A randomized-controlled trial of intensive case management emphasizing the recovery model among patients with severe and enduring mental illness

Effectiveness of video-based psychiatric rehabilitation for patients with early-phase schizophrenia spectrum: A randomized controlled trial

AIM

This study aimed to establish a comprehensive set of recovery-oriented rehabilitation programs for individuals with schizophrenia, comparing the efficacy of video-based rehabilitation to traditional face-to-face interventions. The primary objective was to assess whether video-based rehabilitation could serve as a viable alternative for individuals with schizophrenia residing in remote areas.

METHODS

A randomized controlled study was used to recruit 80 patients with schizophrenia in a stable post-hospitalization stage following discharge. Participants were categorized into three groups: 24 in the control group, 21 in the face-to-face group, and 35 in the remote group. Assessment parameters included psychiatric symptoms, social skills, family function and self-stigma.

RESULTS

A total of 68 participants completed the program. The findings indicated significant differences (p < .05) between the control group and intervention group, particularly in the Positive and Negative Syndrome Scale (PANSS) and the Personal and Social Performance Scale (PSP).

CONCLUSIONS

The rehabilitation program, tailored for patients in the early phase of the schizophrenia spectrum, demonstrates both effectiveness and feasibility in enhancing clinical symptoms and social functions. Notably, interventions conducted via video proved to be equally effective as those administered face-to-face.

Predicting Recovery in Individuals With Serious Mental Illness: Expanding the International Classification of Functioning, Disability, and Health (ICF) Framework

People with psychiatric disabilities experience significant impairment in fulfilling major life roles due to the severity of their mental illness. Recovery for people with serious mental illness (SMI) can be a long, arduous process, impacted by various biological, functional, sociological, and psychological factors which can present as barriers and/or facilitators. The purposes of this study were to: (a) investigate the International Classification of Functioning, Disability, and Health (ICF) framework’s ability to predict recovery in adults with SMI and (b) determine to what extent the ICF constructs in the empirical model explain the variance in recovery. Participants ( N = 192) completed a sociodemographic questionnaire and various measures representing all predictor and outcome variables. Results from hierarchical regression analysis with six sets of predictors entered sequentially (1 = personal factors-demographics, 2 = body functions-mental, 3 = activity-capacity, 4 = environmental factors, 5 = personal factors-characteristics, and 6 = participation-performance) accounted for 75% (large effect) of the variance in recovery. Controlling for all factors, by order of salience, higher levels of significant other support, education, executive function impairment, and social self-efficacy; primary, non-bipolar SMI diagnosis; greater resilience; lower levels of explicit memory-health impairment, affective self-stigma, and cognitive self-stigma; being younger; fewer self-care limitations; less severe psychiatric symptoms; and being unemployed and unmarried were found to significantly predict recovery. Findings support the validation of the ICF framework as a biopsychosocial recovery model and the use of this model in the development of effective recovery-oriented interventions for adults with SMI. Clinical and research implications are discussed.

La littératie en santé chez les personnes présentant des troubles mentaux graves

Le Plan d’action 2015-2020 en santé mentale du Québec vise, chez les personnes présentant des troubles mentaux graves, le développement d’une autonomie optimale dans la société et l’utilisation adéquate des services de santé. Néanmoins, à ce jour, un manque de données est rapporté au Québec, sur la capacité des personnes présentant des troubles mentaux à accéder, à comprendre et à utiliser l’information relative à la santé, ce qui correspond au concept de littératie en santé (LS). Une étude descriptive quantitative a été menée pour décrire la LS chez les personnes présentant des troubles mentaux graves et demeurant dans la communauté de Dolbeau-Mistassini, au Saguenay–Lac-Saint-Jean (Québec). Les données ont été collectées à l’aide de trois questionnaires autorapportés, incluant le Questionnaire sur la littératie en santé (QLS). Ce questionnaire permet de décrire la LS à partir de 9 dimensions, afin de soulever les besoins individuels, organisationnels et sociaux en lien avec la LS des personnes ciblées. Les résultats obtenus auprès des participants (n = 30) ont montré que la LS était plus faible dans la dimension « Comprendre l’information relative à la santé ». Les résultats de cette étude mettent en évidence la nécessité d’adapter les interventions éducatives chez cette population. Cette adaptation pourrait permettre à cette population de mieux intégrer le contenu de l’enseignement reçu, tout en privilégiant l’accompagnement d’un proche lors de la rencontre avec un professionnel de la santé.

Implementation of outcome measurement (HoNOS) in an outpatient psychiatric clinic in Sligo/Leitrim mental health service

BACKGROUND

Routine clinical outcome monitoring (RCOM) is the standardised gathering of measures of clinical outcomes in everyday practice. HoNOS (Health of the Nation Outcome Scales) is a tool used in RCOM.

AIMS

To examine (a) agreement between HoNOS and Global Assessment of Functioning (GAF), (b) HoNOS changes over time/attendance and (c) clinical parameters affecting HoNOS scores.

METHODS

Data from outpatient clinics were collected at each contact over 2 years until June 2016 including: gender, age, diagnosis (ICD-10) and HoNOS scores. In a subsample, the GAF also were completed by community psychiatric nurses blind to HoNOS scores.

RESULTS

A number of 470 outpatients have undergone 1125 HoNOS assessments during the study period. Mean age of the attendants was 43.12; SD 14.6. Male = 220 (46.8%). Longitudinal analysis demonstrated that lower HoNOS scores are independently significantly associated to number of assessments and diagnosis in ICD-10 categories of F20-F29 (Schizophrenia, schizotypal and delusional disorders) F30-F39 (mood disorders) F40-F48 (neurotic, stress-related and somatoform disorders) and F50-F59 (behavioural disorders associated with physiological disturbances). Gender and age were not significantly associated with decline of HoNOS scores. Neither were other diagnostic categories. Agreement between HoNOS and GAF was excellent (N = 261, rho = - 0.919, p < 0.001).

CONCLUSIONS

This study shows that HoNOS is a feasible instrument which can be potentially used in ROCM in mental health services in Ireland and supports further the need for implementation of routine measurements in Mental Health Services. It adds longitudinal data which is lacking in similar previous studies.

Implementing Case Management in Portuguese Mental Health Services: Conceptual Background

Case management implementation processes are one of the best examples on how an evidence-based practice can influence health services organisation. This practice helped shaping mental health teams, increasing their multidisciplinarity and interdisciplinary work in the last decades. Examples from several countries show how effectiveness research blends into health policy development to meet different needs in each health system, thus influencing case management inception and improvement of care. Portugal followed its own path in case management implementation, determined mostly by mental health services organisation and closely linked with the capacity to implement a national mental health policy in the last years.

A strengths-based case management service for people with serious mental illness in Israel: A randomized controlled trial

Case management services for people with serious mental illness are generally found to be effective, but controlled and randomized studies assessing such services are scarce. The aim of the present study was to assess the effectiveness of a new strengths-based case management (SBCM) service in Israel, using a randomized controlled approach. The sample consisted of 1276 individuals with serious mental illness, who consume psychiatric rehabilitation services (PRS) in the community, and were randomly assigned to receive or not to receive the SBCM service in addition to treatment-as-usual PRS. Quality of life, goal setting and attainment, unmet needs, self-efficacy, interpersonal relationships, symptom severity, and service utilization were assessed by clients at onset and after 20 months. Results show that SBCM participants improved in self-efficacy, unmet needs, and general quality of life, and set more goals than the control group. SBCM participants also consumed fewer services at follow-up. Results suggest that SBCM services are effective in helping individuals with serious mental illness set personal goals and use PRS in a better and more focused manner.

Reducing hospitalisation among people living with severe mental illness

Objective People with severe mental illness have high rates of hospitalisation. The present study examined the role that permanent housing and recovery-oriented support can play in reducing the number and length of psychiatric hospital admissions for people with severe mental illness. Methods The study examined de-identified, individual-level health records of 197 people involved in the New South Wales Mental Health Housing and Accommodation Support Initiative (HASI) to compare changes in hospitalisation over a continuous 4-year period. Results On average, HASI consumers experienced significant reductions in the number of psychiatric hospital admissions and length of stay after entering the HASI program, and these reductions were sustained over the first 2 years in HASI. Male consumers and consumers under 45 years of age experienced the largest reductions in the number and length of hospital admissions. Conclusions The findings of the present study add support to the hypothesis that supported housing and recovery-oriented support can be effective approaches to reducing hospital admissions for people with chronic mental illness, and that these changes can be sustained over time. What is known about this topic? People living with severe mental illness are heavy users of health and hospitalisation services. Research into the effects of partnership programs on preventing unnecessary admissions is limited because of short periods of comparison and small sample sizes. What does this paper add? The present study extends previous research by analysing de-identified individual-level health records over a continuous 4-year period and showing that reductions in hospitalisation among people with severe mental illness can be sustained over time. What are the implications for practitioners? These findings provide further evidence that community-based recovery-oriented supported housing programs can assist consumers to manage their mental health and avoid hospital admissions. Although the provision of recovery-oriented community services requires an investment in community mental health, the reduction in consumers' use of hospital services makes this investment worthwhile.

Recovery as a model of care? Insights from an Australian case study

The terms "model of health care," "service model." and "nursing model of practice" are often used interchangeably in practice, policy, and research, despite differences in definitions. This article considers these terms in the context of consumer-centred recovery and its implementation into a publicly-funded health service organization in Australia. Findings of a case study analysis are used to inform the discussion, which considers the diverse models of health care employed by health professionals; together with the implications for organizations worldwide that are responsible for operationalizing recovery approaches to health care. As part of the discussion, it is suggested that the advent of recovery-oriented services, rather than recovery models of health care, presents challenges for the evaluation of the outcomes of these services. At the same time, this situation provides opportunities for mental health nurses to lead the way, by developing rigorous models of practice that support consumers who have acute, chronic, or severe mental illness on their recovery journey; and generate positive, measureable outcomes.

Integrated care in patients with schizophrenia: results of trials published between 2011 and 2013 focusing on effectiveness and efficiency

PURPOSE OF REVIEW

Overview on integrated care trials focusing on effectiveness and efficiency published from 2011 to 2013.

RECENT FINDINGS

Eight randomized controlled trials (RCTs) and 21 non-RCT studies were published from 2011 to 2013. Studies differed in several methodological aspects such as study population, psychotherapeutic approaches used, outcome parameters, follow-up times, fidelities, and implementation of the integrated care model and the nation-specific healthcare context with different control conditions. This makes it difficult to draw firm conclusions. Most studies demonstrated relevant improvements regarding symptoms (P=0.001) and functioning (P=0.01), quality of life (P=0.01), adherence (P<.05) and patient's satisfaction (P=0.01), and reduction of caregiver's stress (P<0.05). Mean total costs were favoring or at least equalizing costs but with positive effects found on subjective health favoring integrated care models.

SUMMARY

There is an increasing interest in the effectiveness and efficiency of integrated care models in patients with mental disorders, specifically in those with severe and persistent mental illness. To increase generalizability, future trials should exactly describe rationales and content of integrated care model and control conditions.