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McGorry PD, Mei C, Dalal N, Alvarez-Jimenez M, Blakemore SJ, Browne V, Dooley B, Hickie IB, Jones PB, McDaid D, Mihalopoulos C, Wood SJ, El Azzouzi FA, Fazio J, Gow E, Hanjabam S, Hayes A, Morris A, Pang E, Paramasivam K, Quagliato Nogueira I, Tan J, Adelsheim S, Broome MR, Cannon M, Chanen AM, Chen EYH, Danese A, Davis M, Ford T, Gonsalves PP, Hamilton MP, Henderson J, John A, Kay-Lambkin F, Le LKD, Kieling C, Mac Dhonnagáin N, Malla A, Nieman DH, Rickwood D, Robinson J, Shah JL, Singh S, Soosay I, Tee K, Twenge J, Valmaggia L, van Amelsvoort T, Verma S, Wilson J, Yung A, Iyer SN, Killackey E. The Lancet Psychiatry Commission on youth mental health. Lancet Psychiatry 2024; 11:731-774. [PMID: 39147461 DOI: 10.1016/s2215-0366(24)00163-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 08/17/2024]
Affiliation(s)
- Patrick D McGorry
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Cristina Mei
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Vivienne Browne
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Barbara Dooley
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Cathrine Mihalopoulos
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Stephen J Wood
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; School of Psychology, University of Birmingham, Birmingham, UK
| | | | | | - Ella Gow
- Orygen, Melbourne, VIC, Australia; Melbourne, VIC, Australia
| | | | | | | | - Elina Pang
- Hong Kong Special Administrative Region, China
| | | | | | | | - Steven Adelsheim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Matthew R Broome
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Mary Cannon
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Andrew M Chanen
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Eric Y H Chen
- Institute of Mental Health, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; LKS School of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Andrea Danese
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; National and Specialist Child and Adolescent Mental Health Service Clinic for Trauma, Anxiety, and Depression, South London and Maudsley NHS Foundation Trust, London, UK
| | - Maryann Davis
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Pattie P Gonsalves
- Youth Mental Health Group, Sangath, New Delhi, India; School of Psychology, University of Sussex, Brighton, UK
| | - Matthew P Hamilton
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jo Henderson
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Long K-D Le
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Ashok Malla
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; ACCESS Open Minds and Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Dorien H Nieman
- Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Debra Rickwood
- Faculty of Health, University of Canberra, Canberra, ACT, Australia; headspace National Youth Mental Health Foundation, Melbourne, VIC, Australia
| | - Jo Robinson
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jai L Shah
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; ACCESS Open Minds and Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Swaran Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick and Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Ian Soosay
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Karen Tee
- Foundry, Providence Health Care, Vancouver, BC, Canada
| | - Jean Twenge
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Lucia Valmaggia
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alison Yung
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia; School of Health Sciences, The University of Manchester, Manchester, UK
| | - Srividya N Iyer
- Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; ACCESS Open Minds and Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Eóin Killackey
- Orygen, Melbourne, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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2
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Ologundudu OM, Palaniyappan L, Cipriano LE, Wijnen BFM, Anderson KK, Ali S. Risk stratification for treating people at ultra-high risk for psychosis: A cost-effectiveness analysis. Schizophr Res 2023; 261:225-233. [PMID: 37804598 DOI: 10.1016/j.schres.2023.09.015] [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: 01/06/2022] [Revised: 08/27/2023] [Accepted: 09/04/2023] [Indexed: 10/09/2023]
Abstract
People who are at ultra-high risk (UHR) for psychosis receive clinical care with the aim to prevent first-episode psychosis (FEP), regardless of the risk of conversion to psychosis. An economic model from the Canadian health system perspective was developed to evaluate the cost-effectiveness of treating all with UHR compared to risk stratification over a 15-year time horizon, based on conversion probability, expected quality-of-life and costs. The analysis used a decision tree followed by a Markov model. Health states included: Not UHR, UHR with <20 % risk of conversion to FEP (based on the North American Prodrome Longitudinal Study risk calculator), UHR with ≥20 % risk, FEP, Remission, Post-FEP, and Death. The analysis found that: risk stratification (i.e., only treating those with ≥20 % risk) had lower costs ($1398) and quality-adjusted life-years (0.055 QALYs) per person compared to treating all. The incremental cost-effectiveness ratio for 'treat all' was $25,448/QALY, and suggests treating all may be cost-effective. The model was sensitive to changes to the probability of conversion.
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Affiliation(s)
- Olajumoke M Ologundudu
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Lauren E Cipriano
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Ivey Business School, Western University, London, Ontario, Canada
| | - Ben F M Wijnen
- Centre of Economic Evaluation (Trimbos Institute), Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Shehzad Ali
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Department of Health Sciences, University of York, United Kingdom; Department of Psychology, Macquarie University, Australia.
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3
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Liu F, Gao M, Wu Q, Yan M, Wu R, Shao P, Huang J. Diagnostic Stability in Psychiatric Patients From Hospital Admission to Discharge: A 10-Year Retrospective Study. Psychiatry Investig 2023; 20:461-470. [PMID: 37253472 PMCID: PMC10232057 DOI: 10.30773/pi.2022.0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/24/2023] [Accepted: 03/08/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the consistency or stability of mental disorders diagnosed in the psychiatry ward setting, investigate factors associated with consistency, and observe the disease distribution over the decade. METHODS A total of 20,359 psychiatric inpatients were included in this retrospective study from June 2011 to December 2020. Diagnoses from the first admission to discharge were evaluated to determine the diagnostic consistency during hospitalization. Readmissions were selected as the subgroup, whose first and last discharge diagnoses were compared to analyze the relatively long-term diagnostic stability. Demographic and clinical characteristics were collected to identify predictors of diagnostic discrepancy. RESULTS From 2011-2020, the hospitalization rate decreased from 42.7% to 20.7% for schizophrenia and grew from 13.3% to 23.8% for depression. Diagnoses were retained by 92.6% of patients at their first discharge diagnosis, ranging from 100% for disorders of psychological development to 16.3% for unspecified mental disorders. About 33.9% of diagnostic conversions were to bipolar disorder in patients having inconsistent diagnoses. However, among rehospitalizations, the diagnostic stability notably dropped to 71.3%. For rehospitalizations, mood disorders and schizophrenia spectrum disorders were relatively stable diagnoses categories, with 72.6% to 76.7% of patients receiving the same diagnosis, although results of specified diagnoses within these categories ranged from 5.9% to 91.0%. Except for mood disorders and schizophrenia spectrum disorders, the diagnoses of all other categories were below 70%. Long lengths of hospitalization and old age were associated with short-term diagnosis alterations. CONCLUSION Longitudinal follow-up and integration of multiple aspects of information are essential for accurate diagnosis.
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Affiliation(s)
- Furu Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Hunan, China
| | | | - Qiongqiong Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Hunan, China
| | - Meiqi Yan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Hunan, China
| | - Renrong Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Hunan, China
| | - Ping Shao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Hunan, China
| | - Jing Huang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Hunan, China
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4
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Moss SJ, Vasilakis C, Wood RM. Exploring financially sustainable initiatives to address out-of-area placements in psychiatric ICUs: a computer simulation study. J Ment Health 2022; 32:551-559. [PMID: 35766323 DOI: 10.1080/09638237.2022.2091769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Transferring individuals for treatment outside their geographic area occurs when healthcare demand exceeds local supply. This can result in significant financial cost while impacting patient outcomes and experience. AIMS The aim of this study was to assess initiatives to reduce psychiatric intensive care unit (PICU) out-of-area bed placements within a major healthcare system in South West England. METHODS Discrete event computer simulation was used to model patient flow across the healthcare system's three PICUs. A scenario analysis was performed to estimate the impact of management plans to decrease admissions and length of stay. The amount of capacity required to minimise total cost was also considered. RESULTS Without increasing in-area capacity, mean out-of-area bed requirement can be reduced by 25.6% and 19.1% respectively through plausible initiatives to decrease admissions and length of stay. Reductions of 34.7% are possible if both initiatives are employed. Adjusting the in-area bed capacity can also lead to aggregate cost savings. CONCLUSIONS This study supports the likely effectiveness of particular initiatives in reducing out-of-area placements for high-acuity bedded psychiatric care. This study also demonstrates the value of computer simulation in an area that has seen little such attention to date.
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Affiliation(s)
- Simon J Moss
- Bristol, North Somerset and South Gloucestershire CCG, UK National Health Service, Bristol, UK
| | | | - Richard M Wood
- Bristol, North Somerset and South Gloucestershire CCG, UK National Health Service, Bristol, UK.,School of Management, University of Bath, Claverton Down, UK
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5
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Napoletano F, Andlauer O, Murguia-Asensio S, Eranti SV, Akyuz E, Estradé A, Buhagiar J, David C, Fusar-Poli P, Gupta S. Establishing a business case for setting up early detection services for preventing psychosis. BJPsych Bull 2022; 47:156-165. [PMID: 35289263 DOI: 10.1192/bjb.2022.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Under standard care, psychotic disorders can have limited response to treatments, high rates of chronicity and disability, negative impacts on families, and wider social and economic costs. In an effort to improve early detection and care of individuals developing a psychotic illness, early intervention in psychosis services and early detection services have been set up in various countries since the 1980s. In April 2016, NHS England implemented a new 'access and waiting times' standard for early intervention in psychosis to extend the prevention of psychosis across England. Unfortunately, early intervention and early detection services are still not uniformly distributed in the UK, leaving gaps in service provision. The aim of this paper is to provide a business case model that can guide clinicians and services looking to set up or expand early detection services in their area. The paper also focuses on some existing models of care within the Pan-London Network for Psychosis Prevention teams.
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Affiliation(s)
| | - Olivier Andlauer
- East London NHS Foundation Trust, London, UK.,Queen Mary University of London, London, UK
| | | | | | - Elvan Akyuz
- North East London NHS Foundation Trust, London, UK
| | - Andrés Estradé
- King's College London, UK.,Catholic University, Montevideo, Uruguay
| | | | | | - Paolo Fusar-Poli
- King's College London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,University of Pavia, Italy
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6
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Ologundudu OM, Lau T, Palaniyappan L, Ali S, Anderson KK. Interventions for people at ultra-high risk for psychosis: A systematic review of economic evaluations. Early Interv Psychiatry 2021; 15:1115-1126. [PMID: 33047497 DOI: 10.1111/eip.13061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 09/02/2020] [Accepted: 09/26/2020] [Indexed: 11/30/2022]
Abstract
AIM Psychotic disorders have long-term negative consequences for functioning and quality of life. Ultra-high risk (UHR) programs aim to identify and treat people during the prodromal period before their first psychotic episode. Though studies on the clinical effectiveness of treating prodromal symptoms in people at UHR for psychosis exist, no review has exclusively and comprehensively evaluated the economic impact of UHR programs. Our objective was to systematically review the literature on economic evaluations of UHR programs. METHODS We searched the Cochrane, EMBASE, MEDLINE, and PsycInfo electronic databases, in addition to grey literature, from inception to March 2020 to identify economic evaluations of UHR programs. We included all cost and cost-effectiveness studies of interventions for people at UHR. The data were synthesized qualitatively, and a risk of bias assessment was performed. RESULTS Of the 1916 articles retrieved, six studies met our inclusion criteria. These included three cost analysis studies and three cost-effectiveness studies. Five studies were conducted from the health system perspective and the time horizon varied between six months and ten years. Only two reported quality-adjusted life-years (QALYs) as their outcome. Overall, all cost-effectiveness studies and one cost analysis suggested that UHR programs were cost-effective and cost saving, respectively. The risk of bias assessment suggested moderate levels of bias across all studies. CONCLUSION Economic evaluations of UHR programs varied in terms of outcomes and length of follow-up; however, most studies found them to be cost-effective. Future studies would benefit from long-term evaluations of UHR programs and consistent valuation of outcomes.
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Affiliation(s)
- Olajumoke M Ologundudu
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Tammy Lau
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Shehzad Ali
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
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7
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Campion J, Taylor MJ, McDaid D, Park AL, Shiers D. Applying economic models to estimate local economic benefits of improved coverage of early intervention for psychosis. Early Interv Psychiatry 2019; 13:1424-1430. [PMID: 30740880 DOI: 10.1111/eip.12787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/10/2018] [Accepted: 12/26/2018] [Indexed: 11/30/2022]
Abstract
AIM Early Intervention Psychosis Services (EIPS) for people experiencing First Episode Psychosis (FEP) offer important clinical and non-clinical benefits over standard care. Similarly, intervention for Clinical High Risk for Psychosis state (CHR-P) can prevent psychosis, ameliorate symptoms and have non-clinical benefits. This study aimed to estimate associated local economic benefits of FEP and CHR-P services compared with standard care. METHODS Across four south London boroughs, proportion of annual number of new cases of FEP and CHR-P seen by early intervention services was estimated. Economic modelling conducted for England's mental health strategy was applied to estimate local economic impacts of current and improved service provision. RESULTS Across four London boroughs during 2011/2012, proportion of 15-34 year olds with FEP seen by EIPS was 100.2% assuming 80/100 000 annual incidence whereas proportion with CHR-P seen by CHR-P services was 4.1% assuming 200/100 000 annual incidence. Application of economic modelling suggests that provision of EIPS to reach all new FEP cases each year would free up resources of £13.1m over 10 years including £2.0m to National Health Service (NHS) after the first year. Scaling up to reach all new CHR-P cases each year would free up resources of £19.7m over 10 years with an estimated 10-year cost of implementation gap for each 1 year cohort of £18.9m. An earlier related briefing resulted in increased funding for EIPS and new CHR-P services despite overall cuts to mental health services. CONCLUSIONS Estimation of local economic impacts of FEP and CHR-P services was associated with improved investment in such services.
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Affiliation(s)
- Jonathan Campion
- Psychosis Clinical Academic Group and Public Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.,Faculty of Brain Sciences, University College London, London, UK
| | - Matthew J Taylor
- Early Psychosis: Intervention and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Psychosis Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - David McDaid
- Personal Social Services Research Unit, Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - A-La Park
- Personal Social Services Research Unit, Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - David Shiers
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK.,Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK
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8
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Wijnen BF, Thielen FW, Konings S, Feenstra T, Van Der Gaag M, Veling W, De Haan L, Ising H, Hiligsmann M, Evers SM, Smit F, Lokkerbol J. Designing and Testing of a Health-Economic Markov Model for Prevention and Treatment of Early Psychosis. Expert Rev Pharmacoecon Outcomes Res 2019; 20:269-279. [DOI: 10.1080/14737167.2019.1632194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Ben F.M. Wijnen
- Centre of Economic Evaluation (Trimbos Institute), Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frederick W. Thielen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Steef Konings
- Department of Psychiatry, University of Groningen,University Medical Center Groningen, Groningen, The Netherlands
| | - Talitha Feenstra
- Faculty of Medical Sciences, Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Mark Van Der Gaag
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Psychiatric Institute, Den Haag, The Netherlands
| | - Wim Veling
- Department of Psychiatry, University of Groningen,University Medical Center Groningen, Groningen, The Netherlands
| | - Lieuwe De Haan
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Helga Ising
- Department of Psychosis Research, Parnassia Psychiatric Institute, Den Haag, The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Silvia M.A.A. Evers
- Centre of Economic Evaluation (Trimbos Institute), Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Filip Smit
- Centre of Economic Evaluation (Trimbos Institute), Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Clinical Psychology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Joran Lokkerbol
- Centre of Economic Evaluation (Trimbos Institute), Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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9
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Becker M, Cunningham CE, Christensen BK, Furimsky I, Rimas H, Wilson F, Jeffs L, Madsen V, Bieling P, Chen Y, Mielko S, Zipursky RB. Investigating service features to sustain engagement in early intervention mental health services. Early Interv Psychiatry 2019; 13:241-250. [PMID: 28836377 DOI: 10.1111/eip.12470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 05/13/2017] [Accepted: 06/17/2017] [Indexed: 01/05/2023]
Abstract
AIM To understand what service features would sustain patient engagement in early intervention mental health treatment. METHODS Mental health patients, family members of individuals with mental illness and mental health professionals completed a survey consisting of 18 choice tasks that involved 14 different service attributes. Preferences were ascertained using importance and utility scores. Latent class analysis revealed segments characterized by distinct preferences. Simulations were carried out to estimate utilization of hypothetical clinical services. RESULTS Overall, 333 patients and family members and 183 professionals (N = 516) participated. Respondents were distributed between a Professional segment (53%) and a Patient segment (47%) that differed in a number of their preferences including for appointment times, individual vs group sessions and mode of after-hours support. Members of both segments shared preferences for many of the service attributes including having crisis support available 24 h per day, having a choice of different treatment modalities, being offered help for substance use problems and having a focus on improving symptoms rather than functioning. Simulations predicted that 60% of the Patient segment thought patients would remain engaged with a Hospital service, while 69% of the Professional segment thought patients would be most likely to remain engaged with an E-Health service. CONCLUSIONS Patients, family members and professionals shared a number of preferences about what service characteristics will optimize patient engagement in early intervention services but diverged on others. Providing effective crisis support as well as a range of treatment options should be prioritized in the future design of early intervention services.
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Affiliation(s)
- Mackenzie Becker
- Department of Psychology, Neuroscience & Behaviour (PNB), McMaster University, Hamilton, Ontario, Canada
| | - Charles E Cunningham
- Department of Psychiatry & Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Bruce K Christensen
- Department of Psychology, Neuroscience & Behaviour (PNB), McMaster University, Hamilton, Ontario, Canada.,Department of Psychiatry & Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,Mental Health and Addiction Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Ivana Furimsky
- Department of Psychiatry & Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,Mental Health and Addiction Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Heather Rimas
- Department of Psychiatry & Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Fiona Wilson
- Department of Psychiatry & Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,Mental Health and Addiction Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Lisa Jeffs
- Mental Health and Addiction Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Victoria Madsen
- Department of Psychiatry & Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,Mental Health and Addiction Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Peter Bieling
- Department of Psychiatry & Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,Mental Health and Addiction Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Yvonne Chen
- Department of Psychiatry & Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Mielko
- Department of Psychiatry & Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert B Zipursky
- Department of Psychiatry & Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.,Mental Health and Addiction Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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10
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Abstract
Out-of-area (OOA) placements occur when patients cannot be admitted to local facilities, which can be extremely stressful for patients and families. Thus, the Department of Health aims to eliminate the need for OOA admissions. Using data from a UK mental health trust we developed a 'virtual mental health ward' to evaluate the potential impact of referral rates and length of stay (LOS) on OOA rates. The results indicated OOA rates were equally sensitive to LOS and referral rate. This suggests that investment in community services that reduce both LOS and referral rates are required to meaningfully reduce OOA admission rates.Declaration of interestP.A.T. holds an honorary consultant contract with the Tees, Esk and Wear Valleys NHS Foundation Trust.
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Affiliation(s)
- Lewis W Paton
- Research Fellow,Department of Health Sciences,University of York,UK
| | - Paul A Tiffin
- Reader in Psychometric Epidemiology,Department of Health Sciences,University of York,UK
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11
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Arango C, Díaz-Caneja CM, McGorry PD, Rapoport J, Sommer IE, Vorstman JA, McDaid D, Marín O, Serrano-Drozdowskyj E, Freedman R, Carpenter W. Preventive strategies for mental health. Lancet Psychiatry 2018; 5:591-604. [PMID: 29773478 DOI: 10.1016/s2215-0366(18)30057-9] [Citation(s) in RCA: 290] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/14/2022]
Abstract
Available treatment methods have shown little effect on the burden associated with mental health disorders. We review promising universal, selective, and indicated preventive mental health strategies that might reduce the incidence of mental health disorders, or shift expected trajectories to less debilitating outcomes. Some of these interventions also seem to be cost-effective. In the transition to mental illness, the cumulative lifetime effect of multiple small effect size risk factors progressively increases vulnerability to mental health disorders. This process might inform different levels and stages of tailored interventions to lessen risk, or increase protective factors and resilience, especially during sensitive developmental periods. Gaps between knowledge, policy, and practice need to be bridged. Future steps should emphasise mental health promotion, and improvement of early detection and interventions in clinical settings, schools, and the community, with essential support from society and policy makers.
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Affiliation(s)
- Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Centro de Investigación Biomédica en Red del área de Salud Mental (CIBERSAM), Madrid, Spain
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Centro de Investigación Biomédica en Red del área de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Patrick D McGorry
- Orygen, National Centre for Excellence in Youth Mental Health, and Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Judith Rapoport
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Iris E Sommer
- Department of Neuroscience, University Medical Center Groningen, Groningen, Netherlands
| | - Jacob A Vorstman
- Department of Psychiatry, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada; Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - David McDaid
- Department of Health Policy at the London School of Economics and Social Science, London, UK
| | - Oscar Marín
- Centre for Developmental Neurobiology, Institute of Psychiatry, Psychology and Neuroscience, and MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Elena Serrano-Drozdowskyj
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Centro de Investigación Biomédica en Red del área de Salud Mental (CIBERSAM), Madrid, Spain
| | - Robert Freedman
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - William Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, Baltimore, MD, USA
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12
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Gin K, Banerjea P, Abbott C, Browning S, Bracegirdle K, Corrigall R, Jolley S. Childhood unusual experiences in community Child and Adolescent Mental Health Services in South East London: Prevalence and impact. Schizophr Res 2018; 195:93-96. [PMID: 28874319 DOI: 10.1016/j.schres.2017.08.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/03/2017] [Accepted: 08/22/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Distressing 'psychotic-like' or unusual experiences (UEDs) signify increased mental health risk in the general population, including greater likelihood and severity of co-occurring non-psychotic mental health problems, and, from fourteen years of age, increased risk of a future psychotic illness. Healthcare guidelines for under eighteens recommend psychological intervention for UEDs, to reduce current distress and adverse functional impact, and, potentially, future mental health risk. Children tend not to report UEDs unless directly asked, indicating a need for routine screening. We report on the feasibility of a routine screening methodology, and screening outcomes, in Child and Adolescent Mental Health Services (CAMHS) in South East London, United Kingdom. METHOD Four general community CAMHS teams were invited to screen, by adding a nine-item self-report UED measure to their routine assessment battery. Screening data were collected over 18months from 02/2015 to 07/2016. RESULTS All but one team agreed to screen. Each team saw around 300 accepted referrals during the audit period (total: 900); 768 of these (85%) were successfully screened; of those screened, 68% (n=524) self-reported UEs, 60% (n=461) with associated distress/adverse functional impact. Screening was acceptable to clinicians, children and families. CONCLUSIONS Assessing UEDs routinely in CAMHS is feasible, and suggests that around two thirds of assessed referrals could potentially benefit from interventions targeting UEDs. Additional training may be required for the CAMHS workforce to address this need.
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Affiliation(s)
- Kimberley Gin
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK.
| | - Partha Banerjea
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Chris Abbott
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Sophie Browning
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | | | | | - Suzanne Jolley
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London SE5 8AF, UK
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13
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Jolley S, Browning S, Corrigall R, Laurens KR, Hirsch C, Bracegirdle K, Gin K, Muccio F, Stewart C, Banerjea P, Kuipers E, Garety P, Byrne M, Onwumere J, Achilla E, McCrone P, Emsley R. Coping with Unusual ExperienceS for 12-18 year olds (CUES+): a transdiagnostic randomised controlled trial of the effectiveness of cognitive therapy in reducing distress associated with unusual experiences in adolescent mental health services: study protocol for a randomised controlled trial. Trials 2017; 18:586. [PMID: 29202862 PMCID: PMC5716372 DOI: 10.1186/s13063-017-2326-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/13/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Childhood 'unusual experiences' (such as hearing voices that others cannot, or suspicions of being followed) are common, but can become more distressing during adolescence, especially for young people in contact with Child and Adolescent Mental Health Services (CAMHS). Unusual experiences that are distressing or have adverse life impact (UEDs) are associated with a range of current and future emotional, behavioural and mental health difficulties. Recommendations for psychological intervention are based on evidence from adult studies, with some support from small, pilot, child-specific evaluations. Research is needed to ensure that the recommendations suit children as well as adults. The CUES+ study (Coping with Unusual ExperienceS for 12-18 year olds) aims to find out whether cognitive behaviour therapy for UEDs (CBT-UED) is a helpful and cost-effective addition to usual community care for 12-18 year olds presenting to United Kingdom National Health Service Child and Adolescent Mental Health Services in four London boroughs. METHODS The CUES+ study is a randomised controlled trial comparing CBT-UED plus routine care to routine care alone. CBT-UED comprises up to 16 sessions, including up to 12 individual and up to four family support meetings, each lasting around 45-60 min, delivered weekly. The primary outcome is emotional distress. Secondary outcomes are change in UEDs, risk events (self-harm, attendance at emergency services, other adverse events) and health economic outcomes. Participants will be randomised in a 1:1 ratio after baseline assessment. Randomisation will be stratified by borough and by severity of mental health presentation: 'severe' (an identified psychotic or bipolar disorder) or any 'other' condition. Outcomes will be assessed by a trained assessor blind to treatment condition at 0, 16 and 24 weeks. Recruitment began in February, 2015 and is ongoing until the end of March, 2017. DISCUSSION The CUES+ study will contribute to the currently limited child-specific evidence base for psychological interventions for UEDs occurring in the context of psychosis or any other mental health presentation. TRIAL REGISTRATION International Standard Randomised Controlled Trials, ID: ISRCTN21802136 . Prospectively registered on 12 January 2015. Protocol V3 31 August 2015 with screening amended.
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Affiliation(s)
- Suzanne Jolley
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Sophie Browning
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | | | - Kristin R. Laurens
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Banyo, QLD 4014 Australia
- Department of Forensic and Neurodevelopmental Sciences, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
- Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, NSW 2052 Australia
- Neuroscience Research Australia, Randwick, NSW 2031 Australia
| | - Colette Hirsch
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit (BRC/U) at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AZ UK
| | | | - Kimberley Gin
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | - Francesca Muccio
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | - Catherine Stewart
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | - Partha Banerjea
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | - Elizabeth Kuipers
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit (BRC/U) at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AZ UK
| | - Philippa Garety
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit (BRC/U) at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AZ UK
| | - Majella Byrne
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, London, SE5 8AZ UK
| | - Juliana Onwumere
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, 16, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Evanthia Achilla
- Department of Health Service and Population Research, King’s Health Economics, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
| | - Paul McCrone
- Department of Health Service and Population Research, King’s Health Economics, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK
| | - Richard Emsley
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL UK
- Manchester Academic Health Science Centre Clinical Trials Unit, Manchester, M13 9PL UK
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14
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Hamilton MP, Hetrick SE, Mihalopoulos C, Baker D, Browne V, Chanen AM, Pennell K, Purcell R, Stavely H, McGorry PD. Identifying attributes of care that may improve cost‐effectiveness in the youth mental health service system. Med J Aust 2017; 207:S27-S37. [DOI: 10.5694/mja17.00972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/17/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Matthew P Hamilton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | | | - David Baker
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Vivienne Browne
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Kerryn Pennell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Rosemary Purcell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Heather Stavely
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
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15
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Cuando la asistencia no sigue a la evidencia: el caso de la falta de programas de intervención temprana en psicosis en España. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2017; 10:78-86. [DOI: 10.1016/j.rpsm.2017.01.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 11/11/2016] [Accepted: 01/03/2017] [Indexed: 12/14/2022]
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16
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McGorry PD, Hamilton MP. Stepwise expansion of evidence-based care is needed for mental health reform. Med J Aust 2017; 204:351-3. [PMID: 27169969 DOI: 10.5694/mja16.00120] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/15/2016] [Indexed: 12/17/2022]
Abstract
Mortality from mental illnesses is increasing and, because they frequently occur early in the life cycle, they are the largest source of disability and reduced economic productivity of all non-communicable diseases. Successful mental health reform can reduce the mortality, morbidity, growing welfare costs and losses in economic productivity caused by mental illness. The government has largely adopted the recommendations of the National Mental Health Commission focusing on early intervention and stepwise care and will implement a reform plan that involves devolving commissioning of federally funded mental health services to primary health networks, along with a greater emphasis on e-mental health. Stepwise expanded investment in and structural support (data collection, evaluation, model fidelity, workforce training) for evidence-based care that rectifies high levels of undertreatment are essential for these reforms to succeed. However, the reforms are currently constrained by a cost-containment policy framework that envisages no additional funding. The early intervention reform aim requires financing for the next stage of development of Australia's youth mental health system, rather than redirecting funds from existing evidence-based programs. People with complex, enduring mental disorders need more comprehensive care. In the context of the National Disability Insurance Scheme, there is a risk that these already seriously underserved patients may paradoxically receive a reduction in coverage. E-health has a key role to play at all stages of illness but must be integrated in a complementary way, rather than as a barrier to access. Research and evaluation are the keys to cost-effective, sustainable reform.
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Affiliation(s)
- Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Matthew P Hamilton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
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17
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Park AL, McCrone P, Knapp M. Early intervention for first-episode psychosis: broadening the scope of economic estimates. Early Interv Psychiatry 2016; 10:144-51. [PMID: 24739331 DOI: 10.1111/eip.12149] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 03/11/2014] [Indexed: 01/29/2023]
Abstract
AIM To explore the economic impacts of early intervention in England on outcomes and costs for people with first-episode psychosis. METHODS Three decision analytical models were constructed to compare treatment by early intervention for first-episode psychosis with standard care in relation to employment, education, homicide and suicide. Data on effectiveness and costs were taken from previous studies and expert opinion. Sensitivity analyses tested the robustness of assumptions. RESULTS Our models indicate that early intervention demonstrates savings of £2087 per person over 3 years from improved employment and education outcomes. In addition, the annual costs over 10 years related to homicide after early intervention were £80 lower than for standard care. There were also annual savings of £957 per person for early intervention over 4 years compared to standard care as a result of suicides averted. CONCLUSIONS Not only can investment in early intervention help reduce some of the long-term costs and consequences of mental disorders to the health-care system. In addition, there are broader economic benefits that strengthen the potential cost savings to society.
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Affiliation(s)
- A-La Park
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Paul McCrone
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, London, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.,Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, London, UK
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18
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Díaz-Caneja CM, Pina-Camacho L, Rodríguez-Quiroga A, Fraguas D, Parellada M, Arango C. Predictors of outcome in early-onset psychosis: a systematic review. NPJ SCHIZOPHRENIA 2015; 1:14005. [PMID: 27336027 PMCID: PMC4849440 DOI: 10.1038/npjschz.2014.5] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 01/31/2023]
Abstract
Given the global burden of psychotic disorders, the identification of patients with early-onset psychosis (EOP; that is, onset before the age of 18) at higher risk of adverse outcome should be a priority. A systematic search of Pubmed, Embase, and PsycInfo (1980 through August 2014) was performed to identify longitudinal observational studies assessing correlates and/or predictors of clinical, functional, cognitive, and biological outcomes in EOP. Seventy-five studies were included in the review. Using multivariate models, the most replicated predictors of worse clinical, functional, cognitive, and biological outcomes in EOP were premorbid difficulties and symptom severity (especially of negative symptoms) at baseline. Longer duration of untreated psychosis (DUP) predicted worse clinical, functional, and cognitive outcomes. Higher risk of attempting suicide was predicted by greater severity of psychotic illness and of depressive symptoms at the first episode of psychosis. Age at onset and sex were not found to be relevant predictors of outcome in most multivariate models, whereas studies using bivariate analyses yielded inconsistent results. Lower intelligence quotient at baseline predicted lower insight at follow-up, worse functional outcomes, and a diagnostic outcome of schizophrenia. Biological predictors of outcome in EOP have been little studied and have not been replicated. Lower levels of antioxidants at baseline predicted greater brain volume changes and worse cognitive functioning at follow-up, whereas neuroimaging markers such as regional cortical thickness and gray matter volume at baseline predicted remission and better insight at follow-up, respectively. EOP patients with poorer premorbid adjustment and prominent negative symptoms at initial presentation are at risk of poor outcome. They should therefore be the target of careful monitoring and more intensive interventions to address whether the disease course can be modified in this especially severely affected group. Early intervention strategies to reduce DUP may also improve outcome in EOP.
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Affiliation(s)
- Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - Laura Pina-Camacho
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, London, UK
| | - Alberto Rodríguez-Quiroga
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - David Fraguas
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid , Madrid, Spain
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19
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van der Gaag M. The efficacy of CBT for severe mental illness and the challenge of dissemination in routine care. World Psychiatry 2014; 13:257-8. [PMID: 25273295 PMCID: PMC4219063 DOI: 10.1002/wps.20162] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mark van der Gaag
- Department of Clinical Psychology; VU University, Amsterdam, The Netherlands; Parnassia Psychiatric Institute; The Hague The Netherlands
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20
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A longitudinal study on the relationship between duration of untreated psychosis and executive function in early-onset first-episode psychosis. Schizophr Res 2014; 158:126-33. [PMID: 25034759 DOI: 10.1016/j.schres.2014.06.038] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 06/23/2014] [Accepted: 06/26/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND The relationship between duration of untreated psychosis (DUP) and executive function (EF) in patients with first-episode psychosis (FEP) is controversial. We aim to assess the influence of DUP on changes in EF over a 2-year period in subjects with early-onset FEP (first psychotic symptom before age 18) and less than 6 months of positive symptoms. METHODS A total of 66 subjects were included in the study (19 females [28.8%], mean age 16.2 ± 1.6 years). The influence of DUP on changes in EF over the 2-year follow-up (expressed as a composite score of 5 cognitive abilities: attention, working memory, cognitive flexibility, response inhibition, and problem solving) was estimated using a multivariate linear regression model after removing the effect of intelligence quotient and controlling for age, gender, diagnosis, premorbid adjustment, severity of positive and negative symptoms at baseline, global functioning at baseline, and mean daily antipsychotic dosage during follow-up. RESULTS Mean DUP was 65.0 ± 6.9 days (95% confidence interval [CI], 51.2, 78.8). Median DUP was 47.5 days (range 2-180 days). Negative symptoms at baseline was the only variable significantly associated with EF at baseline (10.9% of explained variance [e.v. 10.9%], p=0.007). Only shorter DUP (e.v. 8.7%, p=0.013) and greater severity of baseline negative symptoms (e.v. 10.0%, p=0.008) were significantly associated with greater improvement in EF. CONCLUSIONS In early-onset FEP, shorter DUP was associated with greater improvement in EF over a 2-year follow-up period.
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21
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Beecham J. Annual research review: Child and adolescent mental health interventions: a review of progress in economic studies across different disorders. J Child Psychol Psychiatry 2014; 55:714-32. [PMID: 24580503 PMCID: PMC4657502 DOI: 10.1111/jcpp.12216] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Resources for supporting children and adolescents with psychiatric disorders continue to be scarce. Economics research can identify current patterns of expenditure, and help inform allocation of treatment and support resources between competing needs or uses. SCOPE AND METHODS The aim was to identify the costs of supporting children and adolescents, the economic impacts of childhood psychiatric disorders in adulthood and any new evidence on the cost-effectiveness of interventions. An electronic search of databases (including PubMed, Medline and Psychinfo) identified peer-reviewed journal articles published between 2005 and 2012. FINDINGS Sixty-seven papers provided data on support and treatment costs now or in the future, or cost-effectiveness analyses of services. Half the articles came from the United States. Most articles focussed on autism spectrum disorder (ASD; 23 articles), attention deficit hyperactivity disorder (ADHD; n = 15), conduct disorder (CD; n = 7), and anxiety or depression (n = 8). CONCLUSION Only 14 studies used a cost perspective wider than health care; most included education costs (n = 11), but only five included costs to the justice system. The number of studies estimating costs to the family has increased, particularly for children with autism spectrum disorder (ASD). In the United Kingdom, support costs for children and adolescents with conduct disorder (CD) appear to be lower than for those with attention deficit hyperactivity disorder (ADHD), although for the United States, the opposite may be true. Support costs for children and adolescents with ASD may be higher than both CD and ADHD. However, there were many differences between the samples and the methods employed making comparisons between studies difficult. Outcomes in adulthood include negative impacts on (mental) health, quality of life, public sector services, employment status and income. The evidence base is improving for child and adolescent psychiatric disorders, although only one full cost-effectiveness analysis was identified since the previous review published in 2012. However, we still do not know enough about the economic implications of support and treatment for specific disorders.
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Affiliation(s)
- Jennifer Beecham
- Personal Social Services Research Unit, University of KentCanterbury, UK
- London School of Economics and Political ScienceCanterbury, UK
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Tiffin PA, Welsh P. Practitioner review: schizophrenia spectrum disorders and the at-risk mental state for psychosis in children and adolescents--evidence-based management approaches. J Child Psychol Psychiatry 2013; 54:1155-75. [PMID: 24102356 DOI: 10.1111/jcpp.12136] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Schizophrenia spectrum disorders are severe mental illnesses which often result in significant distress and disability. Attempts have been made to prospectively identify and treat young people viewed as at high risk of impending nonaffective psychosis. Once a schizophrenia spectrum disorder has developed, prompt identification and management is required. METHODS This article reviews the literature relating to the assessment and management of 'at-risk mental states' (ARMS) and the treatment of schizophrenia spectrum disorders in children and adolescents. A systematic search of the literature was undertaken using EMBASE, MEDLINE, PsycINFO databases for the period January 1970-December 2012. RESULTS Evidence suggests that young people fulfilling the ARMS criteria are at high risk of adverse mental health outcomes but that the majority do not develop nonaffective psychosis over the medium term. Although clinical trial findings have been inconsistent, psychosocial approaches, such as cognitive behaviour therapy, may reduce the risk of transition to psychosis and improve some symptoms, at least over the short term. The effectiveness of psychotropic medication for the ARMS is uncertain although there is accumulating evidence for potential adverse effects of antipsychotic medication, even at low dose, in this population. For the schizophrenias, clinical trial findings suggest that, as in adults, antipsychotics should be selected on the basis of side-effect profile although clozapine may be helpful in treatment refractory illness. There are almost no studies of psychosocial treatments for schizophrenia in young people under 18, and some caution must be exercised when extrapolating the findings of adult studies to younger individuals. CONCLUSIONS A stepped care approach to the ARMS in young people represents a plausible potential management approach for those at high risk of serious mental health problems. However, predictive models currently lack precision and should focus on accurately identifying those at high risk for a variety of poor outcomes who may benefit most from intervention. There is also an urgent need for age-specific research in the area of psychosocial treatments for children and adolescents with schizophrenia.
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Affiliation(s)
- Paul A Tiffin
- School for Medicine, Pharmacy & Health, The Wolfson Research Institute, Durham University, Queen's Campus, Stockton-on-Tees, UK
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