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Isaacs A, Lambert C, Lawn S, Dyer A. Shortcomings of services for persons with severe and persistent mental health challenges: a qualitative study of service users and family carers. Front Psychiatry 2024; 15:1341248. [PMID: 38419901 PMCID: PMC10899316 DOI: 10.3389/fpsyt.2024.1341248] [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: 11/20/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction The opinions of service users and carers are crucial to identifying ways to innovate and implement system change. This study aims to explore the views and experiences of service users and carerson the services they have used for their mental health challenges and their suggestions for service reform. Methods Twenty participants (15 carers and 5 service users) were interviewed for the study. Results Eight categories emerged from the data. They were: Several gaps in the system, Barriers to accessing services, Services are not fit for purpose, Services operate in isolation, System is not person focused, Service users and carers are treated poorly, Services are overloaded and under resourced and Recommendations for service reform. Respondents reported that a persistent lack of funding and resources for mental health services was a main cause of these shortcomings. Respondents also noted that innovations were needed to re-orient services to enable continuity of care, and training of mental health professionals was needed for a better understanding of the needs of service users and their carers. Discussion Additional research is needed with larger and more diverse samples to further explore these findings.
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Affiliation(s)
- Anton Isaacs
- School of Rural Health, Monash University, Warragul, VIC, Australia
| | - Caroline Lambert
- Tandem Inc., Abbotsford, VIC, Australia
- RMIT University, Melbourne, VIC, Australia
| | - Sharon Lawn
- Lived Experience Australia, Brighton, SA, Australia
- Flinders University, Adelaide, SA, Australia
| | - Anna Dyer
- Latrobe Regional Hospital, Traralgon, VIC, Australia
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Isaacs AN, Mitchell EKL. Mental health integrated care models in primary care and factors that contribute to their effective implementation: a scoping review. Int J Ment Health Syst 2024; 18:5. [PMID: 38331913 PMCID: PMC10854062 DOI: 10.1186/s13033-024-00625-x] [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: 10/13/2023] [Accepted: 02/01/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND In the state of Victoria, Australia, the 111-day lockdown due to the COVID-19 pandemic exacerbated the population's prevailing state of poor mental health. Of the 87% of Australians who visit their GP annually, 71% of health problems they discussed related to psychological issues. This review had two objectives: (1) To describe models of mental health integrated care within primary care settings that demonstrated improved mental health outcomes that were transferable to Australian settings, and (2) To outline the factors that contributed to the effective implementation of these models into routine practice. METHODS A scoping review was undertaken to synthesise the evidence in order to inform practice, policymaking, and research. Data were obtained from PubMed, CINAHL and APA PsycINFO. RESULTS Key elements of effective mental health integrated care models in primary care are: Co-location of mental health and substance abuse services in the primary care setting, presence of licensed mental health clinicians, a case management approach to patient care, ongoing depression monitoring for up to 24 months and other miscellaneous elements. Key factors that contributed to the effective implementation of mental health integrated care in routine practice are the willingness to accept and promote system change, integrated physical and mental clinical records, the presence of a care manager, adequate staff training, a healthy organisational culture, regular supervision and support, a standardised workflow plan and care pathways that included clear role boundaries and the use of outcome measures. The need to develop sustainable funding mechanisms has also been emphasized. CONCLUSION Integrated mental health care models typically have a co-located mental health clinician who works closely with the GP and the rest of the primary care team. Implementing mental health integrated care models in Australia requires a 'whole of system' change. Lessons learned from the Mental Health Nurse Incentive Program could form the foundation on which this model is implemented in Australia.
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Affiliation(s)
- Anton N Isaacs
- Monash University School of Rural Health, Sargeant Street, PO Box 723, Warragul, VIC, 3820, Australia.
| | - Eleanor K L Mitchell
- Monash University School of Rural Health, Corner of Victoria Street & Day Street, PO Box 1497, Bairnsdale, VIC, 3875, Australia
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Wood JD, Watson AC, Pope L, Warnock A, Nelson V, Gesser N, Zern A, Stagoff-Belfort A, de Bibiana JT, Compton MT. Contexts shaping misdemeanor system interventions among people with mental illnesses: qualitative findings from a multi-site system mapping exercise. HEALTH & JUSTICE 2023; 11:20. [PMID: 37014478 PMCID: PMC10071260 DOI: 10.1186/s40352-023-00219-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND People with mental illnesses are disproportionately entangled in the criminal legal system. Historically, this involvement has resulted from minor offending, often accompanied by misdemeanor charges. In recent years, policymakers have worked to reduce the footprint of the criminal legal system. This paper seeks to better understand how misdemeanor systems intervene in the lives of people with mental illnesses. METHODS System mapping exercises were conducted with misdemeanor system stakeholders from the jurisdictions of Atlanta, Chicago, Manhattan, and Philadelphia. Narrative detail on decision-making and case processing, both generally and in relation to specific types of behavior, including trespassing, retail theft/shoplifting, and simple assault, were coded and analyzed for thematic patterns. Based on the qualitative analysis, this paper offers a conceptual diagram of contexts shaping misdemeanor system interventions among people with mental illnesses. RESULTS All four sites have been engaged in efforts to reduce the use of misdemeanor charges both generally and in relation to people with mental illnesses. Decision-makers across all sites experience contexts that shape how, when, and where they intervene, which are: (1) law and policy environments; (2) location of the behavior; (3) expectations of stakeholders; (4) knowledge of mental illnesses; and (5) access to community resources. Law and policy environments expand or constrain opportunities for diversion. The location of offending is relevant to who has a stake in the behavior, and what demands they have. Clinical, experiential, and system-level knowledge of mental illnesses inform a chain of decisions about what to do. The capacity to address mental health needs is contingent on access to social services, including housing. CONCLUSION People making decisions along the criminal legal continuum are critical to illuminating the dynamic, inter-related contexts that facilitate and frustrate attempts to address defendants' mental health needs while balancing considerations of public safety. Multi-sector, scenario-based or case study exercises could help identify concrete ways of improving each of the contexts that surround whole-of-system decisions.
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Affiliation(s)
- Jennifer D. Wood
- Department of Criminal Justice, Temple University, Philadelphia, PA USA
| | - Amy C. Watson
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI USA
| | - Leah Pope
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Amanda Warnock
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | - Veronica Nelson
- Department of Criminal Justice, Temple University, Philadelphia, PA USA
| | - Nili Gesser
- Department of Psychology, University of North Dakota, Grand Forks, ND USA
| | - Adria Zern
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
| | | | | | - Michael T. Compton
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY USA
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Torkar T, Homar V, Švab V. Triangulation study of needs assessment of people with severe mental illness in “follow‐up” day hospital settings. Nurs Open 2022; 10:2859-2868. [PMID: 36451296 PMCID: PMC10077374 DOI: 10.1002/nop2.1527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 08/27/2022] [Accepted: 11/20/2022] [Indexed: 12/03/2022] Open
Abstract
AIM The aim of research was to assess the needs of patients with severe mental illness (SMI) attending follow-up day hospital (DH) programmes from the patients', relatives' and experts' perspective. DESIGN This triangulation research relies on three sources of information and two techniques of data collection. METHODS Qualitative research was conducted comprising semi-structured interviews (n = 15) and focus groups (n = 4) in three sequential rounds, triangulating patients', relatives' and experts' views. A content analysis was carried out. RESULTS Study reveals a diverse spectrum of needs of SMI patients in follow-up DH programmes. The analysis yielded six themes: optimal daily functioning, work and educational activities, social network inclusion, continuous treatment, support and guidance, long-term care. DH programmes should assess the needs of patients with SMI and be adapted according to the findings. In addition to clinical treatment, requirements for continuous treatment, psychological and social needs, therapeutic relationship in less-restrictive settings should be considered.
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Affiliation(s)
- Tanja Torkar
- Department of Public Health, Faculty of Medicine University of Ljubljana Ljubljana Slovenia
- Department of Nursing Angela Boškin Faculty of Health Care Jesenice Slovenia
- Department of Nursing Begunje Psychiatric Hospital Begunje na Gorenjskem Slovenia
| | - Vesna Homar
- Department of Family Medicine, Faculty of Medicine University of Ljubljana Ljubljana Slovenia
- Vrhnika Healthcare Centre Vrhnika Slovenia
| | - Vesna Švab
- Department of Psychiatry, Faculty of Medicine University of Ljubljana Ljubljana Slovenia
- National Institute of Public Health Ljubljana Slovenia
- Logatec Healthcare Centre Logatec Slovenia
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Boschen K, Phelan C, Lawn S. NDIS Participants with Psychosocial Disabilities and Life-Limiting Diagnoses: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10144. [PMID: 36011776 PMCID: PMC9407781 DOI: 10.3390/ijerph191610144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
This research aimed to map evidence about system supports and gaps for Australians with psychosocial disabilities and life-limiting diagnoses. A scoping review of available policy documents, academic, and grey literature was completed to discover key characteristics of this concept and provide context around the phenomenon. Our focus was on Australia's National Disability Insurance Scheme (NDIS), a key reform providing support to the disability population nationally. No peer-reviewed or grey literature was retrieved on the phenomena. Therefore, three lines of enquiry were developed: experiences of NDIS participants living with psychosocial disabilities; the death, dying, and palliative care supports and experiences of NDIS participants of any disability type; and the experiences for people living with severe and persistent mental illness (SPMI) and life-limiting diagnoses. Five themes were identified: (1) the person; (2) advocacy; (3) informal supports; (4) formal supports; and (5) existing research. NDIS participants living with SPMI and their informal and formal support systems are still struggling to navigate the NDIS. While there are no specific publications about their end-of-life experiences, people with SPMI often experience poor end-of-life outcomes. Rigorous research into their death, dying, and palliative care experiences is needed to inform improved support to them, including their end-of-life care.
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Affiliation(s)
- Kathy Boschen
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5050, Australia
| | - Caroline Phelan
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5050, Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5050, Australia
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Effectiveness of personal recovery facilitators in adults with schizophrenia and other psychoses: A systematic review of reviews and narrative synthesis. Schizophr Res 2022; 246:132-147. [PMID: 35777151 DOI: 10.1016/j.schres.2022.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 01/12/2023]
Abstract
This review aimed to examine the evidence base for the use of personal recovery facilitators [non-psychopharmacological approaches] for adults with a diagnosis of schizophrenia and other psychoses. A systematic review (umbrella review) was conducted of reviews published in English between January 2010 and February 2022, which examined the effectiveness of personal recovery facilitators to support aspects of personal recovery as defined by the CHIME framework (connectedness, hope and optimism, identity, meaning and purpose, and empowerment). Twenty-one systematic reviews on thirteen different types of personal recovery facilitators [PRFs] were included in this umbrella review. Only one review sought to directly measure personal recovery processes according to the CHIME framework. Outcome measures mostly aligned with the processes of hope (21 reviews) and connectedness (19 reviews). Those related to empowerment (2 reviews), identity (5 reviews) and meaning and purpose (1 review) were less frequently the focus of PRFs. Yoga and music therapy showed the most promise as PRFs. Vocational treatments and integrated supported employment show good potential as personal recovery facilitators. However, together with narrative photovoice, art making and exhibition, they require further robust research to fully examine their impact. Personal recovery is only beginning to be considered as an intended outcome of interventions for persons with schizophrenia and other psychoses. This may be due in part to the continued predominance of the biomedical model approach to recovery within statutory services. Future evaluations of PRFs should include outcome measures that directly assess personal recovery according to the CHIME framework or other measures developed in consultation with recipients of these approaches. Review registration number and date: PROSPERO 2020 CRD42020215471: 10/11/20.
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Migliorini C, Fossey E, Harvey C. Self-reported needs of people living with psychotic disorders: Results from the Australian national psychosis survey. Front Psychiatry 2022; 13:1013919. [PMID: 36159945 PMCID: PMC9500201 DOI: 10.3389/fpsyt.2022.1013919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
Person-centered care is a collaborative approach to health care. To provide effective, person-centered care to people living with severe mental illness, it is necessary to understand how people view their own needs. The Perceived Need for Care Questionnaire (PNCQ) was used in the Australian National Survey of High Impact Psychosis (SHIP) to deepen understanding and evaluate, at a population level, the needs of Australian adults living with psychotic illness. SHIP participants were 1,825 adults, aged 18-65 years, living with psychotic illness and in contact with public specialized mental health services across Australia in 2010. The survey package included demographic and clinical items, and various scales including the PNCQ appraising a comprehensive range of life domains. Logistic regressions measured the impact that various demographic, clinical and psychosocial independent variables (e.g., loneliness, health-related quality of life, disability, accommodation type) had on the likelihood of inadequately met PNCQ domain-related need. Over two-thirds of people living with psychosis reported at least two areas of unmet need for care despite most being in contact with mental health services. Work or using one's time and socializing, counseling, and self-care domains had the largest proportion of inadequately met needs (range between 49 and 57%). Feelings of loneliness and/or social isolation were significantly associated with unmet needs across all PNCQ domains, except for financial needs. Health-related quality of life was significantly associated with unmet needs across all domains, except for housing needs. Disability was significantly associated with unmet social, occupation (work or time use), housing and medication-related needs. Consumers view their needs for care as unmet across many life areas despite being in contact with mental health services. Loneliness, unmet psychosocial needs, and health-related quality of life appear strongly interconnected and warrant greater attention in the delivery of person-centered care for people living with psychosis. Support to address social, work or time use and housing related needs among people living with psychosis appears less well targeted toward those with disability. Results underscore the link between quality of life, recovery and needs. These inter-relationships should be considered in mental health services research and evaluation.
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Affiliation(s)
- Christine Migliorini
- Department of Psychiatry, Psychosocial Research Centre, The University of Melbourne, Melbourne, VIC, Australia.,NorthWest Area Mental Health Service, NorthWestern Mental Health, Coburg, VIC, Australia
| | - Ellie Fossey
- Department of Occupational Therapy, Monash University, Frankston, VIC, Australia
| | - Carol Harvey
- Department of Psychiatry, Psychosocial Research Centre, The University of Melbourne, Melbourne, VIC, Australia.,NorthWest Area Mental Health Service, NorthWestern Mental Health, Coburg, VIC, Australia
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Pérez-Corrales J, Güeita-Rodríguez J, Huertas-Hoyas E, García-Bravo C, Marconnot R, Jiménez-Antona C, Velarde-García JF, Palacios-Ceña D. The Meaning of Volunteering among People with Severe Mental Disorders: A Phenomenological Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12232. [PMID: 34831988 PMCID: PMC8621690 DOI: 10.3390/ijerph182212232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022]
Abstract
This study aimed to describe the perspectives of people with severe mental disorders who volunteer regarding the relationship between volunteering and work, from the framework of personal recovery. A qualitative phenomenological study was undertaken. Purposive sampling was conducted on people with severe mental disorders who participated in volunteering. In-depth unstructured and semi-structured interviews were used, during which researchers took handwritten field notes. An inductive thematic analysis was applied. Twenty-three participants with severe mental disorders were included (16 men and 7 women) with a mean age of 47 years. Three themes emerged: (a) the relationship between volunteering and working; (b) thinking about a possible future job; and (c) disclosing a mental health condition. Volunteering is perceived as a substitute to working, although not all participants feel able to work, and they do not always disclose that they suffer from a mental health condition.
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Affiliation(s)
- Jorge Pérez-Corrales
- Research Group of Humanities and Qualitative Research in Health Science (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos Avenida Atenas s/n, 28922 Alcorcón, Spain; (J.P.-C.); (R.M.); (C.J.-A.); (D.P.-C.)
| | - Javier Güeita-Rodríguez
- Research Group of Humanities and Qualitative Research in Health Science (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos Avenida Atenas s/n, 28922 Alcorcón, Spain; (J.P.-C.); (R.M.); (C.J.-A.); (D.P.-C.)
| | - Elisabet Huertas-Hoyas
- Research Group in Evaluation and Assessment of Capacity, Functionality and Disability (TO+IDI), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Avenida Atenas s/n, 28922 Alcorcón, Spain; (E.H.-H.); (C.G.-B.)
| | - Cristina García-Bravo
- Research Group in Evaluation and Assessment of Capacity, Functionality and Disability (TO+IDI), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Avenida Atenas s/n, 28922 Alcorcón, Spain; (E.H.-H.); (C.G.-B.)
| | - Romain Marconnot
- Research Group of Humanities and Qualitative Research in Health Science (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos Avenida Atenas s/n, 28922 Alcorcón, Spain; (J.P.-C.); (R.M.); (C.J.-A.); (D.P.-C.)
| | - Carmen Jiménez-Antona
- Research Group of Humanities and Qualitative Research in Health Science (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos Avenida Atenas s/n, 28922 Alcorcón, Spain; (J.P.-C.); (R.M.); (C.J.-A.); (D.P.-C.)
| | - Juan Francisco Velarde-García
- Department of Nursing, Instituto de Investigación del Hospital Gregorio Marañón (IiSGM), Red Cross College, Universidad Autónoma de Madrid, Calle Reina Victoria 28, 28003 Madrid, Spain;
| | - Domingo Palacios-Ceña
- Research Group of Humanities and Qualitative Research in Health Science (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos Avenida Atenas s/n, 28922 Alcorcón, Spain; (J.P.-C.); (R.M.); (C.J.-A.); (D.P.-C.)
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Chan SM, Wong H, Chung RYN, Au-Yeung TC. Association of living density with anxiety and stress: A cross-sectional population study in Hong Kong. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1019-1029. [PMID: 32783296 DOI: 10.1111/hsc.13136] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 06/11/2023]
Abstract
This study aims to enrich the comprehension of the effect of living density on anxiety and stress among adults in a global city. A random sample of 1,978 Hong Kong adults was interviewed in a cross-sectional population study in 2014-2015. Descriptive statistics and logistic regressions were used to investigate the association between housing variables and mental health indicators, namely, anxiety and stress. Logistic regression analysis results have shown that by controlling the confounding effect of demographic variables, income poverty, housing ownership and housing cost, the living density was significantly associated with anxiety and stress of residents. Compared with those living in high density of <7 m2 , living in medium density of ≥7 and <13 m2 was significantly associated with lower risk of anxiety (adjusted OR 0.52, 95% CI 0.30-0.88), and the risk was less for those living in low density of ≥13 m2 (adjusted OR 0.41, 95% CI 0.23-0.72). Meanwhile, living in low density of ≥13 m2 was significantly associated with a lower risk of stress (adjusted OR 0.44, 95% CI 0.20-0.97). These results highlighted the significant impact of living density on personal anxiety and stress. Moreover, female, younger adults or those living in income poverty were also at risk of anxiety and stress. In conclusion, our findings implied that improving housing policies, such as building public housing with adequate living areas and market regulation of living density of private housing, would help enhance the mental well-being of residents.
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Affiliation(s)
- Siu Ming Chan
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
| | - Hung Wong
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
| | - Roger Yat-Nork Chung
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Tat Chor Au-Yeung
- Department of Sociology and Social Policy, Lingnan University, Hong Kong, China
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Isaacs A, Beauchamp A, Sutton K, Kocaali N. Care Coordination Can Reduce Unmet Needs of Persons With Severe and Persistent Mental Illness. Front Psychiatry 2019; 10:563. [PMID: 31447714 PMCID: PMC6697021 DOI: 10.3389/fpsyt.2019.00563] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/18/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Persons with severe and persistent mental illness (SPMI) have multiple and complex needs, many of which are not health related. Mental health services are unable to address these needs without collaboration with other agencies. In the absence of this collaboration, persons with SPMI often fall through the system cracks and are unlikely to experience recovery. Furthermore, previous studies have shown that unmet accommodation needs are associated with unmet needs in other areas. This study aimed to ascertain whether a care coordination model adopted in Australia's Partners in Recovery [PIR] initiative was able to reduce unmet needs in such persons and also if meeting accommodation needs were associated with meeting other needs. Methods: This was a longitudinal study where met and unmet needs of clients measured using the Camberwell Assessment of Needs Short Appraisal Schedule (CANSAS) were compared at enrolment and exit from the PIR initiative. Logistic regression was used to examine the association between change in accommodation needs and change in other CANSAS variables. Results: In total, 337 clients (66% of 508 clients) had both baseline and follow-up data and were seen within the time frame of 14 to 101 weeks. At baseline, the most frequently reported unmet needs were psychological distress, daytime activity, and company (89%, 72%, and 67%, respectively). At follow-up, these had decreased to 27%, 22%, and 22%, respectively. The proportions of clients with an unmet need at baseline who subsequently progressed to having that need met at follow-up ranged between 62% and over 90%. Change in accommodation needs from unmet to met was associated with changes in monetary needs and needs related to childcare, food, safety to self, education, and access to other services, with the greatest change seen for monetary needs (adjusted OR 2.87, 95% CI 1.76, 4.69). Conclusions: Reducing needs of persons with SPMI is the starting point of recovery and is a good indicator of psychiatric care. Care coordination is a useful way to address multiple and complex needs of persons with SPMI. While addressing needs, priority must be given to meeting accommodation needs.
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Affiliation(s)
- Anton Isaacs
- School of Rural Health, Monash University, Traralgon, VIC, Australia
| | - Alison Beauchamp
- Department of Rural Health, Monash University, Warragul, VIC, Australia
| | - Keith Sutton
- Department of Rural Health, Monash University, Warragul, VIC, Australia
| | - Nilay Kocaali
- Gippsland Primary Health Network, Traralgon, VIC, Australia
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