, as did the time spent under involuntary hospital treatment. The number of patients subjected to mechanical restraint, but not to isolation, on the ward decreased significantly, while the total number of coercive interventions remained unchanged. Findings suggest some potential of intensive models of need-adapted care to reduce coercive interventions in psychiatry. However, results must be substantiated by evidence from randomized-controlled trials and longer observation periods.
Collapse
Affiliation(s)
- Alexandre Wullschleger
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jürgen Berg
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
86
|
von Peter S, Ignatyev Y, Johne J, Indefrey S, Kankaya OA, Rehr B, Zeipert M, Bechdolf A, Birkner T, Deister A, Duve A, Rout S, Scherk H, Schulz-Dubois A, Wilms B, Zedlick D, Grollich P, Braun B, Timm J, Heinze M. Evaluation of Flexible and Integrative Psychiatric Treatment Models in Germany-A Mixed-Method Patient and Staff-Oriented Exploratory Study. Front Psychiatry 2018; 9:785. [PMID: 30723433 PMCID: PMC6349706 DOI: 10.3389/fpsyt.2018.00785] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/31/2018] [Indexed: 11/13/2022] Open
Abstract
Contrary to the practice in some countries, access to flexible and integrated forms of psychiatric care (FIT models) is limited in Germany. Several legislations have been introduced to improve this situation, notably the recent §64b (flexible and integrative treatment model; FIT64b) of the German Social Code, which allows for a capitation-based accounting of fees for services. The aim of this study was to explore the effects of FIT64b implementation on various stakeholders (patients, informal caregivers and staff) in 12 psychiatric hospital departments across Germany. Structural as well as quantitative and qualitative data are included, with integration of different methodological approaches. In all departments, the implementation of the new accounting system resulted into a relatively stable set of structural and processual changes where rigid forms of mainly inpatient care shifted to more flexible and integrated types of outpatient and outreach treatments. These changes were more likely to be perceived by patients and staff, and likewise received better evaluations, in those departments showing higher level or longer duration of implementation. Patients' evaluations, furthermore, were largely influenced by the advent of continuous forms of care, better accessibility, and by their degree of autonomy in steering of their services.
Collapse
Affiliation(s)
- Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Yuriy Ignatyev
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Jakob Johne
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Sonja Indefrey
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Onur Alp Kankaya
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Burkhard Rehr
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Manfred Zeipert
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany.,Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, Vivantes Krankenhaus am Urban, Charité University Medicine Berlin, University of Cologne, Berlin, Germany
| | - Thomas Birkner
- Department for Psychiatry, Psychotherapy and Psychosomatic Medicine, Westklinikum Heide, Heide, Germany
| | - Arno Deister
- Psychosoziales Zentrum Itzehoe, Itzehoe, Germany
| | - Annette Duve
- Department of Child and Adolescent Psychiatry, Vitos Klinikum Riedstadt, Riedstadt, Germany
| | - Sandeep Rout
- Department of Psychiatry and Psychotherapy, Vivantes Krankenhaus Neukölln, Charité University Medicine Berlin, Berlin, Germany
| | - Harald Scherk
- Department of Psychiatry and Psychotherapy, Vitos Klinikum Riedstadt, Riedstadt, Germany
| | - Anna Schulz-Dubois
- Department of Psychiatry and Psychotherapy, Imland Krankenhaus Rendsburg, Rendsburg, Germany
| | - Bettina Wilms
- Department of Psychiatry and Psychotherapy, Basedow Klinikum Saalekreis, Querfurt, Germany
| | - Dyrk Zedlick
- Department of Psychiatry and Psychotherapy, Rudolf Virchow Krankenhaus Glauchau, Glauchau, Germany
| | - Peter Grollich
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Bernard Braun
- SOCIUM Research Center, University of Bremen, Bremen, Germany
| | - Jürgen Timm
- Biometry Section, Competence Center for Clinical Trials, University of Bremen, Bremen, Germany
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| |
Collapse
|
87
|
Peritogiannis V, Manthopoulou T, Gogou A, Mavreas V. Mental Healthcare Delivery in Rural Greece: A 10-year Account of a Mobile Mental Health Unit. J Neurosci Rural Pract 2017; 8:556-561. [PMID: 29204014 PMCID: PMC5709877 DOI: 10.4103/jnrp.jnrp_142_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Patients living in rural and remote areas may have limited access to mental healthcare due to lack of facilities and socioeconomic reasons, and this is the case of rural areas in Eastern Europe countries. In Greece, community mental health service delivery in rural areas has been implemented through the development of the Mobile Mental Health Units (MMHUs). Methods: We present a 10-year account of the operation of the MMHU of the prefectures of Ioannina and Thesprotia (MMHU I-T) and report on the impact of the service on mental health delivery in the catchment area. The MMHU I-T is a multidisciplinary community mental health team which delivers services in rural and mountainous areas of Northwest Greece. Results: The MMHU I-T has become an integral part of the local primary care system and is well known to the population of the catchment area. By the end of 2016, the majority of patients (60%) were self-referred or family-referred, compared to 24% in the first 2 years. Currently, the number of active patients is 293 (mean age 63 years, 49.5% are older adults), and the mean caseload for each member of the team is 36.6. A significant proportion of patients (28%) receive care with regular domiciliary visits, and the provision of home-based care was correlated with the age of the patients. Within the first 2 years of operation of the MMHU I-T hospitalizations of treatment, engaged patients were reduced significantly by 30.4%, whereas the treatment engagement rates of patients with psychotic disorders were 67.2% in 5 years. Conclusions: The MMHU I-T and other similar units in Greece are a successful paradigm of a low-cost service which promotes mental health in rural, remote, and deprived areas. This model of care may be informative for clinical practice and health policy given the ongoing recession and health budget cuts. It suggests that rural mental healthcare may be effectively delivered by integrating generic community mental health mobile teams into the primary care system.
Collapse
Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Thiresia Manthopoulou
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Afroditi Gogou
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Venetsanos Mavreas
- Department of Psychiatry, School of Medicine, University of Ioannina, Ioannina, Greece
| |
Collapse
|
88
|
Franke ND, Treglia D, Cnaan RA. Reentry Program and Social Work Education: Training the Next Generation of Criminal Justice Social Workers. JOURNAL OF EVIDENCE-INFORMED SOCIAL WORK 2017; 14:409-420. [PMID: 28901840 DOI: 10.1080/23761407.2017.1367345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Social work plays a marginal role in opposing the trend of mass incarceration and high rates of recidivism, and social work education offers limited opportunities for students to specialize in working with people who are currently or were previously incarcerated. How to train students of social work to work against mass-incarceration is still challenging. METHODS The authors devised and implemented an in-school social service agency devoted to working with people pre and post release from a prison system. The agency is a field practicum setting where interested students study and practice reentry work. In this article, the authors describe and assess the educational merit of this in-school agency. RESULTS Findings from surveys of students and alumni suggest that the program attained its educational goals of connecting classroom education to practice experience and training students for careers in the criminal justice system. The authors also discuss pending challenges. DISCUSSION The experience of the Goldring Reentry Initiative suggests that by developing their own social work agencies, the authors may be able to heighten their students educational experience and expand their contribution to social work practice broadly.
Collapse
Affiliation(s)
- Nancy D Franke
- a University of Pennsylvania School of Social Policy & Practice , Philadelphia , Pennsylvania , USA
| | - Dan Treglia
- a University of Pennsylvania School of Social Policy & Practice , Philadelphia , Pennsylvania , USA
| | - Ram A Cnaan
- a University of Pennsylvania School of Social Policy & Practice , Philadelphia , Pennsylvania , USA
- b Kyung Hee University-Global Campus , Graduate School of Peace Studies , Yongin , Republic of Korea
| |
Collapse
|
89
|
Mueller-Stierlin AS, Helmbrecht MJ, Herder K, Prinz S, Rosenfeld N, Walendzik J, Holzmann M, Dinc U, Schützwohl M, Becker T, Kilian R. Does one size really fit all? The effectiveness of a non-diagnosis-specific integrated mental health care program in Germany in a prospective, parallel-group controlled multi-centre trial. BMC Psychiatry 2017; 17:283. [PMID: 28764729 PMCID: PMC5539984 DOI: 10.1186/s12888-017-1441-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/24/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The Network for Mental Health (NWpG-IC) is an integrated mental health care program implemented in 2009 by cooperation between health insurance companies and community mental health providers in Germany. Meanwhile about 10,000 patients have been enrolled. This is the first study evaluating the effectiveness of the program in comparison to standard mental health care in Germany. METHODS In a parallel-group controlled trial over 18 months conducted in five regions across Germany, a total of 260 patients enrolled in NWpG-IC and 251 patients in standard mental health care (TAU) were recruited between August 2013 and November 2014. The NWpG-IC patients had access to special services such as community-based multi-professional teams, case management, crisis intervention and family-oriented psychoeducation in addition to standard mental health care. The primary outcome empowerment (EPAS) and the secondary outcomes quality of life (WHO-QoL-BREF), satisfaction with psychiatric treatment (CSQ-8), psychosocial and clinical impairment (HoNOS) and information about mental health service needs (CAN) were measured four times at 6-month intervals. Linear mixed-effect regression models were used to estimate the main effects and interaction effects of treatment, time and primary diagnosis. Due to the non-randomised group assignment, propensity score adjustment was used to control the selection bias. RESULTS NWpG-IC and TAU groups did not differ with respect to most primary and secondary outcomes in our participating patients who showed a broad spectrum of psychiatric diagnoses and illness severities. However, a significant improvement in terms of patients' satisfaction with psychiatric care and their perception of treatment participation in favour of the NWpG-IC group was found. CONCLUSIONS Providing integrated mental health care for unspecific mentally ill target groups increases treatment participation and service satisfaction but seems not suitable to enhance the overall outcomes of mental health care in Germany. The implementation of strategies for ameliorating the needs orientation of the NWpG-IC should be considered. TRIAL REGISTRATION German Clinical Trial Register DRKS00005111 , registered 26 July 2013.
Collapse
Affiliation(s)
- Annabel Sandra Mueller-Stierlin
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ulm, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Katrin Herder
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ulm, Germany
| | - Stefanie Prinz
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ulm, Germany
| | - Nadine Rosenfeld
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ulm, Germany
| | - Julia Walendzik
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Marco Holzmann
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Uemmueguelsuem Dinc
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ulm, Germany
| | - Matthias Schützwohl
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Thomas Becker
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ulm, Germany
| | - Reinhold Kilian
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ulm, Germany
| |
Collapse
|
90
|
Dieterich M, Irving CB, Bergman H, Khokhar MA, Park B, Marshall M. Intensive Case Management for Severe Mental Illness. Schizophr Bull 2017; 43:698-700. [PMID: 28969355 PMCID: PMC5472103 DOI: 10.1093/schbul/sbx061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Marina Dieterich
- Department of Psychiatry, Azienda USL Toscana Nord Ovest, Livorno, Italy
| | - Claire B. Irving
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
| | | | - Mariam A. Khokhar
- Oral Health and Development, University of Sheffield, Nottingham, UK
| | - Bert Park
- Adult Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Max Marshall
- The Lantern Centre, University of Manchester, Preston, UK
| |
Collapse
|
91
|
Ward MC, Druss BG. Reverse Integration Initiatives for Individuals With Serious Mental Illness. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2017; 15:271-278. [PMID: 31975857 PMCID: PMC6519558 DOI: 10.1176/appi.focus.20170011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Medical progress has greatly extended the life span of individuals living in the United States, yet certain groups have lagged behind in achieving wellness and longevity. Prominent among these are individuals with serious mental illness. Because of this, various initiatives have been launched at the community, state, and national level to improve the medical care of those with serious mental illness. Many of these initiatives promote "reverse integration," or the provision of collaborative care services in behavioral health locations. Despite significant barriers to implementation, these initiatives have shown moderate success in improving medical outcomes for those with serious mental illness, in both research and "real-life" settings. Additionally, the role of psychiatrists in addressing physical health has been explored, and there is a need for educational opportunities to optimize competency in this area. Overall, work still needs to be done before the mortality gap for those with serious mental illness dissipates.
Collapse
Affiliation(s)
- Martha C Ward
- Dr. Ward is with the Department of Psychiatry and Behavioral Sciences and the Department of Medicine, Emory University School of Medicine, Atlanta. Dr. Druss is the Rosalynn Carter Chair in Mental Health, Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Benjamin G Druss
- Dr. Ward is with the Department of Psychiatry and Behavioral Sciences and the Department of Medicine, Emory University School of Medicine, Atlanta. Dr. Druss is the Rosalynn Carter Chair in Mental Health, Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| |
Collapse
|
92
|
Morandi S, Silva B, Golay P, Bonsack C. Intensive Case Management for Addiction to promote engagement with care of people with severe mental and substance use disorders: an observational study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:26. [PMID: 28545572 PMCID: PMC5445418 DOI: 10.1186/s13011-017-0111-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/19/2017] [Indexed: 11/13/2022]
Abstract
Background Co-occurring severe mental and substance use disorders are associated with physical, psychological and social complications such as homelessness and unemployment. People with severe mental and substance use disorders are difficult to engage with care. The lack of treatment worsens their health and social conditions and increases treatment costs, as emergency department visits arise. Case management has proved to be effective in promoting engagement with care of people with severe mental and substance use disorders. However, this impact seemed mainly related to the case management model. The Intensive Case Management for Addiction (ICMA) aimed to improve engagement with care of people with severe mental and substance use disorders, insufficiently engaged with standard treatment. This innovative multidisciplinary mobile team programme combined Assertive Community Treatment and Critical Time Intervention methodologies. The aim of the study was to observe the impact of ICMA upon service use, treatment adherence and quality of support networks. Participants’ psychosocial and mental functioning, and substance use were also assessed throughout the intervention. Methods The study was observational. Eligible participants were all the people entering the programme during the first year of implementation (April 2014–April 2015). Data were collected through structured questionnaires and medical charts. Assessments were conducted at baseline and at 12 months follow-up or at the end of the programme if completed earlier. McNemar-Bowker’s Test, General Linear Model repeated-measures analysis of variance and non-parametric Wilcoxon Signed Rank tests were used for the analysis. Results A total of 30 participants took part in the study. Results showed a significant reduction in the number of participants visiting the general emergency department compared to baseline. A significantly decreased number of psychiatric emergency department visits was also registered. Moreover, at follow-up participants improved significantly their treatment adherence, clinical status, social functioning, and substance intake and frequency of use. Conclusions These promising results highlight the efficacy of the ICMA. The intervention improved engagement with care and the psychosocial situation of people with severe mental and substance use disorders, with consequent direct impact on their substance misuse.
Collapse
Affiliation(s)
- Stéphane Morandi
- Department of Psychiatry, Social Psychiatry Section, Community Psychiatry Service, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland.
| | - Benedetta Silva
- Department of Psychiatry, Social Psychiatry Section, Community Psychiatry Service, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Philippe Golay
- Department of Psychiatry, Social Psychiatry Section, Community Psychiatry Service, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Charles Bonsack
- Department of Psychiatry, Social Psychiatry Section, Community Psychiatry Service, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
| |
Collapse
|