1
|
Allsopp K, Varese F, French P, Young E, White H, Chung P, Davey J, Hassan AA, Wright SA, Barrett A, Bhutani G, McGuirk K, Shields G, Huntley F, Jordan J, Rowlandson A, Sarsam M, Ten Cate H, Walker H, Watson R, Willbourn J, Hind D. A service mapping exercise of four health and social care staff mental health and wellbeing services, Resilience Hubs, to describe health service provision and interventions. BMC Health Serv Res 2024; 24:430. [PMID: 38575960 PMCID: PMC10996192 DOI: 10.1186/s12913-024-10835-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND NHS England funded 40 Mental Health and Wellbeing Hubs to support health and social care staff affected by the COVID-19 pandemic. We aimed to document variations in how national guidance was adapted to the local contexts of four Hubs in the North of England. METHODS We used a modified version of Price's (2019) service mapping methodology. Service level data were used to inform the analysis. A mapping template was adapted from a range of tools, including the European Service Mapping Schedule, and reviewed by Hub leads. Key data included service model; staffing; and interventions. Data were collected between March 2021 - March 2022 by site research assistants. Findings were accuracy-checked by Hub leads, and a logic model developed to theorise how the Hubs may effect change. RESULTS Hub goals and service models closely reflected guidance; offering: proactive outreach; team-based support; clinical assessment; onward referral, and rapid access to mental health support (in-house and external). Implementation reflected a service context of a client group with high mental health need, and high waiting times at external mental health services. Hubs were predominantly staffed by experienced clinicians, to manage these mental health presentations and organisational working. Formulation-based psychological assessment and the provision of direct therapy were not core functions of the NHS England model, however all Hubs incorporated these adaptations into their service models in response to local contexts, such as extensive waiting lists within external services, and/or client presentations falling between gaps in existing service provision. Finally, a standalone clinical records system was seen as important to reassure Hub users of confidentiality. Other more nuanced variation depended on localised contexts. CONCLUSION This study provides a map for setting up services, emphasising early understandings of how new services will integrate within existing systems. Local and regional contexts led to variation in service configuration. Whilst additional Hub functions are supported by available literature, further research is needed to determine whether these functions should comprise essential components of staff wellbeing services moving forward. Future research should also determine the comparative effectiveness of service components, and the limits of permissible variation. STUDY REGISTRATION researchregistry6303.
Collapse
Affiliation(s)
- Kate Allsopp
- Complex Trauma & Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Research and Innovation, 3rd Floor Rawnsley Building, Hathersage Road, Manchester, UK.
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK.
| | - Filippo Varese
- Complex Trauma & Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Research and Innovation, 3rd Floor Rawnsley Building, Hathersage Road, Manchester, UK
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK
| | - Paul French
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Brooks Building, Bonsall Street, Manchester, UK
- Pennine Care NHS Foundation Trust, Trust Headquarters, 225 Old Street, Ashton-Under-Lyne, Greater Manchester, UK
| | - Ellie Young
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Trust Headquarters, 225 Old Street, Ashton-Under-Lyne, Greater Manchester, UK
| | - Hannah White
- Complex Trauma & Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Research and Innovation, 3rd Floor Rawnsley Building, Hathersage Road, Manchester, UK
| | - Priscilla Chung
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Sceptre Point, Sceptre Way, Walton Summit, Preston, UK
| | - Jessica Davey
- Humber and North Yorkshire Resilience Hub, Tees Esk and Wear Valleys NHS Foundation Trust, West Park Hospital, Edward Pease Way, Darlington, UK
| | - Alysha A Hassan
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, V7 Building, Kings Business Park, Prescot, UK
| | - Sally-Anne Wright
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Sceptre Point, Sceptre Way, Walton Summit, Preston, UK
| | - Alan Barrett
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Trust Headquarters, 225 Old Street, Ashton-Under-Lyne, Greater Manchester, UK
- School of Health Science, University of Salford, Mary Seacole Building, Frederick Road Campus, Broad St, Salford, UK
| | - Gita Bhutani
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Sceptre Point, Sceptre Way, Walton Summit, Preston, UK
| | - Katherine McGuirk
- Greater Manchester Health and Social Care Partnership, 4th Floor, 3 Piccadilly Place, Manchester, UK
| | - Gemma Shields
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK
| | - Fay Huntley
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, V7 Building, Kings Business Park, Prescot, UK
- Doctorate of Clinical Psychology, School of Health in Social Science, Old Medical School, University of Edinburgh, Teviot Place, Room 2.2, Doorway 6, Edinburgh, UK
| | - Joanne Jordan
- Humber and North Yorkshire Resilience Hub, Tees Esk and Wear Valleys NHS Foundation Trust, West Park Hospital, Edward Pease Way, Darlington, UK
| | - Aleix Rowlandson
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, UK
| | - May Sarsam
- Cheshire and Merseyside Resilience Hub, Mersey Care NHS Foundation Trust, V7 Building, Kings Business Park, Prescot, UK
| | - Hein Ten Cate
- Lancashire and South Cumbria Resilience Hub, Lancashire and South Cumbria NHS Foundation Trust, Sceptre Point, Sceptre Way, Walton Summit, Preston, UK
| | - Holly Walker
- Humber and North Yorkshire Resilience Hub, Tees Esk and Wear Valleys NHS Foundation Trust, West Park Hospital, Edward Pease Way, Darlington, UK
| | - Ruth Watson
- Greater Manchester Mental Health NHS Foundation Trust, Trust Headquarters, Bury New Road, Prestwich, Manchester, M25 3BL, UK
| | - Jenni Willbourn
- Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Trust Headquarters, 225 Old Street, Ashton-Under-Lyne, Greater Manchester, UK
| | - Daniel Hind
- School of Health and Related Research, The Innovation Centre, University of Sheffield, 217 Portobello, Sheffield, UK
| |
Collapse
|
2
|
Karolaakso T, Autio R, Suontausta P, Leppänen H, Rissanen P, Näppilä T, Tuomisto MT, Pirkola S. Mental health service diversity and work disability: associations of mental health service system characteristics and mood disorder disability pensioning in Finland. Soc Psychiatry Psychiatr Epidemiol 2024; 59:631-642. [PMID: 37117785 PMCID: PMC10960744 DOI: 10.1007/s00127-023-02481-5] [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: 02/19/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE Public mental health services (MHS) are crucial in preventing psychiatric disability pensions (DP). We studied the associations between mood disorder DP risk and the characteristics of Finnish municipalities' MHS provision using the ESMS-R mapping tool and Finnish population registers, based on first-time granted mood disorder DPs between 2010 and 2015. METHODS The final data set included 13,783 first-time mood disorder DP recipients and 1088 mental health service units in 104 municipalities. We focused on five different MHS types: all MHS, outpatient care provision, local services without and with gatekeeping, and centralized services. Three factors for each MHS type were studied: service resources, richness, and diversity index. Negative binomial regression models were used in the analysis. RESULTS In all the municipalities, higher service richness and diversity regarding all MHS, outpatient care and local services with gatekeeping were associated with a lower DP risk. In urban municipalities, service richness was mainly associated with lower DP risk, and in semi-urban municipalities service diversity and resources were primarily associated with lower DP risk in outpatient care and local services with gatekeeping. In rural municipalities, DP risk indicated no association with MHS factors. CONCLUSION The organization and structure of MHS play a role in psychiatric disability pensioning. MHS richness and diversity are associated with lower mood disorder DP in specific societal contexts indicating their role as quality indicators for regional MHS. The diversity of service provision should be accounted for in MHS planning to offer services matching population needs.
Collapse
Affiliation(s)
- Tino Karolaakso
- Faculty of Social Sciences (Psychology), Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
- Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Reija Autio
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Petra Suontausta
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Helena Leppänen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Päivi Rissanen
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Turkka Näppilä
- Tampere University Library, Tampere University, Tampere, Finland
| | - Martti T Tuomisto
- Faculty of Social Sciences (Psychology), Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
| | - Sami Pirkola
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
- Department of Adult Psychiatry, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
3
|
Savaglio M, Yap M, Vincent A, Skouteris H. Mapping community-based youth mental health services in Tasmania, Australia. Aust J Prim Health 2024; 30:PY23074. [PMID: 38437736 DOI: 10.1071/py23074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 02/15/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Tasmania has the most rurally and remotely dispersed population of young people in Australia with high rates of youth experiencing mental ill health and socioeconomic disadvantage. Standard descriptions of mental healthcare provision are necessary for evidence-informed mental healthcare policy, planning and implementation. This systematic scoping study aimed to: (1) map and describe the characteristics of community-based youth mental health services (including substance-use) for young people in Tasmania, Australia and (2) identify gaps in service accessibility and provision. METHODS A list of eligible services was developed through a systematic search and consultation with key stakeholders. Data were collected from a representative from each eligible service via an interview or online survey. A standardised framework was used to classify, describe and map services. Thematic analysis was used to analyse service providers' perceived gaps to service access and provision. RESULTS Twenty-eight community-based mental health services for youth were identified, predominantly located in the major city of Tasmania's three service regions. Service gaps include the 'missing middle', lack of integrated supports and limited service capacity. CONCLUSIONS The findings highlight the limited availability, accessibility and capacity of youth mental health services across Tasmania. Recommendations focus on increasing accessibility of rural/regional supports, provision of assertive outreach, psychosocial support, integrated care and strengthening the rural mental health workforce. These findings may inform the (re)design/(re)development of community-based youth mental health services in Tasmania. The findings may also guide evidence-informed mental health service planning, decision-making, development and implementation of integrated models of youth mental health care across Australia.
Collapse
Affiliation(s)
- Melissa Savaglio
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Marie Yap
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Vic., Australia; and Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia
| | | | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia; and Warwick Business School, University of Warwick, Coventry, UK
| |
Collapse
|
4
|
Tabatabaei-Jafari H, Furst MA, Bagheri N, D’Cunha NM, Bail K, Sachdev PS, Salvador-Carulla L. The Integrated Atlas of Dementia Care in the Australian Capital Territory: A Collective Case Study of Local Service Provision. Health Serv Insights 2024; 17:11786329241232254. [PMID: 38348356 PMCID: PMC10860480 DOI: 10.1177/11786329241232254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Abstract
Background This study evaluates the dementia care system in a local area and aimed to include all specialised services designed to provide health and social services to people with dementia or age-related cognitive impairment, as well as general services with a high or very high proportion of clients with dementia. Methods The study used an internationally standardised service classification instrument called Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) to identify and describe all services providing care to people with dementia in the Australian Capital Territory (ACT). Results A total of 47 service providers were eligible for inclusion. Basic information about the services was collected from their websites, and further information was obtained through interviews with the service providers. Of the 107 services offered by the 47 eligible providers, 27% (n = 29) were specialised services and 73% (n = 78) were general services. Most of the services were residential or outpatient, with a target population mostly of people aged 65 or older, and 50 years or older in the case of Aboriginal and Torres Strait Islander Australians. There were government supports available for most types of care through various programmes. Conclusions Dementia care in the ACT relies heavily on general services. More widespread use of standardised methods of service classification in dementia will facilitate comparison with other local areas, allow for monitoring of changes over time, permit comparison with services provided for other health conditions and support evidence-informed local planning.
Collapse
Affiliation(s)
- Hossein Tabatabaei-Jafari
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Mary Anne Furst
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Nasser Bagheri
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Nathan M. D’Cunha
- School of Rehabilitation and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Kasia Bail
- School of Nursing, Midwifery and Public Health, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Luis Salvador-Carulla
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
5
|
Karolaakso T, Autio R, Suontausta P, Leppänen H, Suokas K, Rissanen P, Tuomisto MT, Pirkola S. Patterns of mental health services and mood disorder disability pensions: a standard comparison of Finland's three largest hospital districts. BMC Psychiatry 2023; 23:828. [PMID: 37957646 PMCID: PMC10644417 DOI: 10.1186/s12888-023-05342-2] [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: 05/05/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Mental disorders are one of the most common and disabling health conditions worldwide. There is however no consensus on the best practice of system level mental health services (MHS) provision, in order to prevent e.g. mood disorder disability pensions (DPs). We analyzed the MHS provision between Finland's three largest hospital districts Helsinki and Uusimaa (HUS), Southwest Finland and Pirkanmaa, with known differences in mood disorder DP risk but presumably equal rates of mood disorder prevalence. METHODS We used public MHS data analyzed with the standardized DEscription and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) mapping tool, focusing on all MHS, outpatient care provision, local services without and with gatekeeping, and centralized services. We also collected demographic data based on the European Socio-Demographic Schedule (ESDS). As a novel approach, the Gini-Simpson Diversity Index (GSDI) was calculated for the districts. RESULTS Evident differences were observed regarding the districts' MHS factors. As the hospital district with lower DP risk, HUS was characterized by the highest level of regional socioeconomic prosperity as well as high service richness and diversity. With a nationally average DP risk, Southwest Finland had the highest number of MHS personnel in full-time equivalents (FTE) per 100 000 inhabitants. Pirkanmaa, with a higher DP risk, had overall the lowest service richness and the lowest FTE of the three districts in all MHS, outpatient care and local services with gatekeeping. CONCLUSIONS Our findings indicate that greater richness and diversity of MHS, especially in outpatient and community-based settings, may serve as indicators of a balanced, high-quality service system that is more effective in preventing mood disorder DP and meeting the different needs of the population. In addition, the need for sufficient resourcing in all MHS and outpatient services is indicated. We suggest using diversity indices to complement the measuring and reporting of regional service variation.
Collapse
Affiliation(s)
- Tino Karolaakso
- Faculty of Social Sciences (Psychology), Tampere University, Arvo Ylpön katu 34, Tampere, FI- 33520, Finland.
- Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Reija Autio
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Petra Suontausta
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Helena Leppänen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kimmo Suokas
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Päivi Rissanen
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Martti T Tuomisto
- Faculty of Social Sciences (Psychology), Tampere University, Arvo Ylpön katu 34, Tampere, FI- 33520, Finland
| | - Sami Pirkola
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
- Department of Adult Psychiatry, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
6
|
El-Jardali F, Bou-Karroum L, Hilal N, Hammoud M, Hemadi N, Assal M, Kalach N, Harb A, Azzopardi-Muscat N, Sy TR, Novillo-Ortiz D. Knowledge management tools and mechanisms for evidence-informed decision-making in the WHO European Region: a scoping review. Health Res Policy Syst 2023; 21:113. [PMID: 37907919 PMCID: PMC10619313 DOI: 10.1186/s12961-023-01058-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 10/07/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Knowledge management (KM) emerged as a strategy to promote evidence-informed decision-making. This scoping review aims to map existing KM tools and mechanisms used to promote evidence-informed health decision-making in the WHO European Region and identify knowledge gaps. METHODS Following the Joanna Briggs Institute (JBI) guidance for conducting scoping reviews, we searched Medline, PubMed, EMBASE, the Cochrane library, and Open Grey. We conducted a descriptive analysis of the general characteristics of the included papers and conducted narrative analysis of the included studies and categorized studies according to KM type and phase. RESULTS Out of 9541 citations identified, we included 141 studies. The KM tools mostly assessed are evidence networks, surveillance tools, observatories, data platforms and registries, with most examining KM tools in high-income countries of the WHO European region. Findings suggest that KM tools can identify health problems, inform health planning and resource allocation, increase the use of evidence by policymakers and stimulate policy discussion. CONCLUSION Policymakers and funding agencies are called to support capacity-building activities, and future studies to strengthen KM in the WHO European region particularly in Eastern Europe and Central Asia. An updated over-arching strategy to coordinate KM activities in the WHO European region will be useful in these efforts.
Collapse
Affiliation(s)
- Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy Center, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lama Bou-Karroum
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Knowledge to Policy Center, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nadeen Hilal
- Knowledge to Policy Center, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Maya Hammoud
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nour Hemadi
- Knowledge to Policy Center, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Michelle Assal
- Knowledge to Policy Center, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nour Kalach
- Knowledge to Policy Center, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Aya Harb
- Knowledge to Policy Center, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Natasha Azzopardi-Muscat
- Division of Country Health Policies and Systems, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Tyrone Reden Sy
- Division of Country Health Policies and Systems, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - David Novillo-Ortiz
- Division of Country Health Policies and Systems, WHO Regional Office for Europe, Copenhagen, Denmark
| |
Collapse
|
7
|
Beckers T, Koekkoek B, Tiemens B, Hutschemaekers G. Measuring the intensity of mental healthcare: development of the Mental Healthcare Intensity Scale (MHIS). BMC Psychiatry 2023; 23:377. [PMID: 37254123 DOI: 10.1186/s12888-023-04752-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/05/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND There are considerable differences among mental healthcare services, and especially in developed countries there are a substantial number of different services available. The intensity of mental healthcare has been an important variable in research studies (e.g. cohort studies or randomized controlled trials), yet it is difficult to measure or quantify, in part due to the fact that the intensity of mental healthcare results from a combination of several factors of a mental health service. In this article we describe the development of an instrument to measure the intensity of mental healthcare that is easy and fast to use in repeated measurements. METHODS The Mental Healthcare Intensity Scale was developed in four stages. First, categories of care were formulated by using focus group interviews. Second, the fit among the categories was improved, and the results were discussed with a sample of the focus group participants. Third, the categories of care were ranked using the Segmented String Relative Rankings algorithm. Finally, the Mental Healthcare Intensity Scale was validated as a coherent classification instrument. RESULTS 15 categories of care were formulated and were ranked on each of 12 different intensities of care. The Mental Healthcare Intensity Scale is a versatile questionnaire that takes 2-to-3 min to complete and yields a single variable that can be used in statistical analysis. CONCLUSIONS The Mental Healthcare Intensity Scale is an instrument that can potentially be used in cohort studies and trials to measure the intensity of mental healthcare as a predictor of outcome. Further study into the psychometric characteristics of the Mental Healthcare Intensity Scale is needed.
Collapse
Affiliation(s)
- Thijs Beckers
- Primary Healthcare Department, MET ggz, Minister Beverstraat 3, Roermond, 6042 BL, The Netherlands.
- Research Group in Social Psychiatry and Mental Health Nursing, HAN University of Applied Science, Nijmegen, The Netherlands.
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
| | - Bauke Koekkoek
- Research Group in Social Psychiatry and Mental Health Nursing, HAN University of Applied Science, Nijmegen, The Netherlands
- Pro Persona Research, Renkum, The Netherlands
| | - Bea Tiemens
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Pro Persona Research, Renkum, The Netherlands
- Indigo, Utrecht, The Netherlands
| | - Giel Hutschemaekers
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Pro Persona Research, Renkum, The Netherlands
- Indigo, Utrecht, The Netherlands
| |
Collapse
|
8
|
Tabatabaei-Jafari H, Bagheri N, Lueck C, Furst MA, Salinas-Perez JA, Salvador-Carulla L. Standardized Systematic Description of Provision of Care for Multiple Sclerosis at a Local Level: A Demonstration Study. Int J MS Care 2023; 25:124-130. [PMID: 37250197 PMCID: PMC10211356 DOI: 10.7224/1537-2073.2022-014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND This study evaluates and describes the pattern of services provided for people living with multiple sclerosis (MS) in a local area as a starting point for a more global assessment. METHODS A health care ecosystem approach has been followed using an internationally standardized service classification instrument-the Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC)-to identify and describe all services providing care to people with MS in the Australian Capital Territory, Australia. Available services were classified according to the target population into those specifically dedicated to people living with MS and those providing general neurologic services, both public and private, and across both social and health sectors. RESULTS A limited range of services was available. There were no local facilities providing or coordinating multidisciplinary integrated care specific to people with MS. Subspecialty services specific to MS were limited in number (6 of the 28 services), and use of specialist services provided in neighboring states was frequently reported. Overall, very few services were provided outside the core health sector (4%). CONCLUSIONS The provision of care to people living with MS in the Australian Capital Territory is fragmented and relies heavily on generic neurology services in the public and private sectors. More widespread use of the DESDE-LTC as a standardized method of service classification in MS will facilitate comparison with other local areas, allow monitoring of changes over time, and permit comparison with services provided for other health conditions (eg, dementia, mental disorders).
Collapse
Affiliation(s)
- Hossein Tabatabaei-Jafari
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
| | - Nasser Bagheri
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
| | - Christian Lueck
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
- Department of Neurology, Canberra Hospital, Canberra, ACT, Australia (CL)
- Australian National University Medical School, Canberra, ACT, Australia (CL)
| | - Mary Anne Furst
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
| | - Jose A. Salinas-Perez
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
- Department of Quantitative Methods, Loyola University Andalucia, Seville, Spain (JAS-P)
| | - Luis Salvador-Carulla
- From the Mental Health Policy Unit, Health Research Institute, Faculty of Health, University of Canberra, Canberra, ACT, Australia (HT-J, NB, MAF, JAS, LS-C)
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia (LS-C)
| |
Collapse
|
9
|
Salinas-Perez JA, Gutierrez-Colosia MR, Garcia-Alonso CR, Furst MA, Tabatabaei-Jafari H, Kalseth J, Perkins D, Rosen A, Rock D, Salvador-Carulla L. Patterns of mental healthcare provision in rural areas: A demonstration study in Australia and Europe. Front Psychiatry 2023; 14:993197. [PMID: 36815193 PMCID: PMC9939444 DOI: 10.3389/fpsyt.2023.993197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Mental healthcare systems are primarily designed to urban populations. However, the specific characteristics of rural areas require specific strategies, resource allocation, and indicators which fit their local conditions. This planning process requires comparison with other rural areas. This demonstration study aimed to describe and compare specialized rural adult mental health services in Australia, Norway, and Spain; and to demonstrate the readiness of the healthcare ecosystem approach and the DESDE-LTC mapping tool (Description and Evaluation of Services and Directories of Long Term Care) for comparing rural care between countries and across areas. METHODS The study described and classified the services using the DESDE-LTC. The analyses included context analysis, care availability, placement capacity, balance of care, and diversity of care. Additionally, readiness (Technology Readiness Levels - TRL) and impact analyses (Adoption Impact Ladder - AIL) were also assessed by two independent raters. RESULTS The findings demonstrated the usability of the healthcare ecosystem approach and the DESDE-LTC to map and identify differences and similarities in the pattern of care of highly divergent rural areas. Day care had a greater weight in the European pattern of care, while it was replaced by social outpatient care in Australian areas. In contrast, care coordination was more common in Australia, pointing to a more fragmented system that requires navigation services. The share between hospital and community residential care showed no differences between the two regions, but there were differences between catchment areas. The healthcare ecosystem approach showed a TRL 8 (the tool has been demonstrated in a real-world environment and it is ready for release and general use) and an AIL of 5 (the target public agencies provided resources for its completion). Two experts evaluated the readiness of the use of DESDE-LTC in their respective regional studies. All of them were classified using the TRL. DISCUSSION In conclusion, this study strongly supports gathering data on the provision of care in rural areas using standardized methods to inform rural service planning. It provides information on context and service availability, capacity and balance of care that may improve, directly or through subsequent analyses, the management and planning of services in rural areas.
Collapse
Affiliation(s)
- Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain.,Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | | | - Carlos R Garcia-Alonso
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain.,Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Mary Anne Furst
- Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | | | | | - David Perkins
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,Centre for Rural and Remote Mental Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alan Rosen
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Daniel Rock
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,WA Primary Health Alliance, Subiaco, WA, Australia.,Discipline of Psychiatry, The University of Western Australia, Perth, WA, Australia
| | - Luis Salvador-Carulla
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,National Centre for Epidemiology and Population Health (NCEPH), Faculty of Health and Medicine, Australian National University, Canberra, Australia
| |
Collapse
|
10
|
Salvador-Carulla L, Furst MA, Tabatabaei-Jafari H, Mendoza J, Riordan D, Moore E, Rock D, Anthes L, Bagheri N, Salinas-Perez JA. Patterns of service provision in child and adolescent mental health care in Australia. J Child Health Care 2022:13674935221146381. [PMID: 36538047 DOI: 10.1177/13674935221146381] [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] [Indexed: 12/24/2022]
Abstract
Standard description of local care provision is essential for evidence-informed planning. This study aimed to map and compare the availability and diversity of current mental health service provision for children and adolescents in Australia. We used a standardised service classification instrument, the Description and Evaluation of Services and DirectoriEs (DESDE) tool, to describe service availability in eight urban and two rural health districts in Australia. The pattern of care was compared with that available for other age groups in Australia. Outpatient care was found to be the most common type of service provision, comprising 212 (81.2%) of all services identified. Hospital care (acute and non-acute) was more available in urban than in rural areas (20 services [9.7%] vs 1 [1.8%]). The level of diversity in the types of care available for children and adolescents was lower than that for the general adult population, but slightly higher than that for older people in the same areas. Standardised comparison of the pattern of care across regions reduces ambiguity in service description and classification, enables gap analysis and can inform policy and planning.
Collapse
Affiliation(s)
- Luis Salvador-Carulla
- Health Research Institute, Health College, University of Canberra, Australia
- Menzies Centre for Health. Faculty of Medicine and Health. 4334University of Sydney, Australia
| | - Mary Anne Furst
- Health Research Institute, Health College, University of Canberra, Australia
| | | | - John Mendoza
- Mental Health & Prison Health, Central Adelaide Local Health Network, SA, Australia ; Brain and Mind Centre, 4334University of Sydney, Australia
| | - Denise Riordan
- Canberra Health Services, Canberra Australia; 102944Centre for Mental health research, Canberra, Australia
| | - Elizabeth Moore
- 2212Office for Mental Health and Wellbeing Australian Capital Territory, Canberra, Australia
| | - Daniel Rock
- WA Primary Health Alliance, Perth, Western Australia & Discipline of Psychiatry, 2720University of Western Australia, Perth, Australia
| | - Lauren Anthes
- 103006Capital Health Network, Deakin West, ACT, Australia
| | - Nasser Bagheri
- Health Research Institute, Health College, University of Canberra, Australia
| | - Jose A Salinas-Perez
- Health Research Institute, Health College, University of Canberra, Australia
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain
| |
Collapse
|
11
|
Salvador-Carulla L, Furst MA, Gillespie J, Rosenberg S, Aryani A, Anthes L, Ferdousi S, Salinas-Perez JA. Regional evolution of psychosocial services in Australia before and after the implementation of the National Disability Insurance Scheme. Aust N Z J Psychiatry 2022; 57:875-883. [PMID: 36208005 DOI: 10.1177/00048674221130981] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This paper compares the evolution of the psychosocial sector in two Australian regions pre and post introduction of the National Disability Insurance Scheme - a major reform to the financing, planning and provision of disability services in Australia, intended to create greater competition and efficiency in the market, and more choice for service users. METHODS We used a standardised service classification instrument based on a health ecosystems approach to assess service availability and diversity of psychosocial services provided by non-government organisations in two Primary Health Network regions. RESULTS We identified very different evolutionary pathways in the two regions. Service availability increased in Western Sydney but decreased in the Australian Capital Territory. The diversity of services available did not increase in either Primary Health Network 4 years after the reform. Many services were experiencing ongoing funding uncertainty. CONCLUSION Assumptions of increased efficiency through organisational scaling up, and a greater diversity in range of service availability were not borne out. IMPLICATIONS This study shows the urgent need for evaluation of the effects of the NDIS on the provision of psychosocial care in Australia. Four years after the implementation of the NDIS at vast expense key objectives not been met for consumers or for the system as a whole, and an environment of uncertainty has been created for providers. It demonstrates the importance of standardised service mapping to monitor the effects of major reforms on mental health care as well as the need for a focus at the local level.
Collapse
Affiliation(s)
- Luis Salvador-Carulla
- Health Research Institute, University of Canberra, Bruce, ACT, Australia.,Menzies Centre for Health Policy and Economics and Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Mary Anne Furst
- Health Research Institute, University of Canberra, Bruce, ACT, Australia
| | - James Gillespie
- Menzies Centre for Health Policy and Economics and Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | | | - Amir Aryani
- Centre for Transformative Innovation Swinburne University of Technology, Hawthorn, VIC, Australia
| | | | | | - Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Dos Hermanas, Spain.,Psicost Research Association, Jerez de la Frontera, Spain
| |
Collapse
|
12
|
Almeda N, Díaz-Milanés D, Guiterrez-Colosia MR, García-Alonso CR. A systematic review of the international evolution of online mental health strategies and recommendations during the COVID-19 pandemic. BMC Psychiatry 2022; 22:621. [PMID: 36127666 PMCID: PMC9486794 DOI: 10.1186/s12888-022-04257-8] [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: 03/09/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The global health crisis caused by the COVID-19 pandemic has had a negative impact on mental health (MH). As a response to the pandemic, international agencies and governmental institutions provided an initial response to the population's needs. As the pandemic evolved, the population circumstances changed, and some of these international agencies updated their strategies, recommendations, and guidelines for the populations. However, there is currently a lack of information on the attention given to response strategies by the different countries throughout the beginning of the pandemic. OBJECTIVES 1) To evaluate the evolution of online MH strategies and recommendations of selected countries to cope with the MH impact of COVID-19 from the early stages of the pandemic (15 April 2020) to the vaccination period (9 June 2021) and 2) to review and analyse the current structures of these online MH strategies and recommendations. METHODOLOGY An adaptation of the PRISMA guidelines to review online documents was developed with a questionnaire for MH strategies and recommendations assessment. The search was conducted on Google, including documents from April 2020 to June 2021. Basic statistics and Student's t test were used to assess the evolution of the documents, while a two-step cluster analysis was performed to assess the organisation and characteristics of the most recent documents. RESULTS Statistically significant differences were found both in the number of symptoms and mental disorders and MH strategies and recommendations included in the initial documents and the updated versions generated after vaccines became available. The most recent versions are more complete in all cases. Regarding the forty-six total documents included in the review, the cluster analysis showed a broad distribution from wide-spectrum documents to documents focusing on a specific topic. CONCLUSIONS Selected governments and related institutions have worked actively on updating their MH online documents, highlighting actions related to bereavement, telehealth and domestic violence. The study supports the use of the adaptation, including the tailor-made questionnaire, of the PRISMA protocol as a potential standard to conduct longitudinal assessments of online documents used to support MH strategies and recommendations.
Collapse
Affiliation(s)
- Nerea Almeda
- grid.449008.10000 0004 1795 4150Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
| | | | | | - Carlos R. García-Alonso
- grid.449008.10000 0004 1795 4150Department of Quantitative Methods, Universidad Loyola Andalucía, Cordova, Spain
| |
Collapse
|
13
|
Magnitude of terminological bias in international health services research: a disambiguation analysis in mental health. Epidemiol Psychiatr Sci 2022; 31:e59. [PMID: 35993182 PMCID: PMC9428902 DOI: 10.1017/s2045796022000403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
AIMS Health services research (HSR) is affected by a widespread problem related to service terminology including non-commensurability (using different units of analysis for comparisons) and terminological unclarity due to ambiguity and vagueness of terms. The aim of this study was to identify the magnitude of the terminological bias in health and social services research and health economics by applying an international classification system. METHODS This study, that was part of the PECUNIA project, followed an ontoterminology approach (disambiguation of technical and scientific terms using a taxonomy and a glossary of terms). A listing of 56 types of health and social services relevant for mental health was compiled from a systematic review of the literature and feedback provided by 29 experts in six European countries. The disambiguation of terms was performed using an ontology-based classification of services (Description and Evaluation of Services and DirectoriEs - DESDE), and its glossary of terms. The analysis focused on the commensurability and the clarity of definitions according to the reference classification system. Interrater reliability was analysed using κ. RESULTS The disambiguation revealed that only 13 terms (23%) of the 56 services selected were accurate. Six terms (11%) were confusing as they did not correspond to services as defined in the reference classification system (non-commensurability bias), 27 (48%) did not include a clear definition of the target population for which the service was intended, and the definition of types of services was unclear in 59% of the terms: 15 were ambiguous and 11 vague. The κ analyses were significant for agreements in unit of analysis and assignment of DESDE codes and very high in definition of target population. CONCLUSIONS Service terminology is a source of systematic bias in health service research, and certainly in mental healthcare. The magnitude of the problem is substantial. This finding has major implications for the international comparability of resource use in health economics, quality and equality research. The approach presented in this paper contributes to minimise differentiation between services by taking into account key features such as target population, care setting, main activities and type and number of professionals among others. This approach also contributes to support financial incentives for effective health promotion and disease prevention. A detailed analysis of services in terms of cost measurement for economic evaluations reveals the necessity and usefulness of defining services using a coding system and taxonomical criteria rather than by 'text-based descriptions'.
Collapse
|
14
|
Moreno-Küstner B, Fábrega-Ruz J, Gonzalez-Caballero JL, Reyes-Martin S, Ochoa S, Romero-Lopez-Alberca C, Cid J, Vila-Badia R, Frigola-Capell E, Salvador-Carulla L. Patient-reported impact of symptoms in schizophrenia scale (PRISS): Development and validation. Acta Psychiatr Scand 2022; 145:640-655. [PMID: 35188673 DOI: 10.1111/acps.13417] [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: 04/24/2021] [Revised: 02/02/2022] [Accepted: 02/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND We report the psychometric properties of the Patient-Reported Impact of Symptoms in Schizophrenia Scale (PRISS), which assesses the impact of subjective experiences or qualia in outpatients with this condition. METHODS A cross-sectional study was carried out in 162 patients diagnosed with schizophrenia in Spain. The PRISS measures the presence, frequency, concern and interference with daily life of self-reported experiences related to the main symptoms observed in these patients. The psychometric analysis included test-retest reliability, internal consistency and structural and convergent validity. RESULTS The 28-item PRISS showed good test-retest reliability as 64.3% of the intraclass correlation coefficient values were between 0.40 and 0.79, which were statistically significant (p < 0.01). Analysis of the structural validity revealed a three-factor structure, (1) productive subjective experiences, (2) affective-negative subjective experiences and (3) excitation, which accounted for 56.11% of the variance. Of the Pearson's correlation coefficients analysed between the PRISS and the Positive and Negative Syndrome Scale (PANSS), Scale for Assessment of Negative Symptoms (SANS) and World Health Organization Disability Assessment Schedule (WHO-DAS), 72.2% were statistically significant (p < 0.05) and ranged from 0.38-0.42, 0.32-0.42 and 0.40-0.42, respectively. CONCLUSION Our results indicate that the PRISS appears to be a brief, reliable and valid scale to measure subjective experiences in schizophrenia and provides valuable information complementary to clinical evaluation.
Collapse
Affiliation(s)
- Berta Moreno-Küstner
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, Malaga, Spain.,Andalusian Group of Psychosocial Research (GAP), Andalucía, Spain.,Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain.,Asociación Científica Psicost, Cádiz, Spain
| | - Julia Fábrega-Ruz
- Mental Health Department, Regional University Hospital of Malaga, University of Malaga, Málaga, Spain
| | - Juan Luis Gonzalez-Caballero
- Asociación Científica Psicost, Cádiz, Spain.,Department of Statistics and Operational Research, Faculty of Medicine, University of Cadiz, Cádiz, Spain
| | | | - Susana Ochoa
- Asociación Científica Psicost, Cádiz, Spain.,Etiopathogenesis and treatment of severe mental disorders Group (MERITT), Institut de Recerca Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Cristina Romero-Lopez-Alberca
- Asociación Científica Psicost, Cádiz, Spain.,Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychology, University of Cadiz, Cádiz, Spain
| | - Jordi Cid
- Asociación Científica Psicost, Cádiz, Spain.,Institut d'Assistència Sanitària de Girona, Girona, Spain.,Mental Health & Addiction Research Group, Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Regina Vila-Badia
- Etiopathogenesis and treatment of severe mental disorders Group (MERITT), Institut de Recerca Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.,Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Eva Frigola-Capell
- Institut d'Assistència Sanitària de Girona, Girona, Spain.,Mental Health & Addiction Research Group, Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Luis Salvador-Carulla
- Asociación Científica Psicost, Cádiz, Spain.,Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia.,Menzies Centre for Mental Health Policy, Sydney School of Public Health, University of Sydney, Sydney, Australia
| |
Collapse
|
15
|
Rosen A, Salvador‐Carulla L. No service is an island: towards an ecosystem approach to mental health service evaluation. World Psychiatry 2022; 21:237-238. [PMID: 35524610 PMCID: PMC9077609 DOI: 10.1002/wps.20963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Alan Rosen
- Australian Health Services Research InstituteUniversity of WollongongWollongongNSWAustralia,Brain & Mind InstituteUniversity of SydneySydneyNSWAustralia
| | - Luis Salvador‐Carulla
- Health Research Institute, Faculty of HealthUniversity of CanberraCanberraNSWAustralia,Menzies Centre for Health PolicyUniversity of SydneySydneyNSWAustralia
| |
Collapse
|
16
|
García-Alonso CR, Almeda N, Salinas-Pérez JA, Gutiérrez-Colosía MR, Iruin-Sanz Á, Salvador-Carulla L. Use of a decision support system for benchmarking analysis and organizational improvement of regional mental health care: Efficiency, stability and entropy assessment of the mental health ecosystem of Gipuzkoa (Basque Country, Spain). PLoS One 2022; 17:e0265669. [PMID: 35316302 PMCID: PMC8939819 DOI: 10.1371/journal.pone.0265669] [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: 09/21/2021] [Accepted: 03/03/2022] [Indexed: 11/29/2022] Open
Abstract
Decision support systems are appropriate tools for guiding policymaking processes, especially in mental health (MH), where care provision should be delivered in a balanced and integrated way. This study aims to develop an analytical process for (i) assessing the performance of an MH ecosystem and (ii) identifying benchmark and target-for-improvement catchment areas. MH provision (inpatient, day and outpatient types of care) was analysed in the Mental Health Network of Gipuzkoa (Osakidetza, Basque Country, Spain) using a decision support system that integrated data envelopment analysis, Monte Carlo simulation and artificial intelligence. The unit of analysis was the 13 catchment areas defined by a reference MH centre. MH ecosystem performance was assessed by the following indicators: relative technical efficiency, stability and entropy to guide organizational interventions. Globally, the MH system of Gipuzkoa showed high efficiency scores in each main type of care (inpatient, day and outpatient), but it can be considered unstable (small changes can have relevant impacts on MH provision and performance). Both benchmark and target-for-improvement areas were identified and described. This article provides a guide for evidence-informed decision-making and policy design to improve the continuity of MH care after inpatient discharges. The findings show that it is crucial to design interventions and strategies (i) considering the characteristics of the area to be improved and (ii) assessing the potential impact on the performance of the global MH care ecosystem. For performance improvement, it is recommended to reduce admissions and readmissions for inpatient care, increase workforce capacity and utilization of day care services and increase the availability of outpatient care services.
Collapse
Affiliation(s)
| | - Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
- * E-mail:
| | | | | | - Álvaro Iruin-Sanz
- Instituto Biodonostia, Red de Salud Mental Extrahospitalaria de Gipuzkoa, Donostia-San Sebastián, Spain
| | - Luis Salvador-Carulla
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Salinas-Perez JA, Ghuloum S, Gutierrez-Colosia MR, Bagheri N, Salvador-Carulla L. Analysis of the mental health service provision in Qatar: Progressing in community mental health in a Middle East country. Front Psychiatry 2022; 13:1095788. [PMID: 36590608 PMCID: PMC9800284 DOI: 10.3389/fpsyt.2022.1095788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Qatari health planning in the last decade aimed to make the transition from the traditional hospital-based psychiatric care to a community-based care, building an integrated and comprehensive mental health system. The objective of this study was to explore the mental health service provision in Qatar in 2018 and 2022. This time span coincided with two mental health plans (2013-2018 and 2019-2022) and one health plan (2018-2022). METHODS This study followed a healthcare ecosystem approach, including context analysis and the standard description and classification of mental health services. Service provision was studied applying DESDE-LTC system (Description and Evaluation of Services and DirectoriEs-Long Term Care), an internationally validated methodology to assess and describe mental health services. Service data were analyzed along with sociodemographic indicators from public statistics to know the care context. RESULTS The availability of specialized mental health services increased for adults, although it remained the same for other age groups. The diversity of care and the weight of health-related care over social-related care also remained quite similar. It was noteworthy the development of new services for young adults, migrant workers, and female populations. CONCLUSION This was the first time that this service research methodology has been applied in a Middle East country to study its mental healthcare pattern. The analysis of the mental healthcare pattern in the study time period showed the continued progress toward community-based care in Qatar in the framework of three health plans and despite the unexpected COVID-19 world pandemic.
Collapse
Affiliation(s)
- Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Dos Hermanas, Seville, Spain.,Mental Health Policy Unit, Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Suhaila Ghuloum
- Mental Health Services, Hamad Medical Corporation, Doha, Qatar
| | | | - Nasser Bagheri
- Mental Health Policy Unit, Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Luis Salvador-Carulla
- Mental Health Policy Unit, Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia.,Menzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
19
|
Pokhilenko I, Janssen LMM, Evers SMAA, Drost RMWA, Schnitzler L, Paulus ATG. Do Costs in the Education Sector Matter? A Systematic Literature Review of the Economic Impact of Psychosocial Problems on the Education Sector. PHARMACOECONOMICS 2021; 39:889-900. [PMID: 34121169 PMCID: PMC8298334 DOI: 10.1007/s40273-021-01049-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Psychosocial (e.g., anxiety or behavior) problems lead to costs not only in the healthcare sector but also in education and other sectors. As psychosocial problems develop during the critical period of establishing educational trajectories, education costs are particularly relevant in the context of psychosocial problems among children and adolescents. OBJECTIVES This study aimed to gain insights into the methods used for the inclusion of education costs in health economics studies and into the proportion of the education costs in relation to the total costs associated with a condition or an intervention. METHODS We systematically searched the PubMed, Embase, SSCI, CINAHL, PsycINFO, ERIC, and Econlit databases in August 2019 for economic evaluations of mental health, psychosocial and educational interventions, and cost-of-illness studies of mental, behavioral, and neurodevelopmental disorders conducted from a societal perspective in populations of children and adolescents. An additional search was conducted in February 2021 to update the review. RESULTS In total, 49 articles were included in the analysis. The most common cost items were special education, school absenteeism, and various educational professionals (educational psychologist). A variety of methods were employed for the identification, measurement, and/or valuation of education costs. The proportion of education costs to the total costs of condition/intervention ranged from 0 to 67%, with the mean being 18.5%. DISCUSSION Since education costs can constitute a significant proportion of the total costs of an intervention or condition, including them in health economics studies might be important in informing optimal resource allocation decisions. Although various methods are available for including education costs in health economics studies, further research is needed to develop evidence-based methods for producing comparable estimates.
Collapse
Affiliation(s)
- Irina Pokhilenko
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Luca M M Janssen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Centre for Economic Evaluation and Machine Learning, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ruben M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Lena Schnitzler
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Aggie T G Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Faculty of Health Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
20
|
Romero-Lopez-Alberca C, Alonso-Trujillo F, Almenara-Abellan JL, Salinas-Perez JA, Gutierrez-Colosia MR, Gonzalez-Caballero JL, Pinzon Pulido S, Salvador-Carulla L. A Semiautomated Classification System for Producing Service Directories in Social and Health Care (DESDE-AND): Maturity Assessment Study. J Med Internet Res 2021; 23:e24930. [PMID: 33720035 PMCID: PMC8074989 DOI: 10.2196/24930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/19/2020] [Accepted: 12/17/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND DESDE-LTC (Description and Evaluation of Services and DirectoriEs for Long-Term Care) is an international classification system that allows standardized coding and comparisons between different territories and care sectors, such as health and social care, in defined geographic areas. We adapted DESDE-LTC into a computer tool (DESDE-AND) for compiling a directory of care services in Andalucia, Spain. OBJECTIVE The aim of this study was to evaluate the maturity of DESDE-AND. A secondary objective of this study is to show the practicality of a new combined set of standard evaluation tools for measuring the maturity of health technology products. METHODS A system for semiautomated coding of service provision has been co-designed. A panel of 23 domain experts and a group of 68 end users participated in its maturity assessment that included its technology readiness level (TRL), usability, validity, adoption (Adoption Impact Ladder [AIL]), and overall degree of maturity [implementation maturity model [IMM]). We piloted the prototype in an urban environment (Seville, Spain). RESULTS The prototype was demonstrated in an operational environment (TRL 7). Sixty-eight different care services were coded, generating fact sheets for each service and its geolocation map. The observed agreement was 90%, with moderate reliability. The tool was partially adopted by the regional government of Andalucia (Spain), reaching a level 5 in adoption (AIL) and a level 4 in maturity (IMM) and is ready for full implementation. CONCLUSIONS DESDE-AND is a usable and manageable system for coding and compiling service directories and it can be used as a core module of decision support systems to guide planning in complex cross-sectoral areas such as combined social and health care.
Collapse
Affiliation(s)
- Cristina Romero-Lopez-Alberca
- Department of Psychology, Universidad de Cádiz, Cádiz, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Federico Alonso-Trujillo
- Agencia de Servicios Sociales y Dependencia de Andalucía, Junta de Andalucía, Sevilla, Spain
- Health Information Systems Group (SICA-CTS-553), Universidad de Cádiz, Cádiz, Spain
| | - Jose Luis Almenara-Abellan
- Health Information Systems Group (SICA-CTS-553), Universidad de Cádiz, Cádiz, Spain
- Hospital Universitario Reina Sofía, Servicio Andaluz de Salud, Córdoba, Spain
| | - Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | | | | | - Sandra Pinzon Pulido
- Escuela Andaluza de Salud Pública, Gobierno Regional de la Junta de Andalucía, Granada, Spain
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| |
Collapse
|
21
|
Almeda N, García-Alonso C, Salvador-Carulla L. Mental health planning at a very early stage of the COVID-19 crisis: a systematic review of online international strategies and recommendations. BMC Psychiatry 2021; 21:43. [PMID: 33451305 PMCID: PMC7809644 DOI: 10.1186/s12888-020-03015-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/14/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Mental health care systems have been dramatically affected by COVID-19. Containment measures have been imposed, with negative consequences on population mental health. Therefore, an increase in both symptomatology and mental disorder incidence is expected. This research aims to identify, describe and assess the empirical background on online strategies and recommendations developed by international organizations and governments to cope with the psychological impact of COVID-19 at a very early stage of the pandemic. METHODS The PRISMA guidelines were adapted to review online documents. A new questionnaire was developed to identify the existence of common patterns in the selected documents. Questions were classified into three domains: COVID-19 information, mental health strategies and mental health recommendations. A two-step cluster analysis was carried out to highlight underlying behaviours in the data (patterns). The results are shown as spider graphs (pattern profiles) and conceptual maps (multidimensional links between questions). RESULTS Twenty-six documents were included in the review. The questionnaire analysed document complexity and identified their common key mental health characteristics (i.e., does the respondent have the tools for dealing with stress, depression and anxiety?). Cluster analysis highlighted patterns from the questionnaire domains. Strong relationships between questions were identified, such as psychological tips for maintaining good mental health and coping with COVID-19 (question n° 4), describing some psychological skills to help people cope with anxiety and worry about COVID-19 (question n° 6) and promoting social connection at home (question n° 8). CONCLUSIONS When fast results are needed to develop health strategies and policies, rapid reviews associated with statistical and graphical methods are essential. The results obtained from the proposed analytical procedure can be relevant to a) classify documents according to their complexity in structuring the information provided on how to cope with the psychological impact of COVID-19, b) develop new documents according to specific objectives matching population needs, c) improve document design to face unforeseen events, and d) adapt new documents to local situations. In this framework, the relevance of adapting e-mental health procedures to community mental health care model principles was highlighted, although some problems related to the digital gap must be considered.
Collapse
Affiliation(s)
- Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain.
| | - Carlos García-Alonso
- grid.449008.10000 0004 1795 4150Department of Quantitative Methods, Universidad Loyola Andalucía, Seville, Spain
| | - Luis Salvador-Carulla
- grid.1001.00000 0001 2180 7477Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| |
Collapse
|
22
|
Rosen A, Rock D, Salvador-Carulla L. The interpretation of beds: More bedtime stories, or maybe they're dreaming? Aust N Z J Psychiatry 2020; 54:1154-1156. [PMID: 33131281 DOI: 10.1177/0004867420969813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alan Rosen
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Illawarra Institute of Mental Health, University of Wollongong, Wollongong, NSW, Australia
| | - Daniel Rock
- WA Primary Health Alliance, Rivervale, WA, Australia.,Discipline of Psychiatry, The University of Western Australia, Perth, WA, Australia
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| |
Collapse
|
23
|
Tabatabaei-Jafari H, Salinas-Perez JA, Furst MA, Bagheri N, Mendoza J, Burke D, McGeorge P, Salvador-Carulla L. Patterns of Service Provision in Older People's Mental Health Care in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8516. [PMID: 33212966 PMCID: PMC7698522 DOI: 10.3390/ijerph17228516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/26/2022]
Abstract
Australia has a population of around 4 million people aged 65 years and over, many of whom are at risk of developing cognitive decline, mental illness, and/or psychological problems associated with physical illnesses. The aim of this study was to describe the pattern of specialised mental healthcare provision (availability, placement capacity, balance of care and diversity) for this age group in urban and rural health districts in Australia. The Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) tool was used in nine urban and two rural health districts of the thirty-one Primary Health Networks across Australia. For the most part service provision was limited to hospital and outpatient care across all study areas. The latter was mainly restricted to health-related outpatient care, and there was a relative lack of social outpatient care. While both acute and non-acute hospital care were available in urban areas, in rural areas hospital care was limited to acute care. Limited access to comprehensive mental health care, and the uniformity in provision across areas in spite of differences in demographic, socioeconomic and health characteristics raises issues of equity in regard to psychogeriatric care in this country. Comparing patterns of mental health service provision across the age span using the same classification method allows for a better understanding of care provision and gap analysis for evidence-informed policy.
Collapse
Affiliation(s)
- Hossein Tabatabaei-Jafari
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
| | - Jose A. Salinas-Perez
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
- Department of Quantitative Methods, Universidad Loyola Andalucía, 41704 Dos Hermanas, Sevilla, Spain
| | - Mary Anne Furst
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
| | - Nasser Bagheri
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
| | - John Mendoza
- Mental Health & Prison Health, Central Adelaide Local Health Network, Adelaide, SA 5000, Australia;
- Brain and Mind Centre, University of Sydney, Sydney, NSW 2050, Australia
| | - David Burke
- Discipline of Psychiatry, University of Notre Dame, Sydney, NSW 2010, Australia; (D.B.); (P.M.)
| | - Peter McGeorge
- Discipline of Psychiatry, University of Notre Dame, Sydney, NSW 2010, Australia; (D.B.); (P.M.)
- School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW 2006, Australia
| |
Collapse
|
24
|
Alonso-Solís A, Ochoa S, Grasa E, Rubinstein K, Caspi A, Farkas K, Unoka Z, Usall J, Huerta-Ramos E, Isohanni M, Seppälä J, Reixach E, Berdún J, Corripio I, Group MRESIST. A Method to Compare the Delivery of Psychiatric Care for People with Treatment-Resistant Schizophrenia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207527. [PMID: 33081208 PMCID: PMC7589763 DOI: 10.3390/ijerph17207527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Community services are gaining ground when it comes to attention to patients with psychiatric diseases. Regarding patients with treatment-resistant schizophrenia (TRS), the use of information and communication technology (ICT) could help to shift the focus from hospital-centered attention to community services. This study compares the differences in mental health services provided for patients with TRS in Budapest (Hungary), Tel-Aviv (Israel) and Catalonia (Spain) by means of a method for the quick appraisal of gaps among the three places, for a potential implementation of the same ICT tool in these regions. METHODS An adapted version of the Description and Standardised Evaluation of Services and Directories in Europe for Long Term Care (DESDE-LTC) instrument was made by researchers in Semmelweis University (Budapest, Hungary), Gertner Institute (Tel-Aviv, Israel) and Hospital de la Santa Creu I Sant Pau and Parc Sanitari Sant Joan de Déu (Catalonia, Spain). RESULTS Two types of outpatient care services were available in the three regions. Only one type of day-care facility was common in the whole study area. Two residential care services, one for acute and the other for non-acute patients were available in every region. Finally, two self-care and volunteer-care facilities were available in the three places. CONCLUSION Although the availability of services was different in each region, most of the services provided were sufficiently similar to allow the implementation of the same ICT solution in the three places.
Collapse
Affiliation(s)
- Anna Alonso-Solís
- Psychiatry Department, Institutd’ Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa CreuiSant Pau; Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain; (A.A.-S.); (E.G.); (I.C.)
- CIBERSAM, Biomedical Research Networking Centre Consortium on Mental Health, 28029 Madrid, Spain; (S.O.); (E.H.-R.)
| | - Susana Ochoa
- CIBERSAM, Biomedical Research Networking Centre Consortium on Mental Health, 28029 Madrid, Spain; (S.O.); (E.H.-R.)
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi Llobregat, Barcelona, Spain
| | - Eva Grasa
- Psychiatry Department, Institutd’ Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa CreuiSant Pau; Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain; (A.A.-S.); (E.G.); (I.C.)
- CIBERSAM, Biomedical Research Networking Centre Consortium on Mental Health, 28029 Madrid, Spain; (S.O.); (E.H.-R.)
| | - Katya Rubinstein
- The Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Aviv University, 6997801 Tel Aviv, Israel; (K.R.); (A.C.)
| | - Asaf Caspi
- The Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Tel-Aviv University, 6997801 Tel Aviv, Israel; (K.R.); (A.C.)
| | - Kinga Farkas
- Department of Psychiatry and Psychotherapy, Semmelweis University, 1083 Budapest, Hungary; (K.F.); (Z.U.)
| | - Zsolt Unoka
- Department of Psychiatry and Psychotherapy, Semmelweis University, 1083 Budapest, Hungary; (K.F.); (Z.U.)
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi Llobregat, Barcelona, Spain
- Correspondence:
| | - Elena Huerta-Ramos
- CIBERSAM, Biomedical Research Networking Centre Consortium on Mental Health, 28029 Madrid, Spain; (S.O.); (E.H.-R.)
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi Llobregat, Barcelona, Spain
| | - Matti Isohanni
- Centre for Life Course Health Research, University of Oulu, 90570 Oulu, Finland; (M.I.); (J.S.)
- Department of Psychiatry, Oulu University Hospital, 90220 Oulu, Finland
| | - Jussi Seppälä
- Centre for Life Course Health Research, University of Oulu, 90570 Oulu, Finland; (M.I.); (J.S.)
- South Carelia Social and Health Care District, Psychiatric and Substance Use Services, 53130 Lappeenranta, Finland
| | - Elisenda Reixach
- TicSalut Health Department, Generalitat de Catalunya 08005 Barcelona, Spain; (E.R.); (J.B.)
| | - Jesús Berdún
- TicSalut Health Department, Generalitat de Catalunya 08005 Barcelona, Spain; (E.R.); (J.B.)
| | - Iluminada Corripio
- Psychiatry Department, Institutd’ Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa CreuiSant Pau; Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain; (A.A.-S.); (E.G.); (I.C.)
- CIBERSAM, Biomedical Research Networking Centre Consortium on Mental Health, 28029 Madrid, Spain; (S.O.); (E.H.-R.)
| | | |
Collapse
|
25
|
Salinas-Perez JA, Gutierrez-Colosia MR, Furst MA, Suontausta P, Bertrand J, Almeda N, Mendoza J, Rock D, Sadeniemi M, Cardoso G, Salvador-Carulla L. Patterns of Mental Health Care in Remote Areas: Kimberley (Australia), Nunavik (Canada), and Lapland (Finland): Modèles de soins de santé mentale dans les régions éloignées: Kimberley (Australie), Nunavik (Canada) et Laponie (Finlande). CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:721-730. [PMID: 32720514 PMCID: PMC7502882 DOI: 10.1177/0706743720944312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Mental health (MH) care in remote areas is frequently scarce and fragmented and difficult to compare objectively with other areas even in the same country. This study aimed to analyze the adult MH service provision in 3 remote areas of Organization for Economic Cooperation and Development countries in the world. METHODS We used an internationally agreed set of systems indicators, terminology, and classification of services (Description and Evaluation of Services and DirectoriEs for Long Term Care). This instrument provided a standard description of MH care provision in the Kimberley region (Australia), Nunavik (Canada), and Lapland (Finland), areas characterized by an extremely low population density and high relative rates of Indigenous peoples. RESULTS All areas showed high rates of deprivation within their national contexts. MH services were mostly provided by the public sector supplemented by nonprofit organizations. This study found a higher provision per inhabitant of community residential care in Nunavik in relation to the other areas; higher provision of community outreach services in the Kimberley; and a lack of day services except in Lapland. Specific cultural-based services for the Indigenous population were identified only in the Kimberley. MH care in Lapland was self-sufficient, and its care pattern was similar to other Finnish areas, while the Kimberley and Nunavik differed from the standard pattern of care in their respective countries and relied partly on services located outside their boundaries for treating severe cases. CONCLUSION We found common challenges in these remote areas but a huge diversity in the patterns of MH care. The implementation of care interventions should be locally tailored considering both the environmental characteristics and the existing pattern of service provision.
Collapse
Affiliation(s)
- Jose A. Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, Spain
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Mencia R. Gutierrez-Colosia
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, Spain
- Asociación Científica Psicost, Dos Hermanas, Sevilla, Spain
| | - Mary Anne Furst
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Petra Suontausta
- Faculty of Social Sciences, Tampere University, Pirkanmaa, Finland
| | | | - Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, Spain
| | - John Mendoza
- ConNetica Consulting, Coolum, Queensland, Australia
| | - Daniel Rock
- WA Primary Health Alliance, Perth, Western Australia, Australia
- Discipline of Psychiatry, The University of Western Australia, Perth, Western Australia, Australia
| | - Minna Sadeniemi
- Unit for Mental Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health, Comprehensive Health Research Center (CHRC), Nova Medical School, Nova University of Lisbon, Portugal
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| |
Collapse
|
26
|
Salinas-Pérez JA, Gutiérrez-Colosia MR, Romero López-Alberca C, Poole M, Rodero-Cosano ML, García-Alonso CR, Salvador-Carulla L. [Everything is on the map: Integrated Mental Health Atlases as support tools for service planning. SESPAS Report 2020]. GACETA SANITARIA 2020; 34 Suppl 1:11-19. [PMID: 32933792 DOI: 10.1016/j.gaceta.2020.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 06/04/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This article reviews the usability of the Integrated Atlases of Mental Health as a decision support tool for service planning following a health ecosystem research approach. METHOD This study describes the types of atlases and the procedure for their development. Atlases carried out in Spain are presented and their impact in mental health service planning is assessed. Atlases comprise information on the local characteristics of the health care system, geographical availability of resources collected with the DESDE-LTC instrument and their use. Atlases use geographic information systems and other visualisation tools. Atlases follow a bottom-up collaborative approach involving decision-makers from planning agencies for their development and external validation. RESULTS Since 2005, Integrated Atlases of Mental Health have been developed for nine regions in Spain comprising over 65% of the Spanish inhabitants. The impact on service planning has been unequal for the different regions. Catalonia, Biscay and Gipuzkoa, and Andalusia reach the highest impact. In these areas, health advisors have been actively involved in their co-design and implementation in service planning. CONCLUSIONS Atlases allow detecting care gaps and duplications in care provision; monitoring changes of the system over time, and carrying out national and international comparisons, efficiency modelling and benchmarking. The knowledge provided by atlases could be incorporated to decision support systems in order to support an efficient mental health service planning based on evidence-informed policy.
Collapse
Affiliation(s)
- José A Salinas-Pérez
- Asociación Científica Psicost, Sevilla, España; Departamento de Métodos Cuantitativos, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, España.
| | - Mencía R Gutiérrez-Colosia
- Asociación Científica Psicost, Sevilla, España; Departamento de Psicología, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, España
| | - Cristina Romero López-Alberca
- Asociación Científica Psicost, Sevilla, España; Departamento de Psicología, Universidad de Cádiz, San Fernando, Cádiz, España
| | - Miriam Poole
- Asociación Científica Psicost, Sevilla, España; Asociación Nuevo Futuro, Madrid, España
| | - María Luisa Rodero-Cosano
- Asociación Científica Psicost, Sevilla, España; Departamento de Métodos Cuantitativos, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, España
| | - Carlos R García-Alonso
- Asociación Científica Psicost, Sevilla, España; Departamento de Métodos Cuantitativos, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, España
| | - Luis Salvador-Carulla
- Asociación Científica Psicost, Sevilla, España; Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia; Menzies Centre for Health Policy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| |
Collapse
|
27
|
Salvador-Carulla L, Almeda N, Álvarez-Gálvez J, García-Alonso C. [On the roller coaster: An abridged history of mental health planning in Spain. SESPAS Report 2020]. GACETA SANITARIA 2020; 34 Suppl 1:3-10. [PMID: 32843197 DOI: 10.1016/j.gaceta.2020.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/18/2020] [Accepted: 06/02/2020] [Indexed: 01/29/2023]
Abstract
Effective mental health change in Spain started in 1985 with the Report of the Ministerial Commission for the Psychiatric Reform that recommended integrating psychiatric care into the general health system, providing care in the patient's context and for specific diagnoses. The SESPAS 2002 Report carried out an analysis of this reform and recommended the creation of a permanent ministerial commission, the design of a national map of socio-sanitary mental health services, the creation of a coordination and promotion agency for and carrying out a financial analysis of resource provision and research. Since 2004, the Technical Committee for the Mental Health Strategy boosted the elaboration of a theoretical and normative framework that unfortunately did not lead to a road map for the improvement of the system. After 2011, during the financial crisis, the Ministry of Health lost the opportunity to lead a second phase of change of the mental health care, which was evidence-based: no key technical reports were published nor was an action plan based on data developed. Currently, the 1985 community mental health model is still the general framework of mental health care with the addition of aspects related to the recovery model and the balance of care model. Significant progress has been made in developing care systems assessment methods and data-based models that could advance mental health planning. The gap between general health attention and mental health care has increased and the expected reform of the mental health system will not take place in the near future.
Collapse
Affiliation(s)
- Luis Salvador-Carulla
- Asociación Científica Psicost, Sevilla, España; Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | - Nerea Almeda
- Asociación Científica Psicost, Sevilla, España; Departamento de Psicología, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, España.
| | - Javier Álvarez-Gálvez
- Asociación Científica Psicost, Sevilla, España; Departamento de Biomedicina, Biotecnología y Salud Pública, Universidad de Cádiz, Cádiz, España
| | - Carlos García-Alonso
- Asociación Científica Psicost, Sevilla, España; Departamento de Métodos Cuantitativos, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, España
| |
Collapse
|
28
|
Abstract
PURPOSE OF REVIEW The aim of this article is to provide a framework and analysis of a series of critical components to inform the future design, development, sustaining, and monitoring of community mental health services. RECENT FINDINGS Many mental health services remain too hospital-centric, often without adequate outreach services. On the basis of outcome evidence, we need to shift the balance of mental health services from hospital-centered with community outreach when convenient for staff, to community-centered and mobile, with in-reach to hospital only when necessary. Too few training programs those with emphasize the macroskills of public advocacy, working with service users, families, social movements, and the media to improve mental health and wellbeing of regional and local communities. SUMMARY We should adopt a health ecosystems approach to mental healthcare and training, encompassing nano to macrolevels of service in every region. Catchment mental health services should be rebuilt as community-centric mental health services, integrating all community and inpatient components, but led and integrated from community sites. Community psychiatrists and mental health professionals of the future will need to be well trained in the nano to macroskills required to take responsibility for the mental health and wellbeing of their catchment communities and to provide leadership in service-planning, management, and continuing revision on the basis of rigorous evaluation. These approaches should be the core of all training in psychiatry and all mental health professions prior to any subspecialization.
Collapse
|
29
|
Exploring the identification, validation, and categorization of costs and benefits of education in mental health: The PECUNIA project. Int J Technol Assess Health Care 2020. [DOI: 10.1017/s0266462320000203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BackgroundMental health problems can lead to costs and benefits in other sectors (e.g. in the education sector) in addition to the healthcare sector. These related costs and benefits are known as intersectoral costs and benefits (ICBs). Although some ICBs within the education sector have been identified previously, little is known about their extensiveness and transferability, which is crucial for their inclusion in health economics research.ObjectivesThe aim of this study was to identify ICBs in the education sector, to validate the list of ICBs in a broader European context, and to categorize the ICBs using mental health as a case study.MethodsPreviously identified ICBs in the education sector were used as a basis for this study. Additional ICBs were extracted from peer-reviewed literature in PubMed and grey literature from six European countries. A comprehensive list of unique items was developed based on the identified ICBs. The list was validated by surveying an international group of educational experts. The survey results were used to finalize the list, which was categorized according to the care atom.ResultsAdditional ICBs in the education sector were retrieved from ninety-six sources. Fourteen experts from six European countries assessed the list for completeness, clarity, and relevance. The final list contained twenty-four ICBs categorized into input, throughput, and output.ConclusionBy providing a comprehensive list of ICBs in the education sector, this study laid further foundations for the inclusion of important societal costs in health economics research in the broader European context.
Collapse
|
30
|
Furst MA, Bagheri N, Salvador-Carulla L. An ecosystems approach to mental health services research. BJPsych Int 2020; 18:23-25. [PMID: 34287396 PMCID: PMC8274404 DOI: 10.1192/bji.2020.24] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/24/2020] [Accepted: 03/24/2020] [Indexed: 11/23/2022] Open
Abstract
Mental health ecosystems research is an emerging discipline which takes a whole-systems approach to mental healthcare, facilitating analysis of the complex environment and context of mental health systems, and translation of this knowledge into policy and practice. Evidence from the local context is needed in the analysis of complex interventions and of geographic variations in the outcomes of care. Technical tools and support have been developed to gather and interpret evidence from the local context and translate it in a meaningful and relevant manner for planners and policy makers to guide their decision-making.
Collapse
Affiliation(s)
- Mary Anne Furst
- Australian National University College of Health and Medicine.
| | - Nasser Bagheri
- Australian National University College of Health and Medicine.
| | | |
Collapse
|