1
|
Duncan A, Stergiopoulos V, Dainty KN, Wodchis WP, Kirst M. Community mental health funding, stakeholder engagement and outcomes: a realist synthesis. BMJ Open 2023; 13:e063994. [PMID: 36725092 PMCID: PMC9896207 DOI: 10.1136/bmjopen-2022-063994] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
UNLABELLED Mental health services continues to be a high priority for healthcare and social service systems. Funding structures within community mental health settings have shown to impact service providers' behaviour and practices. Additionally, stakeholder engagement is suggested as an important mechanism to achieving the intended goals. However, the literature on community mental health funding reform and associated outcomes is inconsistent and there are no consistent best practices for stakeholder engagement in such efforts. OBJECTIVES This study sought to understand how stakeholder engagement impacts outcomes when there is a change in public funding within community mental health settings. DESIGN A realist synthesis approach was used to address the research question to fully understand the role of stakeholder engagement as a mechanism in achieving outcomes (system and service user) in the context of community mental health service reform. An iterative process was used to identify programme theories and context-mechanism-outcome configurations within the literature. RESULTS Findings highlight that in the absence of stakeholder engagement, funding changes may lead to negative outcomes. When stakeholders were engaged in some form, funding changes were more often associated with positive outcomes. Stakeholder engagement is multifaceted and requires considerable time and investment to support achieving intended outcomes when funding changes are implemented. CONCLUSIONS To support successful transformation of community mental health programmes, it is important that stakeholders are meaningfully engaged during funding allocation changes. Stakeholder engagement may entail connecting around a shared purpose, individual participation and meaningful interactions and dialogue.
Collapse
Affiliation(s)
- Andrea Duncan
- Department of Occupational Sciences & Occupational Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Leadership Team, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Katie N Dainty
- Patient Centred Outcomes, North York General Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Maritt Kirst
- Community Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
| |
Collapse
|
2
|
Suetani S, Kisely S, Parker S, Waterreus A, Morgan VA, Siskind D. Characteristics of people on community treatment orders in Australia: Data from the 2010 National Survey of High Impact Psychosis. Aust N Z J Psychiatry 2022; 56:788-799. [PMID: 34340594 DOI: 10.1177/00048674211036032] [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: 11/16/2022]
Abstract
OBJECTIVE Existing evidence on factors associated with community treatment order placement is largely restricted to administrative data. We utilised the data from a large nationally representative sample to compare the demographic, clinical, social functioning, substance use and service utilisation profiles of people living with psychosis under community treatment orders with those who were not. METHODS Participants were grouped based on whether they had been subject to a community treatment order in the past 12 months or not. We conducted logistic regressions to examine demographic, clinical, social functioning, substance use and service utilisation profiles associated with the two groups. RESULTS People who had recently been subject to community treatment orders were more likely to be treated with long-acting injectable antipsychotics and lacked insight but were less likely to report suicidal ideation. They also had higher psychiatric inpatient admission rates but a lower frequency of general practitioner visits. CONCLUSION People on community treatment orders in Australia may differ from those who are not under a community treatment order in their treatment needs. Resources and care provision must match the needs of this particularly vulnerable group.
Collapse
Affiliation(s)
- Shuichi Suetani
- The University of Queensland, Brisbane, QLD, Australia.,Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Wacol, QLD, Australia.,Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia.,School of Medicine, Griffith University, Nathan, QLD, Australia
| | - Steve Kisely
- The University of Queensland, Brisbane, QLD, Australia.,Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia
| | - Stephen Parker
- The University of Queensland, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Nathan, QLD, Australia.,The Prince Charles Hospital, Chermside, QLD, Australia
| | - Anna Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, The University of Western Australia, Perth, WA, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, The University of Western Australia, Perth, WA, Australia
| | - Dan Siskind
- The University of Queensland, Brisbane, QLD, Australia.,Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Wacol, QLD, Australia.,Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia
| |
Collapse
|
3
|
Song YJC, Rosenberg S, Smith B, Occhipinti JA, Mendoza J, Freebairn L, Skinner A, Hickie IB. Missing in action: the right to the highest attainable standard of mental health care. Int J Ment Health Syst 2022; 16:26. [PMID: 35690833 PMCID: PMC9187849 DOI: 10.1186/s13033-022-00537-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The right to the highest attainable standard of mental health remains a distant goal worldwide. The Report of the UN Special Rapporteur on the right of all people to enjoyment of the highest attainable standard of physical and mental health pleaded the urgent need for governments to act through appropriate laws and policies. We argue that Australia is in breach of international obligations, with inadequate access to mental health services, inconsistent mental health legislation across jurisdictions and ongoing structural (systematic) and individual discrimination. DISCUSSION Inadequate access to mental health services is a worldwide phenomenon. Australia has committed to international law obligations under the Convention on the Rights of Persons with Disabilities (CRPD) to 'promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disability, with respect to their inherent dignity'. This includes people with mental health impairment and this convention includes the right to 'the highest attainable standard of mental health'. Under the Australian Constitution, ratification of this convention enables the national government to pass laws to implement the convention obligations, and such national laws would prevail over any inconsistent state (or territory) laws governing mental health service provision. The authors argue that enabling positive rights through legislation and legally binding mental health service standards may facilitate enhanced accountability and enforcement of such rights. These steps may support critical key stakeholders to improve the standards of mental health service provision supported by the implementation of international obligations, thereby accelerating mental health system reform. Improved legislation would encourage better governance and the evolution of better services, making mental health care more accessible, without structural or individual discrimination, enabling all people to enjoy the highest attainable standard of health.
Collapse
Affiliation(s)
- Yun Ju C Song
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia.
- Mental Wealth Initiative, University of Sydney, Camperdown, Australia.
| | - Sebastian Rosenberg
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, Australia
| | - Belinda Smith
- Sydney Law School, University of Sydney, Camperdown, Australia
| | - Jo-An Occhipinti
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, Australia
| | - John Mendoza
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia
- Health and Sport Science, University of Sunshine Coast, Sippy Downs, Australia
| | - Louise Freebairn
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, Australia
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Adam Skinner
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia
| | - Ian B Hickie
- The Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Building F, Level 54, 94 Mallet Street, Camperdown, NSW, Australia
- Mental Wealth Initiative, University of Sydney, Camperdown, Australia
| |
Collapse
|
4
|
Vine R, Tibble H, Pirkis J, Spittal M, Judd F. The impact of substance use on treatment as a compulsory patient. Australas Psychiatry 2019; 27:378-382. [PMID: 31179714 DOI: 10.1177/1039856219852286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This paper considers the impact of having a diagnosis of substance use disorder on the utilisation of compulsory orders under the Victorian Mental Health Act (2014). METHODS We analysed the subsequent treatment episodes over 2 years of people who had been on a community treatment order for at least 3 months and determined the odds of a further treatment order if there was a diagnosis of substance use at or about the time the index community treatment order ended. RESULTS An additional diagnosis of a substance use disorder was coded in 47.7% and was associated with significantly increased odds of a subsequent treatment order in the following 2 years for those with a main diagnosis of schizophrenia (AOR = 3.03, p<0.001) and 'other' disorders (AOR = 11.60, p=0.002). Those with a main diagnosis of mood disorder had a significant increase in odds for an inpatient treatment order if there was an additional substance use disorder diagnosis (AOR = 3.81, p=0.006). CONCLUSIONS Having an additional diagnosis of substance use disorder was associated with increased likelihood of being placed on an order. This study supports greater emphasis being given to treatment of substance use concurrently with that of mental illness.
Collapse
Affiliation(s)
- Ruth Vine
- Associate Professor, NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Holly Tibble
- Research Assistant, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jane Pirkis
- Professor and Director, Centre for Mental Health, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Matthew Spittal
- Professor, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Fiona Judd
- Professor, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
5
|
Brophy L, Kokanovic R, Flore J, McSherry B, Herrman H. Community Treatment Orders and Supported Decision-Making. Front Psychiatry 2019; 10:414. [PMID: 31244699 PMCID: PMC6580382 DOI: 10.3389/fpsyt.2019.00414] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/24/2019] [Indexed: 11/26/2022] Open
Abstract
This paper presents findings from an interdisciplinary project undertaken in Victoria, Australia, investigating the barriers and facilitators to supported decision-making (SDM) for people living with diagnoses including schizophrenia, psychosis, bipolar disorder, and severe depression; family members supporting them; and mental health practitioners, including psychiatrists. We considered how SDM can be used to align Australian laws and practice with international human rights obligations. The project examined the experiences, views, and preferences of consumers of mental health services, including people with experiences of being on Community Treatment Orders (CTOs), in relation to enabling SDM in mental health service delivery. It also examined the perspectives of informal family members or carers and mental health practitioners. Victoria currently has high rates of use of CTOs, and the emphasis on SDM in the Mental Health Act, 2014, is proposed as one method for reducing coercion within the mental health system and working towards more recovery-oriented practice. Our findings cautiously suggest that SDM may contribute to reducing the use of CTOs, encouraging less use of coercive practices, and improving the experience of people who are subject to these orders, through greater respect for their views and preferences. Nonetheless, the participants in our study expressed an often ambivalent stance towards CTOs. In particular, the emphasis on medication as the primary treatment option and the limited communication about distressing side effects, alongside lack of choice of medication, was a primary source of concern. Fears, particularly among staff, about the risk of harm to self and others, and stigma attached to complex mental health conditions experienced by consumers and their families, represent important overarching concerns in the implementation of CTOs. Supporting the decision-making of people on CTOs, respecting their views and preferences about treatment, and moving towards reducing the use of CTOs require system-wide transformation and a significant shift in values and practice across mental health service delivery.
Collapse
Affiliation(s)
- Lisa Brophy
- School of Allied Health, Human Services and Sport, La Trobe University.,Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Mind Australia, Heidelberg, VIC, Australia
| | - Renata Kokanovic
- Social and Global Studies Centre, RMIT University, Melbourne, VIC, Australia
| | - Jacinthe Flore
- Social and Global Studies Centre, RMIT University, Melbourne, VIC, Australia
| | - Bernadette McSherry
- Melbourne Social Equity Institute and Melbourne Law School, The University of Melbourne, Parkville, VIC, Australia
| | - Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|