Adequacy of help received among individuals with severe mental disorders

[The Standardised Recording of Psychosocial Help Needs within Psychiatric Acute Treatment in a Socio-Educational Counselling Context]

People with mental illness often have complex social problems. Up to now, there has been no systematised/standardised recording of social assistance needs in acute psychiatric care. One reason for this is the lack of adequate instruments and the increasing workload. The review analyses established needs assessment instruments with regard to their suitability for addressing the question. It becomes clear that these instruments are insufficiently suitable for a structured assessment of the need for psychosocial support. This results in the need for the development of a short and standardised instrument for the assessment of psychosocial support needs, which can be used as part of multiprofessional diagnostics within psychiatric care.

Establishing the measurement properties of the Residential Environment Impact Scale (Version 4.0)

BACKGROUND

Developed as an environment assessment informed by the Model of Human Occupation, the Residential Environment Impact Survey considered the physical, social and activity features of the environment, evaluating the impact of the environment on resident's quality of life. Clinicians reported that the Residential Environment Impact Survey was a useful tool; however, it had not been structured to be a measurement tool and did not have established psychometric properties.

AIMS/OBJECTIVES

This study examines the psychometric properties of the restructured Residential Environment Impact Scale Version 4.0 (REIS), which measures the level of environment support provided to residents.

MATERIAL AND METHODS

The REIS was completed across residential sites for people with complex mental health needs. A many facets Rasch analysis was conducted to establish the reliability and validity of the REIS.

RESULTS

The REIS demonstrated reasonable psychometric properties, with items demonstrating internal scale validity and scale items following an expected pattern of increasingly challenging environment support.

CONCLUSIONS AND SIGNIFICANCE

Initial evidence suggests that the REIS provides a valid and reliable measure of environment support, providing a detailed assessment of how physical, social and activity elements of the environment support or inhibit participation and can be applied across a range of living environments.

Typology of patients who use emergency departments for mental and substance use disorders

BACKGROUND

Identifying profiles of people with mental and substance use disorders who use emergency departments may help guide the development of interventions more appropriate to their particular characteristics and needs.

AIMS

To develop a typology for the frequency of visits to the emergency department for mental health reasons based on the Andersen model.

METHOD

Questionnaires were completed by patients who attended an emergency department (n = 320), recruited in Quebec (Canada), and administrative data were obtained related to sociodemographic/socioeconomic characteristics, mental health diagnoses including alcohol and drug use, and emergency department and mental health service utilization. A cluster analysis was performed, identifying needs, predisposing and enabling factors that differentiated subclasses of participants according to frequency of emergency department visits for mental health reasons.

RESULTS

Four classes were identified. Class 1 comprised individuals with moderate emergency department use and low use of other health services; mostly young, economically disadvantaged males with substance use disorders. Class 2 comprised individuals with high emergency department and specialized health service use, with multiple mental and substance use disorders. Class 3 comprised middle-aged, economically advantaged females with common mental disorders, who made moderate use of emergency departments but consulted general practitioners. Class 4 comprised older individuals with multiple chronic physical illnesses co-occurring with mental disorders, who made moderate use of the emergency department, but mainly consulted general practitioners.

CONCLUSIONS

The study found heterogeneity in emergency department use for mental health reasons, as each of the four classes represented distinct needs, predisposing and enabling factors. As such, interventions should be tailored to different classes of patients who use emergency departments, based on their characteristics.

Profiles of Service Users with Severe Mental Disorders Based on Adequacy of Help

This study has for aims to develop a typology describing adequacy of help based on socio-demographic, clinical and service utilization variables for 204 service users with severe mental disorders treated in the community. Study participants were recruited in an urban area of Quebec (Canada). Adequacy of help was assessed with the Montreal Assessment of Needs Questionnaire. A cluster analysis identified five profiles of service users. Adequacy of help was mainly related to continuity of care, help given by services, seriousness of needs and, to some extent, quality of life (QOL). Adequacy of help was highest among Class 3 participants, described as older individuals with mood disorders, who lived in autonomous housing and enjoyed good QOL. They received substantial help from both relatives and services. Adequacy of help was lowest for Class 5, which included individuals affected by co-occurring mental disorders but who also lived autonomously. Health service utilization was more strongly related to adequacy of help for this sample than were the socio-demographic and clinical factors tested.

A Digital Platform Designed for Youth Mental Health Services to Deliver Personalized and Measurement-Based Care

Mental disorders that commonly emerge during adolescence and young adulthood are associated with substantial immediate burden and risks, as well as potentially imparting lifetime morbidity and premature mortality. While the development of health services that are youth focused and prioritize early intervention has been a critical step forward, an ongoing challenge is the heterogeneous nature of symptom profiles and illness trajectories. Consequently, it is often difficult to provide quality mental health care, at scale, that addresses the broad range of health, social, and functional needs of young people. Here, we describe a new digital platform designed to deliver personalized and measurement-based care. It provides health services and clinicians with the tools to directly address the multidimensional needs of young people. The term "personalized" describes the notion that the assessment of, and the sequence of interventions for, mental disorders are tailored to the young person-and their changing needs over time, while "measurement-based" describes the use of systematic and continuing assessment of a young person's outcomes over the entire course of clinical care. Together, these concepts support a framework for care that transcends a narrow focus on symptom reduction or risk reduction. Instead, it prioritizes a broader focus on enhancing social, health, and physical outcomes for young people and a commitment to tracking these outcomes throughout this key developmental period. Now, with twenty-first century technologies, it is possible to provide health services with the tools needed to deliver quality mental health care.

Care Coordination Can Reduce Unmet Needs of Persons With Severe and Persistent Mental Illness

Introduction: Persons with severe and persistent mental illness (SPMI) have multiple and complex needs, many of which are not health related. Mental health services are unable to address these needs without collaboration with other agencies. In the absence of this collaboration, persons with SPMI often fall through the system cracks and are unlikely to experience recovery. Furthermore, previous studies have shown that unmet accommodation needs are associated with unmet needs in other areas. This study aimed to ascertain whether a care coordination model adopted in Australia's Partners in Recovery [PIR] initiative was able to reduce unmet needs in such persons and also if meeting accommodation needs were associated with meeting other needs. Methods: This was a longitudinal study where met and unmet needs of clients measured using the Camberwell Assessment of Needs Short Appraisal Schedule (CANSAS) were compared at enrolment and exit from the PIR initiative. Logistic regression was used to examine the association between change in accommodation needs and change in other CANSAS variables. Results: In total, 337 clients (66% of 508 clients) had both baseline and follow-up data and were seen within the time frame of 14 to 101 weeks. At baseline, the most frequently reported unmet needs were psychological distress, daytime activity, and company (89%, 72%, and 67%, respectively). At follow-up, these had decreased to 27%, 22%, and 22%, respectively. The proportions of clients with an unmet need at baseline who subsequently progressed to having that need met at follow-up ranged between 62% and over 90%. Change in accommodation needs from unmet to met was associated with changes in monetary needs and needs related to childcare, food, safety to self, education, and access to other services, with the greatest change seen for monetary needs (adjusted OR 2.87, 95% CI 1.76, 4.69). Conclusions: Reducing needs of persons with SPMI is the starting point of recovery and is a good indicator of psychiatric care. Care coordination is a useful way to address multiple and complex needs of persons with SPMI. While addressing needs, priority must be given to meeting accommodation needs.

Unmet needs of persons with a severe and persistent mental illness and their relationship to unmet accommodation needs

This is a cross-sectional study of unmet needs of persons enrolled in Australia's Partners in Recovery (PIR) initiative. It aimed to explore the unmet needs reported by persons with a severe and persistent mental illness (SPMI) and to examine the associations between unmet accommodation needs and other unmet needs. The study was undertaken in the Gippsland region of Victoria from February to May 2015. Data were collected from the administrative database for the PIR initiative in Gippsland, which was held by the Gippsland Primary Health Network. Data on unmet needs, as measured by the Camberwell Assessment of Needs Short Appraisal Schedule, were analysed using proportions and logistic regression. Psychological distress, daytime activities, company/someone to spend time with and employment and volunteering were the most commonly reported unmet needs. Participants with unmet accommodation needs were less likely to receive information on their condition or access other services. They also had unmet needs relating to food, money, transport, childcare, looking after home, physical health, psychological distress and self-care. Supported accommodation may not be enough for persons with SPMI who have poor functioning skills and are incapable of looking after themselves. Services such as Housing First that have shown promising results need to be part of a comprehensive strategy to care for persons with severe and enduring mental illness.

Assessing health service satisfaction among users with substance use disorders within the municipalities in Norway

BACKGROUND

The purpose of this study was to assess what is associated with health service satisfaction among adults with a substance use disorder receiving services provided within different municipalities in Norway. An additional aim was to examine demographic and municipality characteristics, mental health, and types of substance use associated with health service satisfaction.

METHOD

A cross-sectional partial explorative study was executed in 2017 among 491 service users with substance use disorders from 20 randomly selected municipalities. The sample consisted of 70% males. The sample majority were single and unemployed, and their main sources of healthcare were the general practitioner (78%), The Norwegian Labor and Welfare Administration (72%), and addiction counsellors (62%).

RESULTS

Overall satisfaction was negatively associated with age, size of municipality, Global Severity Index (GSI) and illicit substance use during the last 12 months. Satisfaction with practical help, such as housing, economy, work and education, was negatively associated with GSI and positively associated with onset of first alcohol intoxication. Satisfaction with personnel was positively associated with onset of first alcohol intoxication and negatively associated with municipality size, GSI and illicit use the last 12 months. The results showed that more than half of the respondents (54%) to a large or great extent were satisfied with the overall services provided. The services they were less satisfied with were related to housing, economy, getting started with exercise and establishing a social network.

CONCLUSION

The results show areas associated with satisfaction and domains where the municipalities can improve their services to meet the users' needs and increase service satisfaction.

Modeling variables associated with personal recovery among service users with mental disorders using community-based services

BACKGROUND

Mental health research is evolving toward the identification of conceptual models and associated variables, which may provide a better understanding of personal recovery, given its importance for individuals affected by mental disorders (MDs).

AIMS

This article evaluated personal recovery in a sample of adults with MDs using an adapted conceptual framework based on the Andersen behavioral model, which evaluates predisposing, enabling and needs factors in service use.

METHODS

The study design was cross-sectional and included 327 mental health service users recruited across four local health service networks in Quebec (Canada). Data were collected using seven standardized instruments and participant medical records. Structural equation modeling was performed.

RESULTS

Quality of life (QOL), an enabling factor, was most strongly associated with personal recovery. Health behavior variables associated with recovery included the following: use of alcohol services, having a family physician, consulting a psychologist, use of food banks, consulting fewer professionals and not using drug services. Regarding needs factors, higher numbers of needs, lower severity of unmet health, social and basic needs and absence of mood disorders were also associated with personal recovery. No predisposing factors emerged as significant in the model.

CONCLUSION

Findings suggest that QOL, needs variables and comprehensive service delivery are important in personal recovery. Services should be individualized to the health, social and basic needs of service users, particularly those with mood disorders or co-occurring mental health/substance use disorders.

Comparing Perceived Adequacy of Help Received Among Different Classes of Individuals with Severe Mental Disorders at Five-Year Follow-Up: A Longitudinal Cluster Analysis

This study developed a typology describing change in the perceived adequacy of help received among 204 individuals with severe mental disorders, 5 years after transfer to the community following a major mental health reform in Quebec (Canada). Participant typologies were constructed using a two-step cluster analysis. There were significant differences between T0 and T2 for perceived adequacy of help received and other independent variables, including seriousness of needs, help from services or relatives, and care continuity. Five classes emerged from the analysis. Perceived adequacy of help received at T2 increased for Class 1, mainly comprised of older women with mood disorders. Overall, greater care continuity and levels of help from services and relatives related to higher perceived AHR. Changes in perceived adequacy of help received resulting from several combinations of associated variables indicate that MH service delivery should respond to specific profiles and determinants.

A typology of satisfaction with mental health services based on Andersen's behavioral model

OBJECTIVE

Patients with mental disorders (MDs) form a highly heterogeneous group, whose satisfaction with mental health services (MHS) may vary according to different variables. Identifying patient subgroups with similar levels of satisfaction may help identify variables that contribute to satisfaction or dissatisfaction with services. This study established a typology of patient satisfaction with MHS that revealed variables specific to each group.

METHODS

The study included 325 patients with MDs across four health service networks offering integrated and diversified services. Data were collected using five standardized instruments, and participant medical records. A conceptual framework was developed, based on Andersen's Behavioral Model, which integrates socio-demographic, clinical, needs-related and service use variables. Using cluster analysis, a typology of patient satisfaction was created.

RESULTS

Analyses yielded four patient clusters: two where levels of satisfaction were relatively high and two with lower levels of satisfaction (range 3.74-4.37). Greater care continuity and higher income related to greater patient satisfaction; whereas co-occurring MDs and substance use disorders (SUD), as well as more numerous and severe needs, characterized dissatisfied patients who were frequent users of MHS.

CONCLUSIONS

Results highlight the need for continuity of care and adequate socio-economic conditions for increasing patient satisfaction with MHS. Lower levels of satisfaction among patients with common MDs and SUDs suggest the importance of addressing their specific needs to enhance satisfaction and MH recovery.

Patient satisfaction with mental health services based on Andersen's Behavioral Model

OBJECTIVE

The purpose of this article was to assess the satisfaction of adult patients who received mental health services (MHS) in healthcare networks staffed by multidisciplinary professionals and offering a range of MHS, and to identify variables associated with patient satisfaction.

METHODS

This cross-sectional study included 325 patients with mental disorders (MDs) among 4 Quebec health service networks. Data were collected using 9 standardized instruments and participant medical records. A 3-factor conceptual framework (predisposing, enabling, and needs-related factors) based on Andersen's Behavioral Model was used, integrating sociodemographic, clinical, needs-related, service utilization, social support, and quality-of-life (QOL) variables. An adjusted multiple linear regression model was performed.

RESULTS

The global mean score for patient satisfaction was 4.11 (minimum: 2.0; maximum: 5.0). Among the enabling factors, continuity of care, having a case manager, and help received from services were positively associated with patient satisfaction, whereas being hospitalized was negatively associated. Among the needs-related factors, the number of needs was negatively associated with satisfaction.

CONCLUSIONS

Findings demonstrated higher levels of satisfaction among patients who received good continuity of care and well-managed, frequent services in relation to their needs. Dissatisfaction was higher for patients with serious unmet needs or those hospitalized, which underlines the importance of taking these particular variables into account in the interest of improving MHS delivery and patient recovery.

Mediation analysis of severity of needs, service performance and outcomes for patients with mental disorders

BACKGROUND

Needs and service performance assessment are key components in improving recovery among individuals with mental disorders.

AIMS

To test the role of service performance as a mediating factor between severity of patients' needs and outcomes.

METHOD

A total of 339 adults with mental disorders were interviewed. A mediation analysis between severity of needs, service performance (adequacy of help, continuity of care and recovery orientation of services) and outcomes (personal recovery and quality of life) was carried out using structural equation modelling.

RESULTS

The structural equation model provided a good fit with the data. An increase in needs was associated with lower service performance and worse outcomes, whereas higher service performance was associated with better outcomes. Service performance partially mediated the effect of patient needs on outcomes.

CONCLUSIONS

Poorer service performance has a negative impact on outcomes for patients with the highest needs. Ensuring more efficient services for patients with high needs may help improve their recovery and quality of life.

Utility of the Montreal assessment of need questionnaire for community mental health planning

Needs assessment facilitates mental health services planning, provision, and evaluation. This study aimed to (a) validate a new instrument, the Montreal Assessment of Needs Questionnaire (MANQ), and (b) use this to assess variations and predictors of need (number and seriousness) in 297 individuals with severe mental disorders for 18 months, during implementation of the Quebec Mental Health Action Plan. MANQ internal and external validations were adequate. Variables significantly associated with need number and seriousness variations were used to build multiple linear regression models. Autonomous housing, not receiving welfare, not having consulted a health educator, higher level of help from services, Alcohol Use Disorders Identification Test total score, and social support were associated with decreasing need number and seriousness over time. Having a higher education was also associated with decreasing need number. In a reform context, the MANQ's unique ability to detect rapid improvement in patient needs has usefulness for Quebec mental health planning.

Predictors of quality of life in a longitudinal study of users with severe mental disorders

Background

Since the end of the 20th century, quality of life has become a key outcome indicator in planning and evaluation of health services. From a sample of 297 users with severe mental disorders from Montreal (Canada), this study aimed to identify the key predictors of subjective quality of life (SQOL).

Methods

Users were recruited and interviewed from December 2008 to September 2010 and re-interviewed approximately 18 months later. A comprehensive framework including socio-demographic data, clinical, needs and functionality variables, negative life events, social support and healthcare service use, and appreciation data were considered as predictors. Clinical records and eight standardized instruments were used.

Results

Lower severity of needs, schizophrenia, better social integration, better reassurance of worth, fewer drug abuse problems, and living in supervised housing are predictors of SQOL. With regard to needs, absence or lower severity of needs in the areas of company, daytime activities, social exclusion, safety to self, and benefits are linked to SQOL.

Conclusion

Reducing the severity of needs is especially beneficial to ensure a higher SQOL for users with severe mental disorders. To improve SQOL, priority must be given to programs and interventions that promote the development of a stimulating and supportive social network, and maintain a plurality of residential services matching the functional abilities of users.

Typology of persons with severe mental disorders

BACKGROUND

Persons with severe mental disorders (PSMD) form a highly heterogeneous group. Identifying subgroups sharing similar PSMD profiles may help to develop treatment plans and appropriate services for their needs. This study seeks to establish a PSMD typology by looking at individual characteristics and the amount and adequacy of help received.

METHODS

The study recruited a sample of 352 persons located in south-western Montreal (Quebec, Canada). Cluster analysis was used to create a PSMD typology.

RESULTS

Analysis yielded five clusters: 1. highly functional older women with mood disorders, receiving little help from services; 2. middle-aged men with diverse mental disorders and alcohol abuse, receiving insufficient and inadequate help; 3. middle-aged women with serious needs, mood and personality disorders and suicidal tendencies, living in autonomous apartments, and receiving ample but inadequate help; 4. highly educated younger men with schizophrenia, living in autonomous apartments, and receiving adequate help; and 5. older poorly educated men with schizophrenia, living in supervised apartments, with ample help perceived as adequate. Marked differences were found between men and women, between users diagnosed with schizophrenia and others, and between persons living in supervised or autonomous apartments.

CONCLUSION

Our study highlights the existence of parallel subgroups among PSMD related to their socio-demographic status, clinical needs and service-use profiles, which could be used to focus more appropriate interventions. For mental health service planning, it demonstrates the relevance of focusing on individuals showing critical needs who are affected by multiple mental disorders (especially when associated with alcohol abuse), and often find help received as less adequate.