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Prom MC, Stovall J, Bedregal LE, Phillips J, Davidson MA. Therapeutic alliance: satisfaction and attrition of patients from a mental health clinic in Ayacucho, Peru. Int Psychiatry 2018. [DOI: 10.1192/s1749367600004707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study examines the role of the patient–provider relationship (alliance) and patient satisfaction in early patient withdrawal from mental health therapy in rural Peru. A prospective comparison of 60 patients demonstrated that early withdrawal was associated with the clinician's, but not the patient's, evaluation of the patient–provider alliance. This suggests that the satisfaction and alliance questionnaires typically used in high-income countries may not be effective in evaluating patient attitudes in this population, but may be useful for clinician evaluations of the alliance. Clinicians can use the Working Alliance Inventory to indicate the need for early intervention to prevent patient drop-out in middle- and low-income countries.
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Abstract
The recovery model has permeated mental health systems by leading to the development of new psychiatric interventions and services and the reconfiguration of traditional ones. There is growing evidence that these interventions and services confer benefits in clinical and recovery-oriented outcomes. Despite the seeming adoption of recovery by policy makers, the transformation of mental health systems into recovery-oriented systems has been fraught with challenges.
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Minamisawa A, Narumoto J, Yokota I, Fukui K. Evaluation of factors associated with psychiatric patient dropout at a university outpatient clinic in Japan. Patient Prefer Adherence 2016; 10:1903-1911. [PMID: 27703335 PMCID: PMC5036564 DOI: 10.2147/ppa.s111178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient dropout from treatment can lead to a deterioration in clinical condition, thereby increasing the need for more intensive therapy that incurs substantial social and economic losses. The aim of this study was to identify factors related to psychiatric patient dropout at a university outpatient clinic in Japan. METHODS We retrospectively examined the medical charts of new psychiatric patients who were diagnosed with either a mood disorder (International Classification of Diseases, 10th revision, code: F3) or an anxiety disorder (F4) in the outpatient clinic at Kyoto Prefectural University of Medicine Hospital in Kyoto, Japan, between April 2010 and March 2013. The baseline characteristics of the patients (age, sex, Global Assessment of Functioning score, Clinical Global Impression-Severity of Illness score, education, occupation, marital status, duration of treatment, and prior treatment history), treating psychiatrist experience in years, and sex concordance between the patients and their treating psychiatrists were analyzed using Cox regression models. RESULTS From among 1,626 eligible new patients during the study period, 532 patients were enrolled in the study (F3: n=176; F4: n=356). The dropout rate was 35.7%, which was similar to that of previous studies. Higher educational level, being married, and lower Global Assessment of Functioning scores were associated with a lower dropout rate. Although psychiatrist experience was not significantly associated with patient dropout in the multivariate analysis, patients treated by less experienced psychiatrists had a higher hazard ratio for dropout (1.31; 95% confidence interval: 0.94-1.85). CONCLUSION In order to reduce the dropout rate, special focus should be placed on patients with the factors identified in this study, and young psychiatrists should undergo further education to foster adherence.
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Affiliation(s)
- Atsumi Minamisawa
- Department of Psychiatry
- Correspondence: Atsumi Minamisawa, Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokoji Kamigyo-ku, Kyoto City, Kyoto 602-8566, Japan, Tel +81 75 251 5612, Fax +81 75 251 5839, Email
| | | | - Isao Yokota
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Mulligan J, Haddock G, Hartley S, Davies J, Sharp T, Kelly J, Neil ST, Taylor CDJ, Welford M, Price J, Rivers Z, Barrowclough C. An exploration of the therapeutic alliance within a telephone-based cognitive behaviour therapy for individuals with experience of psychosis. Psychol Psychother 2014; 87:393-410. [PMID: 24464969 DOI: 10.1111/papt.12018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 09/21/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study investigated the therapeutic alliance (TA) between clients and therapists involved in a telephone-based cognitive behaviour therapy (CBT) oriented psychological intervention for individuals experiencing psychosis. DESIGN The telephone intervention involved recovery-focused CBT with use of a self-help guide and group intervention co-facilitated by colleagues with personal experience of psychosis. It was delivered as part of a Participant Preference Trial. METHODS Twenty-one client/therapist dyads were examined within this study. In addition to a measure of TA, clients completed measures of depression, social functioning, symptom severity, and strength of treatment preference, while therapists completed measures related to the level of shared formulation, therapist confidence, and therapeutic change estimates. RESULTS Therapeutic alliance levels were comparable to previously reported face-to-face psychosis intervention studies. Clients consistently reported significantly higher TA ratings compared to therapists. Depression scores and the strength of preference for treatment were significantly associated with client TA. Greater therapist perceived change was associated with higher therapist rated TA, while higher numbers of missed therapy sessions associated with lower therapist ratings. CONCLUSIONS Telephone-based psychosis interventions may support the formation of positive relationships that are comparable to the quality of relationships developed between therapists and clients during face-to-face CBT therapy. Methodological limitations including low participant numbers and heightened risk of a Type I error necessitate caution when interpreting findings. Further research into therapist and client variables associated with TA is required. PRACTITIONER POINTS Telephone delivered interventions to support people with psychosis-related difficulties can result in the development of a good quality TA between therapists and clients. There is a significant difference between therapist and client ratings of TA. Clients tend to score the quality of the TA significantly more highly than therapists. Providing clients with choice when participating in therapeutic interventions could potentially contribute towards improved TA reporting by clients.
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Affiliation(s)
- John Mulligan
- Psychosis Research Unit, Greater Manchester West Mental Health Foundation Trust, Prestwich, UK
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Abstract
Filling an alarming gap in evidence-based data on the post-1978 reformed Italian psychiatric system, two turn-of-millennium nationwide projects, Progetto Residenze (PROGRES) and PROGRES-Acute, provided detailed qualitative-quantitative information about care facilities. In 2000, there were 2.9 residential beds per 10,000 inhabitants, hospital care being delivered through small (15-bed) psychiatric units. Private inpatient facilities had proliferated, private inpatient beds per 10,000 inhabitants outnumbering public beds. In 2002, there were 1.7 acute inpatient beds per 10,000 inhabitants, one of Europe's lowest current ratios. The PROGRES and other subsequent projects showed marked nationwide variation in the provision of residential inpatient and outpatient care, grounds for concern about the quality of such care, and an uneven service use pattern. Although the Italian reform law produced a broad network of facilities to meet diverse mental health care needs, the present overview article confirms that further efforts are required to improve quality, balance public and private sectors, and coordinate resources and agencies.
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Abstract
Outcome measurement, to be valid, reliable, and useful to both program planning and evaluation of interventions, should be based on the principle of multiaxiality (i.e., considering the perspectives of all those involved in the care process, including clinicians, patients, caregivers, users' representatives, third-party payers) and of multidimensionality (i.e., considering an intervention's effect on various dimensions of patients' life, including clinical outcomes such as psychopathology, disability, and needs for care and self-perceived outcomes such as quality of life and service satisfaction). Unfortunately, in Italy, this methodology has not been applied on a large scale. However, some Italian centers with a long-lasting tradition in the area of psychiatric epidemiology have provided evidence that outcome assessment in routine practice is not only sustainable but also advantageous in the medium- and long-term. This article summarizes the results obtained in some of these studies, including three longitudinal studies on the outcome of community psychiatric care promoted by the research group of South Verona, such as the South Verona Outcome Project, the Psychosis Incident Cohort Outcome Study, and the Genetics Endophenotypes and Treatment: Understanding early Psychosis - • Psychosis: early Intervention and Assessment of Needs and Outcome trial.Implementation of routine outcome assessment can lead-and to a certain extent has already led-to a cultural change among Italian mental health service staff members, to facilitate a) the establishment of a revision-of-practice process, b) greater acceptance of the importance of evidence, and a predisposition to put it into practice.
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Lee J, Korczak D. Factors Associated with Parental Satisfaction with a Pediatric Crisis Clinic (PCC). JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2014; 23:118-127. [PMID: 24872827 PMCID: PMC4032080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 03/05/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Little is known about parental satisfaction with pediatric crisis clinics (PCCs) that provide a single consultation to families in need of urgent psychiatric care. Parental satisfaction may improve long-term adherence to physician recommendations. OBJECTIVE To explore parental satisfaction with a PCC. METHODS Parental satisfaction was ascertained by a structured telephone interview following crisis consultation at the PCC of an academic, tertiary care centre. METHODS Parents of 71% (n = 124) of 174 pediatric patients seen in the PCC from 2007-2008 participated in the post-consultation interview. RESULTS The majority of parents stated they were either somewhat satisfied (49/122, 40.2%) or very satisfied (49/122, 40.2%) with the PCC. Parental satisfaction correlated with time between referral and consultation (p<0.05), the degree to which parents felt listened to by the consultant (p<0.01), the amount of psychoeducation parents felt they received (p<0.01), and appointment length (p<0.001). CONCLUSIONS Parents were satisfied overall with an urgent care service model. Satisfaction was correlated with the time between referral and consultation, degree to which they felt their consultant had listened to them, and the amount of information they received at the consultation's conclusion.
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Affiliation(s)
- Jonathan Lee
- Department of Psychiatry, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Daphne Korczak
- Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
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Mavrogiorgou P, Siebers F, Juckel G, Kienast T. Patient satisfaction with specialized mental health service for obsessive-compulsive disorder. Ann Gen Psychiatry 2013; 12:41. [PMID: 24341311 PMCID: PMC4029369 DOI: 10.1186/1744-859x-12-41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 12/02/2013] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Patient satisfaction is an important outcome variable that is increasingly used in mental health service evaluation. There are no results available for patients with obsessive-compulsive disorder (OCD) yet. METHODS Using the Verona Service Satisfaction Scale, patient satisfaction with a specialized mental health service was examined in patients with OCD. RESULTS OCD patients were overall satisfied with the professional help provided, whereas satisfaction with the professional involvement of relatives within the treatment and health care process was found to be quite low. Patients with more severe OCD, as measured by the Yale-Brown Obsessive-Compulsive Scale, as well as chronically ill and more disabled patients were more likely to be dissatisfied with the overall care they received. Patient satisfaction plays an important role in the long-term course of an illness such OCD. This seems to be decreased so longer illness is not or badly treated. There is a stronger need for involvement of family members in the treatment and health care of patients with OCD. CONCLUSIONS More OCD-specific treatment offers have to be established for patients with this long-term illness such as psychotherapy in groups.
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Affiliation(s)
- Paraskevi Mavrogiorgou
- Department of Psychiatry, Ruhr University Bochum, LWL-Universitätsklinikum, Alexandrinenstr 1, Bochum 44791, Germany
| | - Frauke Siebers
- Department of Psychiatry, Ruhr University Bochum, LWL-Universitätsklinikum, Alexandrinenstr 1, Bochum 44791, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL-Universitätsklinikum, Alexandrinenstr 1, Bochum 44791, Germany
| | - Thorsten Kienast
- Department of Psychiatry and Psychotherapy, Charite Campus Mitte, Universitätsmedizin Berlin, Chariteplatz 1, Berlin 10117, Germany
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Post-inpatient attrition from care "as usual" in veterans with multiple psychiatric admissions. Community Ment Health J 2013; 49:694-703. [PMID: 23086009 DOI: 10.1007/s10597-012-9544-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 09/18/2012] [Indexed: 10/27/2022]
Abstract
Disengagement from outpatient care following psychiatric hospitalization is common in high-utilizing psychiatric patients and contributes to intensive care utilization. To investigate variables related to treatment attrition, a range of demographic, diagnostic, cognitive, social, and behavioral variables were collected from 233 veterans receiving inpatient psychiatric services who were then monitored over the following 2 years. During the follow-up period, 88.0 % (n = 202) of patients disengaged from post-inpatient care. Attrition was associated with male gender, younger age, increased expectations of stigma, less short-term participation in group therapy, and poorer medication adherence. Of those who left care, earlier attrition was predicted by fewer prior-year inpatient psychiatric days, fewer lifetime psychiatric hospitalizations, increased perceived treatment support from family, and less short-term attendance at psychiatrist appointments. Survival analyses were used to analyze the rate of attrition of the entire sample as well as the sample split by short-term group therapy attendance. Implications are discussed.
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Fenger M, Mortensen EL, Poulsen S, Lau M. No-shows, drop-outs and completers in psychotherapeutic treatment: demographic and clinical predictors in a large sample of non-psychotic patients. Nord J Psychiatry 2011; 65:183-91. [PMID: 20854221 DOI: 10.3109/08039488.2010.515687] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A primary challenge in mental health services is a high rate of non-attendance (i.e. no-show and drop-out) for patients referred to treatment for psychiatric disorders. AIM The aim of the present study was to assess the influence of demographic and clinical variables on mental health treatment attendance and to investigate differences in predictors for no-shows and drop-outs. METHODS A naturalistic study of 2473 non-psychotic consecutive patients offered psychotherapeutic treatment at a community mental health centre in Denmark. Fifteen demographic and clinical variables were recorded at assessment. Bivariate and multiple logistic regression analyses were conducted to investigate the associations between these variables and no-show and drop-out. RESULTS Of the 2473 participants, 668 (27.0%) did not show up for treatment, whereas 290 (11.7%) dropped out of treatment. Regression analysis showed that the significant predictors of treatment no-show were: age below 25, no more than the compulsory 9 years of school education, no sick leave, a diagnosis of personality disorder, a Global Assessment of Functioning score (GAF) below 40 or above 70, no previous psychiatric/psychological treatment, no use of antidepressants and substance abuse. The significant predictors of treatment drop-out were: age below 45, no more than the compulsory 9 years of school education or up to 11 years of school education, no vocational/university education, unemployment and substance abuse. CONCLUSION No-show was predicted by both demographic and clinical factors, whereas drop-out was predicted by demographic factors and substance abuse as the only clinical factor. Results and strategies to reduce non-attendance are discussed.
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Affiliation(s)
- Morten Fenger
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark. Morten.Fenger@.regionh.dk
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Morlino M, Buonocore M, Calento A, Ravel MG, Schiavone V. First contact with psychiatric services: who leaves and who remains. Gen Hosp Psychiatry 2009; 31:367-75. [PMID: 19555798 DOI: 10.1016/j.genhosppsych.2009.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 02/16/2009] [Accepted: 02/20/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objective of this study was to obtain information on patients in their first contact with community mental health departments in the south of Italy, particularly on dropout patients leaving care without a previous agreement. METHOD A 3-month cohort of 265 "first-contact" psychiatric patients assisted at four different community mental health centers (CMHCs) was examined and followed up at 6 months. RESULTS The overall dropout rate after 6 months was 38.7%; it was higher for patients receiving pharmacological therapy alone and for patients seeking help on their own initiative, whereas physician-referred patients showed a lower dropout rate. More severely ill patients, as evaluated by physicians, showed dropout rates lower than those of patients "rating" themselves as severely ill. CONCLUSIONS To lower dropout rates in CMHC settings, physicians should be provided with more concrete support in the patient selection and referral process. Greater focus should be placed on patients' motivational aspects and on their perceptions of their own symptom severity, as well as on the risks of dispensing "easy" solutions such as pharmacological therapy alone.
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Affiliation(s)
- Massimo Morlino
- Section of Psychiatry, Department of Neurosciences, University Medical School Federico II, 80131 Naples, Italy.
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Kreyenbuhl J, Nossel IR, Dixon LB. Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: a review of the literature. Schizophr Bull 2009; 35:696-703. [PMID: 19491314 PMCID: PMC2696379 DOI: 10.1093/schbul/sbp046] [Citation(s) in RCA: 257] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Disengagement from mental health services can lead to devastating consequences for individuals with schizophrenia and other serious mental illnesses who require ongoing treatment. We review the extent and correlates of dropping out of mental health treatment for individuals with schizophrenia and suggest strategies for facilitating treatment engagement. Although rates vary across studies, reviews of the literature suggest that up to one-third of individuals with serious mental illnesses who have had some contact with the mental health service system disengage from care. Younger age, male gender, ethnic minority background, and low social functioning have been consistently associated with disengagement from mental health treatment. Individuals with co-occurring psychiatric and substance use disorders, as well as those with early-onset psychosis, are at particularly high risk of treatment dropout. Engagement strategies should specifically target these high-risk groups, as well as high-risk periods, including following an emergency room or hospital admission and the initial period of treatment. Interventions to enhance engagement in mental health treatment range from low-intensity interventions, such as appointment reminders, to high-intensity interventions, such as assertive community treatment. Disengagement from treatment may reflect the consumer's perspective that treatment is not necessary, is not meeting their needs, or is not being provided in a collaborative manner. An emerging literature on patient-centered care and shared decision making in psychiatry provides suggestive evidence that efforts to enhance client-centered communication and promote individuals' active involvement in mental health treatment decisions can also improve engagement in treatment.
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Affiliation(s)
- Julie Kreyenbuhl
- Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, 5th floor, 737 West Lombard Street, Baltimore, MD 21201, USA.
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Kumari S, Mishra SN, Chaudhury S, Singh AR, Verma AN, Kumari S. An experience of community mental health program in rural areas of Jharkhand. Ind Psychiatry J 2009; 18:47-50. [PMID: 21234163 PMCID: PMC3016700 DOI: 10.4103/0972-6748.57860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In the present era, mental disability is a major public health problem in the society. Many of the mental disabilities are correctable if detected early. OBJECTIVES To assess the prevalence and pattern of mental disability. MATERIALS AND METHODS Community-based cross-sectional study. Patients of all age groups in the age range of 0-60 years were randomly selected from 10 blocks of 2 districts, viz., Ranchi and Hazaribagh. Thirty villages from each block were taken for the study. The study was conducted by making house-to-house visits, interviewing and examining all the individuals in the families selected using pre-tested questionnaire. STATISTICAL ANALYSIS It was done by the proportions. RESULTS AND CONCLUSION The prevalence of mental disability was found higher among males (67.9%) than among females (32.1%). The prevalence rate was higher among the productive groups and among individuals with low socioeconomic status. There is scope of community-based rehabilitation of the mentally disabled.
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Thara R, Padmavati R, Aynkran JR, John S. Community mental health in India: A rethink. Int J Ment Health Syst 2008; 2:11. [PMID: 18625047 PMCID: PMC2499987 DOI: 10.1186/1752-4458-2-11] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 07/14/2008] [Indexed: 11/16/2022] Open
Abstract
Background Community care of the chronic mentally ill has always been prevalent in India, largely due to family involvement and unavailability of institutions. In the 80s, a few mental health clinics became operational in some parts of the country. The Schizophrenia Research Foundation (SCARF), an NGO in Chennai had established a community clinic in 1989 in Thiruporur, which was functional till 1999. During this period various programmes such as training of the primary health center staff, setting up a referral system, setting up of a Citizen's Group, and self-employment schemes were initiated. It was decided to begin a follow up in 2005 to determine the present status of the schemes as well as the current status of the patients registered at the clinic. This we believed would lead to pointers to help evolve future community based programmes. Methods One hundred and eighty five patients with chronic mental illness were followed up and their present treatment status determined using a modified version of the Psychiatric and Personal History Schedule (PPHS). The resources created earlier were assessed and qualitative information was gathered during interviews with patient and families and other stakeholders to identify the reasons behind the sustenance or failure of these initiatives. Results Of the 185 patients followed up, 15% had continued treatment, 35% had stopped treatment, 21% had died, 12% had wandered away from home and 17% were untraceable. Of the patients who had discontinued treatment 25% were asymptomatic while 75% were acutely psychotic. The referral service was used by only 15% of the patients and mental health services provided by the PHC stopped within a year. The Citizen's group was functional for only a year and apart from chicken rearing, all other self-employment schemes were discontinued within a period of 6 months to 3 years. There were multiple factors contributing to the failure, the primary reasons being the limited access and associated expenses entailed in seeking treatment, inadequate knowledge about the illness, lack of support from the family and community and continued dependence by the family on the service provider to provide solutions. Conclusion Community based initiatives in the management of mental disorders however well intentioned will not be sustainable unless the family and the community are involved in the intervention program with support being provided regularly by mental health professionals.
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Affiliation(s)
- Rangawsamy Thara
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar, West Extension, Chennai, 600101, India
| | - Ramachandran Padmavati
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar, West Extension, Chennai, 600101, India
| | - Jothy R Aynkran
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar, West Extension, Chennai, 600101, India
| | - Sujit John
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar, West Extension, Chennai, 600101, India
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