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Martinelli A, Dal Corso E, Pozzan T, Cristofalo D, Bonetto C, Ruggeri M. Addressing Challenges in Residential Facilities: Promoting Human Rights and Recovery While Pursuing Functional Autonomy. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2023; 6:12-22. [PMID: 38510484 PMCID: PMC10948939 DOI: 10.1176/appi.prcp.20230034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/12/2023] [Accepted: 10/03/2023] [Indexed: 03/22/2024] Open
Abstract
Objective Italian residential facilities (RFs) aim to promote human rights and recovery for individuals with severe mental disorders. Italian RFs can be distinguished into five main types: high-intensity rehabilitation (RF1), medium-intensity rehabilitation (RF2), medium-level support (RF3.1), high-level support (RF3.2), low-level support (RF3.3). This study aimed to assess the effectiveness of Italian RFs in achieving functional autonomy while upholding human rights and recovery. Methods Data on socio-demographics, clinical information, patient and staff assessments of functional autonomy, types of interventions, and RF performance in various domains were collected in a pilot study with a cross-sectional design. Descriptive and inferential analyses were conducted. Results Twelve RFs and 113 patients participated, with varying proportions in each RF type. RF1 patients were the oldest (p < 0.001) with the lowest functional autonomy (p < 0.001), while RF2 patients were the youngest (p < 0.001) with the lowest hospitalization rate (p < 0.001). RF3.1 patients had the highest employment rate (p = 0.024), while RF3.2 had the lowest employment rate (p = 0.024) and the longest service contact (p < 0.001). RF3.3 users had the highest functional autonomy (p < 0.001). The highest functional autonomy was in self-care which received the highest focus in objectives and interventions. Patients rated their functional autonomy higher than professionals (p < 0.001). RFs excelled in the "human rights" and "social interface" domains but performed poorly in "recovery-based practice," with RF1 having the lowest performance and RF3.3 the highest. Conclusions This pilot study suggests that Italian RFs generally aligne with their mission and human rights principles, but personalizing interventions and implementing recovery-oriented practices face challenges.
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Affiliation(s)
| | | | - Tecla Pozzan
- Section of PsychiatryVerona Hospital TrustAOUIVeronaItaly
| | - Doriana Cristofalo
- Dipartimento di Neuroscienze, Biomedicina e MovimentoUniversità di VeronaVeronaItaly
| | - Chiara Bonetto
- Dipartimento di Neuroscienze, Biomedicina e MovimentoUniversità di VeronaVeronaItaly
| | - Mirella Ruggeri
- Section of PsychiatryVerona Hospital TrustAOUIVeronaItaly
- Dipartimento di Neuroscienze, Biomedicina e MovimentoUniversità di VeronaVeronaItaly
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Brekke E, Clausen H, Brodahl M, Landheim AS. Patients' experiences with coercive mental health treatment in Flexible Assertive Community Treatment: a qualitative study. BMC Psychiatry 2023; 23:764. [PMID: 37853402 PMCID: PMC10585822 DOI: 10.1186/s12888-023-05264-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Flexible Assertive Community Treatment (FACT) teams have been implemented in Norwegian health and social services over the last years, partly aiming to reduce coercive mental health treatment. We need knowledge about how service users experience coercion within the FACT context. The aim of this paper is to explore service user experiences of coercive mental health treatment in the context of FACT and other treatment contexts they have experienced. Are experiences of coercion different in FACT than in other treatment contexts? If this is the case, which elements of FACT lead to a different experience? METHOD Within a participatory approach, 24 qualitative interviews with service users in five different FACT teams were analyzed with thematic analysis. RESULTS Participants described negative experiences with formal and informal coercion. Three patterns of experiences with coercion in FACT were identified: FACT as clearly a change for the better, making the best of FACT, and finding that coercion is just as bad in FACT as it was before. Safety, improved quality of treatment, and increased participation were described as mechanisms that can prevent coercion. CONCLUSION Results from this study support the argument that coercion is at odds with human rights and therefore should be avoided as far as possible. Results suggest that elements of the FACT model may prevent the use of coercion by promoting safety, improved quality of treatment and increased participation.
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Affiliation(s)
- Eva Brekke
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway.
| | - Hanne Clausen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway
- Department of Research and Development, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Morten Brodahl
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway
| | - Anne S Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway
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Ferrara M, Gentili E, Belvederi Murri M, Zese R, Alberti M, Franchini G, Domenicano I, Folesani F, Sorio C, Benini L, Carozza P, Little J, Grassi L. Establishment of a Public Mental Health Database for Research Purposes in the Ferrara Province: Development and Preliminary Evaluation Study. JMIR Med Inform 2023; 11:e45523. [PMID: 37584563 PMCID: PMC10461404 DOI: 10.2196/45523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/04/2023] [Accepted: 06/01/2023] [Indexed: 08/17/2023] Open
Abstract
Background The immediate use of data exported from electronic health records (EHRs) for research is often limited by the necessity to transform data elements into an actual data set. Objective This paper describes the methodology for establishing a data set that originated from an EHR registry that included clinical, health service, and sociodemographic information. Methods The Extract, Transform, Load process was applied to raw data collected at the Integrated Department of Mental Health and Pathological Addictions in Ferrara, Italy, from 1925 to February 18, 2021, to build the new, anonymized Ferrara-Psychiatry (FEPSY) database. Information collected before the first EHR was implemented (ie, in 1991) was excluded. An unsupervised cluster analysis was performed to identify patient subgroups to support the proof of concept. Results The FEPSY database included 3,861,432 records on 46,222 patients. Since 1991, each year, a median of 1404 (IQR 1117.5-1757.7) patients had newly accessed care, and a median of 7300 (IQR 6109.5-9397.5) patients were actively receiving care. Among 38,022 patients with a mental disorder, 2 clusters were identified; the first predominantly included male patients who were aged 25 to 34 years at first presentation and were living with their parents, and the second predominantly included female patients who were aged 35 to 44 years and were living with their own families. Conclusions The process for building the FEPSY database proved to be robust and replicable with similar health care data, even when they were not originally conceived for research purposes. The FEPSY database will enable future in-depth analyses regarding the epidemiology and social determinants of mental disorders, access to mental health care, and resource utilization.
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Affiliation(s)
- Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Local Health Trust, Ferrara, Italy
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | | | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Local Health Trust, Ferrara, Italy
| | - Riccardo Zese
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Marco Alberti
- Department of Mathematics and Computer Science, University of Ferrara, Ferrara, Italy
| | - Giorgia Franchini
- Department of Physics, Informatics and Mathematics, University of Modena and Reggio Emilia, Modena, Italy
| | - Ilaria Domenicano
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Federica Folesani
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Local Health Trust, Ferrara, Italy
| | - Cristina Sorio
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Local Health Trust, Ferrara, Italy
| | - Lorenzo Benini
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Local Health Trust, Ferrara, Italy
| | - Paola Carozza
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Local Health Trust, Ferrara, Italy
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Integrated Department of Mental Health and Pathological Addictions, Ferrara Local Health Trust, Ferrara, Italy
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Lasalvia A, Bodini L, D’Astore C, Gomez F, Pesarin A, Imperadore G, Bonetto C. The Impact of COVID-19 Pandemic on Psychiatric Rehabilitation in Residential Facilities: Perspectives of Staff and Residents. JOURNAL OF PSYCHOSOCIAL REHABILITATION AND MENTAL HEALTH 2023:1-15. [PMID: 37360914 PMCID: PMC10123581 DOI: 10.1007/s40737-023-00343-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/05/2023] [Indexed: 06/28/2023]
Abstract
The coronavirus pandemic imposed significant changes in the care of patients in psychiatric residential facilities, especially during lockdown periods. The aim of this study was to assess the impact of the pandemic on patients and staff of psychiatric residential facilities (RFs). This cross-sectional survey was conducted between 30 June and 30 July 2021 and involved 31 RFs located in the province of Verona (Italy). In total, 170 staff members and 272 residents participated in this study. Staff showing clinically significant symptoms of anxiety, depression and burnout were, respectively, 7.7%, 14.2% and 6%. Staff were concerned about the risk that COVID-19 infection might spread among residents (67.6%) and that residents could not receive an acceptable service due to service reconfiguration because of the pandemic (50.3%). Residents found it very unpleasant not to be permitted to attend family members (85.3%), and not to be allowed to engage in outdoor activities due to the restrictions (84%). Both staff and residents agree that the main problematic areas for the residents was the interdiction to meet family members or friends and the interdiction to outdoor activities, whereas problems related to the COVID-19 infection were considered by the staff members as more frequently problematic than reported by residents. The COVID-19 pandemic had a significant impact on the rehabilitation care and recovery journeys of the residents of psychiatric RFs. Therefore, sustained, and careful attention is needed to ensure that the rehabilitation needs of people with severe mental disorders are not neglected in time of pandemics. Supplementary Information The online version contains supplementary material available at 10.1007/s40737-023-00343-6.
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Affiliation(s)
- Antonio Lasalvia
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) Di Verona, Policlinico “G.B. Rossi”, P.le Scuro, 10, 37134 Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Luca Bodini
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Camilla D’Astore
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) Di Verona, Policlinico “G.B. Rossi”, P.le Scuro, 10, 37134 Verona, Italy
| | - Francesca Gomez
- Department of Mental Health, ULSS 9 Scaligera, Verona, Italy
| | - Alessia Pesarin
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Chiara Bonetto
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Martinelli A, D'Addazio M, Zamparini M, Thornicroft G, Torino G, Zarbo C, Rocchetti M, Starace F, Casiraghi L, Ruggeri M, de Girolamo G. Needs for care of residents with schizophrenia spectrum disorders and association with daily activities and mood monitored with experience sampling method: the DIAPASON study. Epidemiol Psychiatr Sci 2023; 32:e18. [PMID: 37039434 PMCID: PMC10130736 DOI: 10.1017/s2045796023000124] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/24/2023] [Accepted: 03/12/2023] [Indexed: 04/12/2023] Open
Abstract
AIMS Care needs represent an essential paradigm in planning residential facility (RF) interventions. However, possible disagreements between users and staff are critical issues in service delivery. The Experience Sampling Method (ESM) tracks experiences in the real world and real time. This study aimed to evaluate the care needs of patients with schizophrenia spectrum disorder (SSD) in RFs and its association with daily activities and mood monitored using the ESM. METHODS As part of the DIAPASON project, 313 residents with SSD were recruited from 99 Italian RFs. Sociodemographic and clinical characteristics were recorded. Care needs, the severity of symptomatology and negative symptoms were assessed. Fifty-six residents were also assessed for 7 consecutive days using the mobile ESM. Descriptive, agreement, predictor and moderator analyses were conducted. RESULTS The staff rated a higher number of total and met needs than service users (p < 0.001). Only a slight agreement between users and staff on unmet needs was found in self-care (k = 0.106) and information (k = 0.100) needs, while a moderate agreement was found in accommodation (k = 0.484), food (k = 0.406), childcare (k = 0.530), physical health (k = 0.470), telephone (k = 0.458) and transport (k = 0.425) needs. Older age (-0.15; p < 0.01), longer SSD diagnosis (-0.16; p < 0.01), higher collaboration (-0.16; p < 0.01) and lower symptomatology (-0.16; p < 0.01) decreased the number of unmet needs, while being a female (0.27; p < 0.05) and a shorter length of stay in an RF (0.54; p < 0.001) increased the number of unmet needs. A higher number of unmet needs was associated with a lower amount of time spent in leisure activities or reporting a positive mood: on the contrary, more unmet needs were associated with a greater amount of time spent in religious or non-productive activities. The associations between unmet needs rated by staff and users and momentary mood as assessed using the ESM were not moderated by the severity of symptomatology. CONCLUSIONS Although care needs are fundamental in planning residential activities aimed at recovery-oriented rehabilitation, RF interventions did not fully meet users' needs, and some disagreements on unmet needs between users and staff were reported. Further efforts are necessary to overcome Italian RF limits in delivering rehabilitative interventions defined by real users' needs to facilitate users' productivity and progress towards personal recovery.
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Affiliation(s)
- Alessandra Martinelli
- Unit of Clinical Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Miriam D'Addazio
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Manuel Zamparini
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gabriele Torino
- Department of Psychology, Clinical Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Cristina Zarbo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Matteo Rocchetti
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Fabrizio Starace
- Department of Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Letizia Casiraghi
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Mirella Ruggeri
- Section of Psychiatry, Verona Hospital Trust, AOUI, Verona, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Adamus C, Alpiger J, Jäger M, Richter D, Mötteli S. Independent Supported Housing Versus Institutionalised Residential Rehabilitation for Individuals with Severe Mental Illness: A Survey of Attitudes and Working Conditions Among Mental Healthcare Professionals. Community Ment Health J 2023; 59:531-539. [PMID: 36227518 PMCID: PMC9981490 DOI: 10.1007/s10597-022-01037-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/29/2022] [Indexed: 11/03/2022]
Abstract
Despite widespread support for Independent Supported Housing (ISH) interventions, psychiatric housing rehabilitation still commonly takes place in residential care facilities (RCFs). This study compares preferences, attitudes and working conditions of mental healthcare professionals (MHCPs) in ISH and RCFs using an online survey. The survey included setting preferences, stress and strain at work, recovery attitudes, stigmatisation, and factors experienced as particularly important or obstructive in housing rehabilitation. Data were analysed using quantitative and qualitative approaches. Of the 112 participating MHCPs, 37% worked in ISH and 63% in RCFs. Professionals' education, work-related demands and influence at work were higher in ISH, stigmatising attitudes were higher in RCFs. MHCPs in both settings endorsed ISH. The support process was seen as particularly important whereas stigmatisation, regulatory and political requirements were seen as obstructive for successful housing rehabilitation. Results indicate that social inclusion of individuals with severe mental illness is seldom feasible without professional support.
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Affiliation(s)
- Christine Adamus
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland. .,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland. .,Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Sägestrasse 75, 3098, Köniz, Switzerland.
| | - Jovin Alpiger
- School of Applied Psychology, ZHAW Zurich University of Applied Sciences, Zurich, Switzerland
| | - Matthias Jäger
- Psychiatrie Baselland, Liestal, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Dirk Richter
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Sonja Mötteli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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Martinelli A, Killaspy H, Zarbo C, Agosta S, Casiraghi L, Zamparini M, Starace F, Rocchetti M, de Girolamo G, Ruggeri M, Boero ME, Cerveri G, Clerici M, D’Anna G, De Novellis A, Di Michele V, Di Prisco P, Durbano F, Facchini F, Ghio L, Giosuè P, Greco C, Latorre V, Leuci E, Malagamba D, Maone A, Marina M, Maurizi A, Monzani E, Placenti R, Rancati L, Rippa A, Rovera C, Silva A, Tura G, Zanolini S. Quality of residential facilities in Italy: satisfaction and quality of life of residents with schizophrenia spectrum disorders. BMC Psychiatry 2022; 22:717. [PMID: 36397009 PMCID: PMC9672559 DOI: 10.1186/s12888-022-04344-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 09/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recovery and human rights promotion for people with Schizophrenia Spectrum Disorders (SSDs) is fundamental to provide good care in Residential Facilities (RFs). However, there is a concern about rehabilitation ethos in RFs. This study aimed to investigate the care quality of Italian RFs, the quality of life (QoL) and care experience of residents with SSD. METHODS Fourty-eight RFs were assessed using a quality assessment tool (QuIRC-SA) and 161 residents with SSD were enrolled. Seventeen RFs provided high intensity rehabilitation (SRP1), 15 medium intensity (SRP2), and 16 medium-low level support (SRP3). Staff-rated tools measured psychiatric symptoms and psychosocial functioning; user-rated tools assessed QoL and satisfaction with services. RFs comparisons were made using ANOVA and Chi-squared. RESULTS Over two-thirds patients (41.5 y.o., SD 9.7) were male. Seventy-six were recruited from SRP1 services, 48 from SRP2, and 27 from SRP3. The lowest QuIRC-SA scoring was Recovery Based Practice (45.8%), and the highest was promotion of Human Rights (58.4%). SRP2 had the lowest QuIRC-SA ratings and SRP3 the highest. Residents had similar psychopathology (p = 0.140) and functioning (p = 0.537). SRP3 residents were more employed (18.9%) than SRP1 (7.9%) or SRP2 (2.2%) ones, and had less severe negative symptoms (p = 0.016) and better QoL (p = 0.020) than SRP2 residents. There were no differences in the RF therapeutic milieu and their satisfaction with care. CONCLUSIONS Residents of the lowest supported RFs in Italy had less severe negative symptoms, better QoL and more employment than others. The lowest ratings for Recovery Based Practice across all RFs suggest more work is needed to improve recovery.
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Affiliation(s)
- Alessandra Martinelli
- Section of Psychiatry, Verona Hospital Trust, AOUI, Verona, Italy. .,Unit of Clinical Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, BS, Italy.
| | - Helen Killaspy
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Cristina Zarbo
- grid.419422.8Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Sara Agosta
- grid.476047.60000 0004 1756 2640Mental Health and Dependence, AUSL of Modena, Modena, Italy ,Clinical Psychology Unit, ASST of Mantua, Mantua, Italy
| | - Letizia Casiraghi
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Manuel Zamparini
- grid.419422.8Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Fabrizio Starace
- grid.476047.60000 0004 1756 2640Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Matteo Rocchetti
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Giovanni de Girolamo
- grid.419422.8Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Mirella Ruggeri
- grid.411475.20000 0004 1756 948XSection of Psychiatry, Verona Hospital Trust, AOUI, Verona, Italy
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Martinelli A, Iozzino L, Pozzan T, Cristofalo D, Bonetto C, Ruggeri M. Performance and effectiveness of step progressive care pathways within mental health supported accommodation services in Italy. Soc Psychiatry Psychiatr Epidemiol 2022; 57:939-952. [PMID: 35041014 DOI: 10.1007/s00127-021-02128-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/22/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND In Italy, a growing number of people with severe mental illness (SMI) require care in residential facilities (RFs), a key component of the care pathway. However, despite their development, studies about resident samples have been very few. AIMS This study, the VALERE-REC Study (eVALuation of outcomE in Residential-use of clinical data with REsearch objeCtives) aims to identify the characteristics that increase the probability to move patients living in RFs to a more independent setting. METHODS A survey involved 167 patients hosted in 25 RFs of the Verona Mental Health Department. Forty-five patients were residents (27%) in Comunità Terapeutico Riabilitativa Protetta (CTRP); 56 (34%) in Comunità Alloggio (CA), 14 (8%) in Gruppo Appartamento Protetto (GAP), 52 (31%) in Comunità Alloggio Estensiva (CAE). They were assessed for their care pathway after 30-months. The Quality Indicators for Rehabilitative Care-Supported Accommodation (QuIRC-SA) evaluated the quality of 19/25 (76%) RFs. Descriptive analyses were done. RESULTS According to the mission stated by the Veneto Region guidelines, RFs hosted patients with different needs and clinical profiles. The mean stay was longer than expected, most patients were unemployed, unmet needs were related to self-management and patient's social contacts, and recovery-oriented practices were not implemented. CONCLUSIONS Despite the appropriate admission of patients in different RFs considering their psychopathology, functioning, and needs, the progressive step care pathway did not result effectively pursued. To improve the effectiveness of residential interventions a major task should be to focus on the acquisition of the necessary skills to live independently.
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Affiliation(s)
- Alessandra Martinelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.,Verona Hospital Trust, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "G.B. Rossi", Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Laura Iozzino
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Tecla Pozzan
- Verona Hospital Trust, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "G.B. Rossi", Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Doriana Cristofalo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Chiara Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Mirella Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy. .,Verona Hospital Trust, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Policlinico "G.B. Rossi", Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
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9
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Martinelli A, Bonetto C, Bonora F, Cristofalo D, Killaspy H, Ruggeri M. Supported employment for people with severe mental illness: a pilot study of an Italian social enterprise with a special ingredient. BMC Psychiatry 2022; 22:296. [PMID: 35473634 PMCID: PMC9040313 DOI: 10.1186/s12888-022-03881-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/03/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND People with mental disorders are far more likely to be unemployed than the general population. Two internationally recognized, evidence-based models of interventions for employment for people with severe mental health problems are Individual Placement Support and the Clubhouse. In Italy, a common model is the 'social enterprise' (SE), which is a programme run by non-profit organisations that help individuals with disabilities to be employed. Despite SEs spread and relevance in Italy, there are no studies about Italian samples. This paper reports on a pilot evaluation of psychosocial and work outcomes of a SE based in Verona, Italy. The study aims to investigate if people with SMI involved in SE job placements may achieve personal recovery and better outcomes over time, and in comparison with a comparable group of users. METHODS This is a pilot descriptive study with three components. A longitudinal design that comprised a functioning description of 33 SE members with a psychiatric disability in two time-points (when they joined the SE-on average 5 years before the study recruitment, and at the study recruitment-year 2018); and a repeated collection of job details of the 33 members in three time points: 2 years before the recruitment,-year 2016; 1 year before the recruitment - year 2017; and at the recruitment-year 2018. An assessment at the recruitment time-year 2018, of SE users' satisfaction with the job placement, symptoms, functioning, and quality of life (QoL). A cross-sectional study that compared the 33 SE members at the recruitment time-year 2018, with a matched group of people with the following criteria: living in local supported accommodations, being unemployed and not SE members. The two groups were compared on ratings of psychopathology, functioning, and QoL. Descriptive analyses were done. RESULTS At the recruitment time - year 2018, all SE participants showed a significant better functioning (p < 0.001) than when they joined the SE-when they had been employed for an average of 5 years. In comparison to the matched group, SE members had significantly better functioning (p = 0.001), psychopathology (p = 0.007), and QoL (p = 0.034). According to their SE membership status, participants comprised trainees (21.2%) and employee members (78.8%). Trainees compared to employees had lower autonomies, functioning, QoL and more severe psychopathology. Over the two years prior to study recruitment, trainees showed stable poor autonomies, while employee members showed a variation from average autonomies in the 2 years before the recruitment time - year 2016, to good ones at the recruitment time - year 2018. Over the two years, all SE members set increasing numbers of objectives in all three domains. All SE participants reported high levels of satisfaction with all aspects of the job placement. CONCLUSIONS SE that provides tailored support to assist people to gain employment skills may be an effective component in helping recovery from SMI.
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Affiliation(s)
- Alessandra Martinelli
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy ,grid.419422.8Unit of Clinical Psychiatry, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni, 4, 25125 Brescia, BS Italy
| | - Chiara Bonetto
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Federica Bonora
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Doriana Cristofalo
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Helen Killaspy
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Mirella Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy. .,Section of Psychiatry, Verona Hospital Trust, AOUI, Verona, Italy.
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10
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Almeda N, García-Alonso CR, Killaspy H, Gutiérrez-Colosía MR, Salvador-Carulla L. The critical factor: The role of quality in the performance of supported accommodation services for complex mental illness in England. PLoS One 2022; 17:e0265319. [PMID: 35298512 PMCID: PMC8929565 DOI: 10.1371/journal.pone.0265319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 02/24/2022] [Indexed: 12/02/2022] Open
Abstract
Rehabilitation services have a key role in ensuring integrated and comprehensive mental health (MH) care in the community for people suffering from long-term and severe mental disorders. MH-supported accommodation services aim to promote service users’ autonomy and independence. Given the complexity associated with MH-supported accommodation services in England, a comparative evaluation of critical performance indicators, including service provision and quality of care, seems to be necessary in designing evidence-informed policies. This study aims to explore the influence of service quality indicators on the performance of MH-supported accommodation services in England. The analysed sample includes supported accommodation services from 14 nationally representative local authorities in England from the QuEST study grouped by three main types of care: residential care homes (divided into two subgroups: move-on and non-move-on oriented), supported housing and floating outreach. EDeS-MH (efficient decision support-mental health) was used to assess the performance indicators for the selected services by combining a Monte Carlo simulation engine, data envelopment analysis and a fuzzy inference engine for integrating expert knowledge. Depending on the type of care, six/seven quality domains were sequentially included after a baseline scenario (only technical) was analysed. Relative technical efficiency scores for the baseline scenarios revealed high performance in all the selected supported accommodation services, but the statistical variability was high. Quality domains significantly improved performance in every type of care. The inclusion of quality indicators has a positive impact on the global performance of each type of care. Remaining at the corresponding services more than expected for two years has a negative impact on performance. These findings can be considered from a planning perspective to facilitate the design of pathways of care with more realistic expectations about gaining autonomy in two years.
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Affiliation(s)
- Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
- * E-mail:
| | | | - Helen Killaspy
- Faculty of Brain Sciences, Division of Psychiatry, University College London, London, United Kingdom
| | | | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
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11
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Adamus C, Mötteli S, Jäger M, Richter D. Independent Supported Housing for non-homeless individuals with severe mental illness: Comparison of two effectiveness studies using a randomised controlled and an observational study design. Front Psychiatry 2022; 13:1033328. [PMID: 36440393 PMCID: PMC9685807 DOI: 10.3389/fpsyt.2022.1033328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND No randomised controlled study (RCT) on the effectiveness of Independent Supported Housing (ISH) vs. housing as usual (HAU) settings for non-homeless individuals with severe mental illness (SMI) has been conducted to date because of limited feasibility. Alternative designs, such as observational studies, might be suitable for providing adequate evidence if well conducted. To test this hypothesis, this article reports on a prospective, direct comparison of the designs of two parallel studies in this field. METHODS A two-centre, parallel-group non-inferiority effectiveness study was conducted at two locations in Switzerland using identical instruments and clinical hypotheses. One centre applied an RCT design and the other an observational study (OS) design with propensity score methods (ClinicalTrials.gov: NCT03815604). The comparability of the two study centres was investigated in terms of participants, procedures, and outcomes. The primary outcome was social inclusion and the secondary outcomes were quality of life and psychiatric symptoms. RESULTS The study included 141 participants (RCT: n = 58; OS: n = 83). Within one year, 27% study dropouts occurred (RCT: 34%; OS: 22%). A similar balance of sample characteristics was achieved in the RCT and the OS using propensity score methods (inverse probability of treatment weighting). After one year, ISH was non-inferior to the control condition regarding social inclusion (mean differences [95% CI]) in the RCT (6.28 [-0.08 to 13.35]) and the OS (2.24 [-2.30 to 6.77]) and showed no significant differences in quality of life (RCT: 0.12 [-0.52 to 0.75]; OS: 0.16 [-0.26 to 0.58]) and symptoms (RCT: -0.18 [-0.75 to 0.40]; OS: 0.21 [-0.17 to 0.60]) in both study centres. However, strong and persistent preferences for ISH in the RCT control group reduced participants' willingness to participate. Because of several limitations in the RCT, the results of the RCT and the OS are not comparable. CONCLUSION Participants were comparable in both study sites. However, there were significant problems in conducting the RCT because of strong preferences for ISH. The OS with propensity score methods provided results of more stable groups of participants and revealed balanced samples and valid outcome analysis. Our results do not support further investment in RCTs in this field.
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Affiliation(s)
- Christine Adamus
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sonja Mötteli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zürich, Switzerland
| | - Matthias Jäger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zürich, Switzerland.,Psychiatrie Baselland, Liestal, Switzerland
| | - Dirk Richter
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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12
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Gurrera RJ, Grosso D. Treatment Bed Utilization Following Placement in a Foster Care Program for Veterans with Serious Mental Illness. Community Ment Health J 2021; 57:1442-1448. [PMID: 33386531 DOI: 10.1007/s10597-020-00758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022]
Abstract
Hospital and residential treatment bed utilization rates were measured before and after foster home placement in individuals with serious mental illness. Medical records of all Veterans consecutively enrolled in a Department of Veterans Affairs Community Residential Care (CRC) program during a 6 year period (N = 140) were reviewed retrospectively. Treatment bed days were tabulated by bed type (psychiatric hospital, inpatient detoxification, medical hospital, physical rehabilitation, and psychosocial residential treatment) for each patient during symmetric pre- and post-placement time intervals. Pre- and post-placement bed days were compared using the paired-sample t test in a naturalistic one-group pretest-posttest analytic design. Psychiatric hospital and residential treatment bed days were significantly reduced post-placement (-77.5% and -99.8%, respectively). Most patients (89.0%) had fewer psychiatric hospital bed days post-placement, and all patients with pre-placement residential treatment program bed days had fewer of those days post-placement. Longer CRC placements were associated with greater reductions in bed utilization.
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Affiliation(s)
- Ronald J Gurrera
- VA Boston Healthcare System, 940 Belmont Street (116A), Brockton, MA, 02301, USA.
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Darryl Grosso
- VA Boston Healthcare System, 940 Belmont Street (116A), Brockton, MA, 02301, USA
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13
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Marutani T, Chhim S, Nishio A, Nosaki A, Fuse-Nagase Y. Quality of life and its social determinants for patients with schizophrenia and family caregivers in Cambodia. PLoS One 2020; 15:e0229643. [PMID: 32130240 PMCID: PMC7055908 DOI: 10.1371/journal.pone.0229643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 02/11/2020] [Indexed: 11/30/2022] Open
Abstract
Due to inadequate human and financial resource support, the development of mental health services in Cambodia has been undertaken by various non-governmental organizations (NGOs). Schizophrenia is the most common functional psychotic disorder, causing severe and chronic symptoms, and the programs provided by the NGOs should have enhanced the quality of life (QoL) of patients and their caregivers; however, epidemiological research, which is a driving force behind the recognition of mental health as a global public health concern, is lacking for schizophrenia in Cambodia. This study therefore aimed to create QoL evaluation questionnaires available in Khmer (the Cambodian language) for patients with schizophrenia and family caregivers, and to identify the social determinants and predictors of their QoL. This cross-sectional study recruited 59 patients and 59 caregivers attending three clinics operated by two NGOs: the Transcultural Psychosocial Organization (TPO) Cambodia and the Supporters for Mental Health (SUMH) Cambodia. We conducted linguistic validation of the Schizophrenia Quality of Life Questionnaire 18-item version (S-QoL 18) and the Schizophrenia Caregiver Questionnaire (SCQ), then analyzed correlations between the QoL dimensions and socio-demographic factors. The main findings of this study were as follows: 1) the newly created Khmer versions of S-QoL 18 and SCQ are relatively good psychometric tools that are suitable for research to identify patients’ and caregivers’ needs to improve their QoL; and 2) engaging in paid work or being of the post-Khmer Rouge generation results in higher QoL for patients, but having low household economic status or being affected by chronic disease leads to lower QoL for family caregivers. These findings are useful for enabling community mental health professionals and aid organizations to create programs to lessen the patient and caregiver burden in Cambodia. Further research is necessary to develop practical projects that will improve patients’ and caregivers’ QoL in various clinical settings in Cambodia.
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Affiliation(s)
- Toshiyuki Marutani
- Health Support Center, Tokyo Institute of Technology, Yokohama, Japan
- Supporters for Mental Health, Tokyo, Japan
- * E-mail:
| | - Sotheara Chhim
- Transcultural Psychosocial organization Cambodia, Phnom Penh, Cambodia
| | - Akihiro Nishio
- Supporters for Mental Health, Tokyo, Japan
- Health Administration Center, Gifu University, Gifu, Japan
| | - Akiko Nosaki
- Supporters for Mental Health, Tokyo, Japan
- Psychiatric and Mental Health Nursing, Graduate School of Nursing, Chiba University, Chiba, Japan
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Martinelli A, Ruggeri M. The impact of COVID-19 on patients of Italian mental health supported accommodation services. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1395-1396. [PMID: 32712677 PMCID: PMC7381855 DOI: 10.1007/s00127-020-01897-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/09/2020] [Indexed: 11/01/2022]
Affiliation(s)
- Alessandra Martinelli
- grid.5611.30000 0004 1763 1124Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy ,grid.411475.20000 0004 1756 948XVerona Hospital Trust, AOUI, Verona, Italy
| | - Mirella Ruggeri
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy. .,Verona Hospital Trust, AOUI, Verona, Italy.
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