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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.
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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
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Kvestad CA, Holte IR, Reitan SK, Chiappa CS, Helle GK, Skjervold AE, Rosenlund AMA, Watne Ø, Brattland H, Helle J, Follestad T, Hara KW, Holgersen KH. Measuring the Effect of the Early assessment Team (MEET) for patients referred to outpatient mental health care: a study protocol for a randomised controlled trial. Trials 2024; 25:179. [PMID: 38468321 DOI: 10.1186/s13063-024-08028-6] [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: 10/06/2023] [Accepted: 03/01/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Referrals to specialised mental health care (such as community mental health centres; CMHC) have increased over the last two decades. Patients often have multifaceted problems, which cannot only be solved by such care. Resources are limited, and triaging is challenging. A novel method which approaches patients early and individually upon referral to a CMHC-possibly with a brief intervention-is an Early assessment Team (EaT). In an EaT, two therapists meet the patient early in the process and seek to solve the present problem, often involving community services, primary health care, etc.; attention is paid to symptoms and functional strife, rather than diagnoses. This is in contrast to treatment as usual (TAU), where the patient (after being on a waiting list) meets one therapist, who focuses on history and situation to assign a diagnosis and eventually start a longitudinal treatment. The aim of this study is to describe and compare EaT and TAU regarding such outcomes as work and social adjustment, mental health, quality of life, use of health services, and patient satisfaction. The primary outcome is a change in perceived function from baseline to 12-month follow-up, measured by the Work and Social Adjustment Scale. METHOD Patients (18 years and above; n = 588) referred to outpatient health care at a CMHC are randomised to EaT or TAU. Measures (patient self-reports and clinician reports, patients' records, and register data) are collected at baseline, after the first and last meeting, and at 2, 4, 8, 12, and 24 months after inclusion. Some participants will be invited to participate in qualitative interviews. TRIAL DESIGN The study is a single-centre, non-blinded, RCT with two conditions involving a longitudinal and mixed design (quantitative and qualitative data). DISCUSSION This study will examine an intervention designed to determine early on which patients will benefit from parallel or other measures than assessment and treatment in CMHC and whether these will facilitate their recovery. Findings may potentially contribute to the development of the organisation of mental health services. TRIAL REGISTRATION ClinicalTrials.gov NCT05087446. Registered on 21 October 2021.
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Affiliation(s)
- Camilla Angelsen Kvestad
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Ingvild Rønneberg Holte
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Solveig Klæbo Reitan
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Charlotte S Chiappa
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gunn Karin Helle
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne E Skjervold
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Marit A Rosenlund
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Øyvind Watne
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Heidi Brattland
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jon Helle
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Turid Follestad
- Clinical Research Unit Central Norway, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karen Walseth Hara
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Trondheim, Norway
- Norwegian Labour and Welfare Administration Trøndelag, Trondheim, Norway
| | - Katrine Høyer Holgersen
- Nidelv Community Mental Health Center, Clinic of Mental Health, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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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.
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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
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Diaz-Milanes D, Almeda N, Gutierrez-Colosia MR, Garcia-Alonso CR, Sadeniemi M, Salvador-Carulla L. Impact of the workforce allocation on the technical performance of mental health services: the collective case of Helsinki-Uusimaa (Finland). Health Res Policy Syst 2023; 21:108. [PMID: 37872626 PMCID: PMC10594770 DOI: 10.1186/s12961-023-01061-y] [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: 06/22/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Long-term mental health (MH) policies in Finland aimed at investing in community care and promoting reforms have led to a reduction in the number of psychiatric hospital beds. However, most resources are still allocated to hospital and community residential services due to various social, economic and political factors. Despite previous research focussing on the number and cost of these services, no study has evaluated the emerging patterns of use, their technical performance and the relationship with the workforce structure. OBJECTIVE The purpose of this study was to observe the patterns of use and their technical performance (efficiency) of the main types of care of MH services in the Helsinki-Uusimaa region (Finland), and to analyse the potential relationship between technical performance and the corresponding workforce structure. METHODS The sample included acute hospital residential care, non-hospital residential care and outpatient care services. The analysis was conducted using regression analysis, Monte Carlo simulation, fuzzy inference and data envelopment analysis. RESULTS The analysis showed a statistically significant linear relationship between the number of service users and the length of stay, number of beds in non-hospital residential care and number of contacts in outpatient care services. The three service types displayed a similar pattern of technical performance, with high relative technical efficiency on average and a low probability of being efficient. The most efficient acute hospital and outpatient care services integrated multidisciplinary teams, while psychiatrists and nurses characterized non-hospital residential care. CONCLUSIONS The results indicated that the number of resources and utilization variables were linearly related to the number of users and that the relative technical efficiency of the services was similar across all types. This suggests homogenous MH management with small variations based on workforce allocation. Therefore, the distribution of workforce capacity should be considered in the development of effective policies and interventions in the southern Finnish MH system.
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Affiliation(s)
- Diego Diaz-Milanes
- Department of Quantitative Methods, Universidad Loyola Andalucía, Avenida de las Universidades, S/N, Dos Hermanas, Seville, 41704, Cordova, Spain.
- Institute of Health Research, University of Canberra, Canberra, Australia.
| | - Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
| | | | - Carlos R Garcia-Alonso
- Department of Quantitative Methods, Universidad Loyola Andalucía, Avenida de las Universidades, S/N, Dos Hermanas, Seville, 41704, Cordova, Spain
- Institute of Health Research, University of Canberra, Canberra, Australia
| | | | - Luis Salvador-Carulla
- Institute of Health Research, University of Canberra, Canberra, Australia
- Health Information Systems Group (SICA-CTS-553), University of Cadiz, Cadiz, Spain
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Katschnig H, Straßmayr C, Endel F, Posch M, Steiner I. Are early post-discharge physician contacts associated with 30-day psychiatric re-hospitalisation? A nationwide claims data based retrospective cohort study in Austria free of immortal time bias. Int J Methods Psychiatr Res 2023; 33:e1983. [PMID: 37608583 PMCID: PMC10804335 DOI: 10.1002/mpr.1983] [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: 05/17/2023] [Revised: 06/28/2023] [Accepted: 07/27/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVES Cost containment and quality of care considerations have increased research interest in the potential preventability of early re-hospitalisations. Various registry-based retrospective cohort studies on psychiatric re-hospitalisation have focused on the role of early post-discharge service contacts, but either did not consider their time-dependent nature ('immortal time bias') or evaded the issue by analysing late re-hospitalisations. The present study takes care of the immortal time bias in studying early psychiatric re-hospitalisations. METHODS In a retrospective cohort study using nationwide electronic claims data in Austria, 10,689 adults discharged from acute psychiatric inpatient wards were followed up for 30 days. Cox regression analyses were performed with post-discharge psychiatric and general practitioner contacts as time-dependent covariates and time to first psychiatric re-hospitalisation as outcome. RESULTS Post-discharge ambulatory physician contacts were significantly associated with a decreased psychiatric re-hospitalisation rate (hazard ratio 0.77 [95% CI 0.69; 0.87], p < 0.0001), with similarly strong contributions to this association by general practitioners and psychiatrists. CONCLUSIONS Despite avoiding the immortal time bias and controlling for several confounders, we suggest to be cautious with a causal interpretation of the identified association, since potentially relevant confounders, such as disease severity, were unavailable in our claims data base.
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Affiliation(s)
- H. Katschnig
- Department of PsychiatryMedical University of ViennaViennaAustria
- IMEHPS.researchViennaAustria
| | | | | | - M. Posch
- Medical University of ViennaCenter for Medical Data ScienceInstitute of Medical StatisticsViennaAustria
| | - I. Steiner
- Medical University of ViennaCenter for Medical Data ScienceInstitute of Medical StatisticsViennaAustria
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Manesh AE, Dalvandi A, Zoladl M. The experience of stigma in family caregivers of people with schizophrenia spectrum disorders: A meta-synthesis study. Heliyon 2023; 9:e14333. [PMID: 36938397 PMCID: PMC10015248 DOI: 10.1016/j.heliyon.2023.e14333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 02/15/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023] Open
Abstract
Introduction Schizophrenia is a chronic disabling and the most stigmatizing mental disorder worldwide. The stigma experienced by family caregivers impacts their lives in different ways. This study reports the results of qualitative synthesis to understand the perceptions and experiences of stigma in families of people with schizophrenia spectrum disorders across various socio-cultural contexts. Methods An initial comprehensive search was performed in databases like Web of Science, PsycINFO, CINAHL, Scopus, and Ovid-based MEDLINE. By searching, 3560 studies were found, of which 16 articles were included in the present study. A meta-synthesis was done according to the meta-ethnographic approach. Result Three themes were generated: perpetuated stigma by general misunderstandings about schizophrenia, mental health inequality contributes to structural stigma, and long-term family caregiving stigmas, attitudes, and coping strategies. These themes indicated the essential experiences of stigma in families of people with schizophrenia, which appeared due to unknown and socio-cultural misconceptions of schizophrenia that led to emotional challenges for family caregivers. Conclusion This study addresses stigma-related issues, and coping strategies used almost exclusively by family caregivers. Health policymakers and healthcare professionals working in mental health institutions should consider this data. Substantial steps must be taken to combat stigma, with education initiatives topping the list.
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Affiliation(s)
- Azadeh Eghbal Manesh
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Science, Islamic Azad University, Tehran, Iran
| | - Asghar Dalvandi
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Science, Islamic Azad University, Tehran, Iran
- Corresponding author.
| | - Mohammad Zoladl
- Associate Professor of Nursing, Yasuj University of Medical Sciences, Yasuj, Iran
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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.
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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
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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.
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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
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Furst MA, Salinas-Perez JA, Gutiérrez-Colosia MR, Salvador-Carulla L. A new bottom-up method for the standard analysis and comparison of workforce capacity in mental healthcare planning: Demonstration study in the Australian Capital Territory. PLoS One 2021; 16:e0255350. [PMID: 34314451 PMCID: PMC8315559 DOI: 10.1371/journal.pone.0255350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022] Open
Abstract
The aims of this study are to evaluate and describe mental health workforce and capacity, and to describe the relationship between workforce capacity and patterns of care in local areas. We conducted a comparative demonstration study of the applicability of an internationally validated standardised service classification instrument—the Description and Evaluation of Services and Directories—DESDE-LTC) using the emerging mental health ecosystems research (MHESR) approach. Using DESDE-LTC as the framework, and drawing from international occupation classifications, the workforce was classified according to characteristics including the type of care provided and professional background. Our reference area was the Australian Capital Territory, which we compared with two other urban districts in Australia (Sydney and South East Sydney) and three benchmark international health districts (Helsinki-Uusima (Finland), Verona (Italy) and Gipuzkoa (Spain)). We also compared our data with national level data where available. The Australian and Finnish regions had a larger and more highly skilled workforce than the southern European regions. The pattern of workforce availability and profile varied, even within the same country, at the local level. We found significant differences between regional rates of identified rates of psychiatrists and psychologists, and national averages. Using a standardised classification instrument at the local level, and our occupational groupings, we were able to assess the available workforce and provide information relevant to planners about the actual capacity of the system. Data obtained at local level is critical to providing planners with reliable data to inform their decision making.
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Affiliation(s)
- Mary Anne Furst
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
- * E-mail:
| | | | | | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
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Trane K, Aasbrenn K, Rønningen M, Odden S, Lexén A, Landheim A. Flexible assertive community treatment teams can change complex and fragmented service systems: experiences of service providers. Int J Ment Health Syst 2021; 15:38. [PMID: 33892769 PMCID: PMC8067287 DOI: 10.1186/s13033-021-00463-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/15/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Implementing innovative health service models in existing service systems is complicated and context dependent. Flexible assertive community treatment (FACT) is a multidisciplinary service model aimed at providing integrated care for people with severe mental illness. The model was developed in the Netherlands and is now used in several countries, such as Norway. The Norwegian service system is complex and fragmented, with challenges in collaboration. Limited research has been performed on FACT teams and other new integrative health service models as part of such systems. However, such knowledge is important for future adjustments of innovation processes and service systems. Our aim was to explore how FACT teams are integrated into the existing formal public service system, how they function and affect the system, and describe some influencing factors to this. We sought to address how service providers in the existing service system experience the functioning of FACT teams in the system. METHODS Five focus group interviews were undertaken 3 years after the FACT teams were implemented. Forty service providers representing different services from both levels of administration (primary and specialist healthcare) from different Norwegian regions participated in this study. Team leaders of the FACT teams also participated. Service providers were recruited through purposeful sampling. Interviews were analysed using thematic text analysis. RESULTS The analysis revealed five main themes regarding FACT teams: (1) They form a bridge between different services; (2) They collaborate with other services; (3) They undertake responsibility and reassure other services; (4) They do not close all gaps in service systems; and (5) They are part of a service system that hampers their functioning. CONCLUSIONS The FACT teams in this study contributed to positive changes in the existing service system. They largely contributed to less complex and fragmented systems by forming a bridge and undertaking responsibility in the system and by collaborating with and reassuring other services; this has reduced some gaps in the system. The way FACT teams function and needs of the existing system appear to have contributed positively to these findings. However, complexity and fragmentation of the system partly hamper functioning of the FACT teams.
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Affiliation(s)
- Kristin Trane
- Inland Hospital Trust, The Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Hamar, Norway.
| | | | | | - Sigrun Odden
- Inland Hospital Trust, The Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Hamar, Norway
| | - Annika Lexén
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Anne Landheim
- Inland Hospital Trust, The Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Hamar, Norway
- Inland Norway University of Applied Sciences, Hamar, Norway
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11
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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.
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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.)
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12
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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.
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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
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13
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Ford T. Transitional care for young adults with ADHD: transforming potential upheaval into smooth progression. Epidemiol Psychiatr Sci 2020; 29:e87. [PMID: 31915090 PMCID: PMC7214737 DOI: 10.1017/s2045796019000817] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 01/10/2023] Open
Abstract
Increasing numbers of young adults need continued support for their attention deficit hyperactivity disorder (ADHD) beyond the age-boundary for children's services. The sparse literature on transition in general suggests patchy provision and huge gaps in transitional care, but also that young people with ADHD and other neurodevelopmental disorders fair particularly badly. Transition in health care coincides with many other important life-transitions while the difficulties associated with ADHD may make these challenges particularly hard to cope with. Parents or other advocates therefore often need to be involved, which can present problems in adult mental health services given that they tend to be less family oriented than children's services. Importantly, young people need help negotiating the transition from passive recipient of care to active self-management, and in building relationships with the adult team.In addition to patchy provision of adult ADHD services, transition is currently hampered by poor understanding of ADHD as a long term condition and uncertain knowledge of what services are available among young people and parents as well as the clinicians working with them. Guidelines recommend, and more importantly young people want, access to psycho-social interventions as well as medication. However, available evidence suggests poor quality transitional care and adult services that are highly focused on medication.Adult ADHD services need to undergo similar development to that experienced by Child and Adolescent Mental Health Services and community paediatrics over the last few decades. While we debate the relative merits of dedicated or specialist v. generic adult mental health services, for young adults with ADHD the training, experience and availability of professionals are more important than their qualifications or setting.
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Affiliation(s)
- Tamsin Ford
- Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road Cambridge CB2 2AH, Exeter, UK
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14
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Romero-López-Alberca C, Gutiérrez-Colosía MR, Salinas-Pérez JA, Almeda N, Furst M, Johnson S, Salvador-Carulla L. Standardised description of health and social care: A systematic review of use of the ESMS/DESDE (European Service Mapping Schedule/Description and Evaluation of Services and DirectoriEs). Eur Psychiatry 2019; 61:97-110. [PMID: 31426008 DOI: 10.1016/j.eurpsy.2019.07.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/27/2019] [Accepted: 07/26/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Evidence-informed planning and interpretation of research results both require standardised description of local care delivery context. Such context analysis descriptions should be comparable across regions and countries to allow benchmarking and organizational learning, and for research findings to be interpreted in context. The European Service Mapping Schedule (ESMS) is a classification of adult mental health services that was later adapted for the assessment of health and social systems research (Description and Evaluation of Services and DirectoriEs - DESDE). The aim of the study was to review the diffusion and use of the ESMS/DESDE system in health and social care and its impact in health policy and decision-making. METHOD We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (1997-2018). RESULTS Out of 155 papers mentioning ESMS/DESDE, 71 have used it for service research and planning. The classification has been translated into eight languages and has been used by seven international research networks. Since 2000, it has originated 11 instruments for health system research with extensive analysis of their metric properties. The ESMS/DESDE coding system has been used in 585 catchment areas in 34 countries for description of services delivery at local, regional and national levels. CONCLUSIONS The ESMS/DESDE system provides a common terminology, a classification of care services, and a set of tools allowing a variety of aims to be addressed in healthcare and health systems research. It facilitates comparisons across and within countries for evidence-informed planning.
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Affiliation(s)
| | | | - José A Salinas-Pérez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Seville, Asociación Científica Psicost, Spain
| | - Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
| | - Maryanne Furst
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra. Menzies Centre for Health Policy, University of Sydney, Australia
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15
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Katschnig H, Straßmayr C, Endel F, Berger M, Zauner G, Kalseth J, Sfetcu R, Wahlbeck K, Tedeschi F, Šprah L. Using national electronic health care registries for comparing the risk of psychiatric re-hospitalisation in six European countries: Opportunities and limitations. Health Policy 2019; 123:1028-1035. [PMID: 31405616 DOI: 10.1016/j.healthpol.2019.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 05/19/2019] [Accepted: 07/09/2019] [Indexed: 11/30/2022]
Abstract
Psychiatric re-hospitalisation rates have been of longstanding interest as health care quality metric for planners and policy makers, but are criticized for not being comparable across hospitals and countries due to measurement unclarities. The objectives of the present study were to explore the interoperability of national electronic routine health care registries of six European countries (Austria, Finland, Italy, Norway, Romania, Slovenia) and, by using variables found to be comparable, to calculate and compare re-hospitalisation rates and the associated risk factors. A "Methods Toolkit" was developed for exploring the interoperability of registry data and protocol led pilot studies were carried out. Problems encountered in this process are described. Using restricted but comparable data sets, up to twofold differences in psychiatric re-hospitalisation rates were found between countries for both a 30- and 365-day follow-up period. Cumulative incidence curves revealed noteworthy additional differences. Health system characteristics are discussed as potential causes for the differences. Multi-level logistic regression analyses showed that younger age and a diagnosis of schizophrenia/mania/bipolar disorder consistently increased the probability of psychiatric re-hospitalisation across countries. It is concluded that the advantage of having large unselected study populations of national electronic health care registries needs to be balanced against the considerable efforts to examine the interoperability of databases in cross-country comparisons.
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Affiliation(s)
- Heinz Katschnig
- IMEHPS.research, Vienna, Austria; Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria.
| | | | | | | | | | | | - Raluca Sfetcu
- National School of Public Health, Management and Professional Development (SNSPMPDS), Bucharest, Romania
| | - Kristian Wahlbeck
- National Institute for Health and Welfare (THL), Mental Health Unit, Helsinki, Finland
| | - Federico Tedeschi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Lilijana Šprah
- Research Centre of the Slovenian Academy of Sciences and Arts (ZRC SAZU), Ljubljana, Slovenia
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