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Steele M. A reflection on improving the lives of people who use and inject drugs. Drug Alcohol Rev 2024; 43:1112-1115. [PMID: 38922755 DOI: 10.1111/dar.13889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Maureen Steele
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, Australia
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2
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Gosdin MM, Hoeft T, Henderson S, Wagner J, Hinton L. Missing link: a qualitative analysis of community-based organisations' contributions to partnered collaborative care to treat late-life depression. BMJ Open 2024; 14:e074403. [PMID: 38670617 PMCID: PMC11057290 DOI: 10.1136/bmjopen-2023-074403] [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: 04/05/2023] [Accepted: 03/31/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE Extending collaborative care, a model integrating mental health services into primary care, to include community-based organisations (CBOs) may improve older patient health outcomes by increasing access to care and addressing patients' social needs; however, little is known about how CBOs contribute to such partnered depression care. We explored how six primary care clinic and CBO partnerships came together to provide late-life depression care through the Care Partners funded in 2014. DESIGN 43 key informant interviews and 15 focus groups were conducted with care managers, administrators and primary care providers partnering to provide late-life depression care. Data were coded and analysed iteratively using qualitative thematic analysis. SETTING Six primary care clinic-CBO sites across California. PARTICIPANTS Care managers, administrators and primary care providers participated in this study. RESULTS Three unique contributions of CBOs to depression care in these clinic-CBO partnerships were identified: (1) CBOs added new services that focus on social needs and enhanced depression care; (2) CBOs strengthened core aspects of collaborative care for depression; (3) CBOs provided new avenues for building connections and trust with underserved patients. CONCLUSIONS CBOs, when partnered with clinics, enhanced both medical and social aspects of depression treatment for older adults. CBOs are well positioned to assist primary care clinics in treating the complex health needs of older adults by providing new and strengthening existing aspects of partnered depression care while building patient trust among culturally diverse populations.
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Affiliation(s)
- Melissa M Gosdin
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA
| | - Theresa Hoeft
- Psychiatry & Behavioral Sciences School of Medicine, University of Washington, Seattle, Washington, USA
| | - Stuart Henderson
- Office of Evaluations, UC Davis School of Medicine, Sacramento, California, USA
| | - Jenny Wagner
- Department of Public Health Sciences, University of California Davis, Davis, California, USA
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California Davis, University of California, Davis, Sacramento, CA, USA
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Parker SM, Paine K, Spooner C, Harris M. Barriers and facilitators to the participation and engagement of primary care in shared-care arrangements with community mental health services for preventive care of people with serious mental illness: a scoping review. BMC Health Serv Res 2023; 23:977. [PMID: 37697280 PMCID: PMC10494334 DOI: 10.1186/s12913-023-09918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/14/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND People with serious mental illness die about 20 years earlier than the general population from preventable diseases. Shared-care arrangements between general practitioners and mental health services can improve consumers' access to preventive care, but implementing shared care is challenging. This scoping review sought to describe current evidence on the barriers and facilitators to the participation and engagement of primary care (specifically general practitioners) in shared-care arrangements with community mental health services for preventive health care of this population. METHODS We searched Medline, Embase, CINAHL, Scopus, APA PsychINFO and EBM Reviews from 2010 to 2022. Data was extracted against a Microsoft Excel template developed for the review. Data was synthesised through tabulation and narrative methods. RESULTS We identified 295 records. After eligibility screening and full-text review, seven studies were included. Facilitators of engagement included a good fit with organisation and practice and opportunities to increase collaboration, specific roles to promote communication and coordination and help patients to navigate appointments, multidisciplinary teams and teamwork, and access to shared medical/health records. Barriers included a lack of willingness and motivation on the part of providers and low levels of confidence with tasks, lack of physical structures to produce capacity, poor alignment of funding/incentives, inability to share patient information and challenges engaging people with severe mental illness in the service and with their care. CONCLUSION Our results were consistent with other research on shared care and suggests that the broader literature is likely to be applicable to the context of general practitioner/mental health services shared care. Specific challenges relating to this cohort present difficulties for recruitment and retention in shared care programs. Sharing "goals and knowledge, mutual respect" and engaging in "frequent, timely, accurate, problem-solving communication", supported by structures such as shared information systems are likely to engage primary care in shared care arrangements more than the traditional focus on incentives, education, and guidelines.
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Affiliation(s)
- Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.
| | - Katrina Paine
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales , Australia
| | - Catherine Spooner
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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van Genk C, Roeg D, van Vugt M, van Weeghel J, Van Regenmortel T. Current insights of community mental healthcare for people with severe mental illness: A scoping review. Front Psychiatry 2023; 14:1156235. [PMID: 37143787 PMCID: PMC10151504 DOI: 10.3389/fpsyt.2023.1156235] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/23/2023] [Indexed: 05/06/2023] Open
Abstract
Background For the last four decades, there has been a shift in mental healthcare toward more rehabilitation and following a more humanistic and comprehensive vision on recovery for persons with severe mental illness (SMI). Consequently, many community-based mental healthcare programs and services have been developed internationally. Currently, community mental healthcare is still under development, with a focus on further inclusion of persons with enduring mental health problems. In this review, we aim to provide a comprehensive overview of existing and upcoming community mental healthcare approaches to discover the current vision on the ingredients of community mental healthcare. Methods We conducted a scoping review by systematically searching four databases, supplemented with the results of Research Rabbit, a hand-search in reference lists and 10 volumes of two leading journals. We included studies on adults with SMI focusing on stimulating independent living, integrated care, recovery, and social inclusion published in English between January 2011 and December 2022 in peer-reviewed journals. Results The search resulted in 56 papers that met the inclusion criteria. Thematic analysis revealed ingredients in 12 areas: multidisciplinary teams; collaboration within and outside the organization; attention to several aspects of health; supporting full citizenship; attention to the recovery of daily life; collaboration with the social network; tailored support; well-trained staff; using digital technologies; housing and living environment; sustainable policies and funding; and reciprocity in relationships. Conclusion We found 12 areas of ingredients, including some innovative topics about reciprocity and sustainable policies and funding. There is much attention to individual ingredients for good community-based mental healthcare, but very little is known about their integration and implementation in contemporary, fragmented mental healthcare services. For future studies, we recommend more empirical research on community mental healthcare, as well as further investigation(s) from the social service perspective, and solid research on general terminology about SMI and outpatient support.
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Affiliation(s)
- Caroline van Genk
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- *Correspondence: Caroline van Genk,
| | - Diana Roeg
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- Kwintes Housing and Rehabilitation Services, Zeist, Netherlands
| | - Maaike van Vugt
- Trimbos Institute, Dutch Institute of Mental Health and Addiction, Utrecht, Netherlands
- HVO-Querido, Amsterdam, Netherlands
| | - Jaap van Weeghel
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | - Tine Van Regenmortel
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- Faculty of Social Sciences – HIVA, University of Leuven, Leuven, Belgium
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A M, K LBC, E S, S C, P F. A protocol for a multi-site cohort study to evaluate child and adolescent mental health service transformation in England using the i-THRIVE model. PLoS One 2023; 18:e0265782. [PMID: 37155627 PMCID: PMC10166497 DOI: 10.1371/journal.pone.0265782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/14/2023] [Indexed: 05/10/2023] Open
Abstract
The National i-THRIVE Programme seeks to evaluate the impact of the NHS England-funded whole system transformation on child and adolescent mental health services (CAMHS). This article reports on the design for a model of implementation that has been applied in CAMHS across over 70 areas in England using the 'THRIVE' needs-based principles of care. The implementation protocol in which this model, 'i-THRIVE' (implementing-THRIVE), will be used to evaluate the effectiveness of the THRIVE intervention is reported, together with the evaluation protocol for the process of implementation. To evaluate the effectiveness of i-THRIVE to improve care for children and young people's mental health, a cohort study design will be conducted. N = 10 CAMHS sites that adopt the i-THRIVE model from the start of the NHS England-funded CAMHS transformation will be compared to N = 10 'comparator sites' that choose to use different transformation approaches within the same timeframe. Sites will be matched on population size, urbanicity, funding, level of deprivation and expected prevalence of mental health care needs. To evaluate the process of implementation, a mixed-methods approach will be conducted to explore the moderating effects of context, fidelity, dose, pathway structure and reach on clinical and service level outcomes. This study addresses a unique opportunity to inform the ongoing national transformation of CAMHS with evidence about a popular new model for delivering children and young people's mental health care, as well as a new implementation approach to support whole system transformation. If the outcomes reflect benefit from i-THRIVE, this study has the potential to guide significant improvements in CAMHS by providing a more integrated, needs-led service model that increases access and involvement of patients with services and in the care they receive.
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Affiliation(s)
- Moore A
- The Anna Freud National Centre for Children and Families, London, United Kingdom
- Psychoanalysis Unit, Division of Psychology and Language Sciences, University College London, London, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Lindley Baron-Cohen K
- Psychoanalysis Unit, Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Simes E
- The Anna Freud National Centre for Children and Families, London, United Kingdom
- Psychoanalysis Unit, Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Chen S
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Fonagy P
- The Anna Freud National Centre for Children and Families, London, United Kingdom
- Psychoanalysis Unit, Division of Psychology and Language Sciences, University College London, London, United Kingdom
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Kariotis TC, Prictor M, Chang S, Gray K. Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review. J Med Internet Res 2022; 24:e30405. [PMID: 35507393 PMCID: PMC9118021 DOI: 10.2196/30405] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/14/2021] [Accepted: 01/13/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The adoption of electronic health records (EHRs) and electronic medical records (EMRs) has been slow in the mental health context, partly because of concerns regarding the collection of sensitive information, the standardization of mental health data, and the risk of negatively affecting therapeutic relationships. However, EHRs and EMRs are increasingly viewed as critical to improving information practices such as the documentation, use, and sharing of information and, more broadly, the quality of care provided. OBJECTIVE This paper aims to undertake a scoping review to explore the impact of EHRs on information practices in mental health contexts and also explore how sensitive information, data standardization, and therapeutic relationships are managed when using EHRs in mental health contexts. METHODS We considered a scoping review to be the most appropriate method for this review because of the relatively recent uptake of EHRs in mental health contexts. A comprehensive search of electronic databases was conducted with no date restrictions for articles that described the use of EHRs, EMRs, or associated systems in the mental health context. One of the authors reviewed all full texts, with 2 other authors each screening half of the full-text articles. The fourth author mediated the disagreements. Data regarding study characteristics were charted. A narrative and thematic synthesis approach was taken to analyze the included studies' results and address the research questions. RESULTS The final review included 40 articles. The included studies were highly heterogeneous with a variety of study designs, objectives, and settings. Several themes and subthemes were identified that explored the impact of EHRs on information practices in the mental health context. EHRs improved the amount of information documented compared with paper. However, mental health-related information was regularly missing from EHRs, especially sensitive information. EHRs introduced more standardized and formalized documentation practices that raised issues because of the focus on narrative information in the mental health context. EHRs were found to disrupt information workflows in the mental health context, especially when they did not include appropriate templates or care plans. Usability issues also contributed to workflow concerns. Managing the documentation of sensitive information in EHRs was problematic; clinicians sometimes watered down sensitive information or chose to keep it in separate records. Concerningly, the included studies rarely involved service user perspectives. Furthermore, many studies provided limited information on the functionality or technical specifications of the EHR being used. CONCLUSIONS We identified several areas in which work is needed to ensure that EHRs benefit clinicians and service users in the mental health context. As EHRs are increasingly considered critical for modern health systems, health care decision-makers should consider how EHRs can better reflect the complexity and sensitivity of information practices and workflows in the mental health context.
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Affiliation(s)
- Timothy Charles Kariotis
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia
- Melbourne School of Government, The University of Melbourne, Carlton, Australia
| | - Megan Prictor
- Melbourne Law School, University of Melbourne, Carlton, Australia
- Centre for Digital Transformation of Health, University of Melbourne, Parkville, Australia
| | - Shanton Chang
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, University of Melbourne, Parkville, Australia
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Trane K, Aasbrenn K, Rønningen M, Odden S, Lexén A, Landheim A. Integration of Care in Complex and Fragmented Service Systems: Experiences of Staff in Flexible Assertive Community Treatment Teams. Int J Integr Care 2022; 22:17. [PMID: 35651735 PMCID: PMC9139156 DOI: 10.5334/ijic.6011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 05/16/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction To provide more integrated care, several countries have implemented the Flexible Assertive Community Treatment (FACT) model. However, this model does not guarantee full integration, especially in complex and fragmented service systems like in Norway. Hence, we investigated which barriers that might reduce the potential for integrated care in the Norwegian system, as described by staff in FACT teams, and how they adjust their way of working to increase the opportunities for integration. Methods Online focus group interviews involving 35 staff members of five Norwegian FACT teams were conducted using a semi-structured interview guide. The material was analysed using thematic text analysis. Results Six themes described the barriers to integrated care in the service system: fragmentation, different legislation and digital systems, challenges in collaboration, bureaucracy and limited opening hours. Three themes described adjustments in the teams' way of working to enhance integration: working as the responsible co-ordinator, being a collaborator, and the only entry channel into the service system. Conclusion The FACT team staff described several barriers to integration within the system. However, they made some adjustments in their way of working that might provide opportunities for integrated care within complex and fragmented service systems.
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Fleury MJ, Grenier G, Gentil L, Roberge P. Deployment of the consultation-liaison model in adult and child-adolescent psychiatry and its impact on improving mental health treatment. BMC FAMILY PRACTICE 2021; 22:82. [PMID: 33926390 PMCID: PMC8086343 DOI: 10.1186/s12875-021-01437-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/06/2021] [Indexed: 11/21/2022]
Abstract
Background Little information exists on the perceptions of psychiatrists regarding the implementation and various impacts of the consultation-liaison model. This model has been used in Quebec (Canada) through the function of specialist respondent-psychiatrists (SRP) since 2009. This study assessed the main activities, barriers or facilitators, and impact of SRP in adult and child-adolescent psychiatry on the capacity of service providers in primary care and youth centers to treat patients with mental health disorders (MHD). Methods Data included 126 self-administered questionnaires from SRP and semi-structured interviews from 48 SRP managers. Mixed methods were used, with qualitative findings from managers complementing the SRP survey. Comparative analyses of SRP responses in adult versus child-adolescent psychiatry were also conducted. Results Psychiatrists dedicated a median 24.12 h/month to the SRP function, mainly involving case discussions with primary care teams or youth centers. They were confident about the level of support they provided and satisfied with their influence in clinical decision-making, but less satisfied with the support provided by their organizations. SRP evaluated their impacts on clinical practice as moderate, particularly among general practitioners (GP). SRP working in child-adolescent psychiatry were more comfortable, motivated, and positive about their overall performance and impact than in adult psychiatry. Organizational barriers (e.g. team instability) were most prevalent, followed by system-level factors (e.g. network size and complexity, lack of resources, model inflexibility) and individual factors (e.g. GP reluctance to treat patients with MHD). Organizational facilitators included support from family medicine group directors, collaboration with university family medicine groups and coordination by liaison nurses; at the system level, pre-existing relationships and working in the same institution; while individual-level facilitators included SRP personality and strong organizational support. Conclusion Quebec SRP were implemented sparingly in family medicine groups and youth centers, while SRP viewed their overall impact as moderate. Results were more positive in child-adolescent psychiatry than in adult psychiatry. Increased support for the SRP function, adapting the model to GP in need of more direct support, and resolving key system issues may improve SRP effectiveness in terms of team stability, coordination among providers, access to MH services and readiness to implement innovations. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01437-5.
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Affiliation(s)
- M-J Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada. .,Douglas Mental Health University Institute Research Center, Montréal, QC, Canada.
| | - G Grenier
- Douglas Mental Health University Institute Research Center, Montréal, QC, Canada
| | - L Gentil
- Douglas Mental Health University Institute Research Center, Montréal, QC, Canada
| | - P Roberge
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
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Gentil L, Grenier G, Vasiliadis HM, Huỳnh C, Fleury MJ. Predictors of Recurrent High Emergency Department Use among Patients with Mental Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094559. [PMID: 33923112 PMCID: PMC8123505 DOI: 10.3390/ijerph18094559] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 11/23/2022]
Abstract
Few studies have examined predictors of recurrent high ED use. This study assessed predictors of recurrent high ED use over two and three consecutive years, compared with high one-year ED use. This five-year longitudinal study is based on a cohort of 3121 patients who visited one of six Quebec (Canada) ED at least three times in 2014–2015. Multinomial logistic regression was performed. Clinical, sociodemographic and service use variables were identified based on data extracted from health administrative databases for 2012–2013 to 2014–2015. Of the 3121 high ED users, 15% (n = 468) were recurrent high ED users for a two-year period and 12% (n = 364) over three years. Patients with three consecutive years of high ED use had more personality disorders, anxiety disorders, alcohol or drug related disorders, chronic physical illnesses, suicidal behaviors and violence or social issues. More resided in areas with high social deprivation, consulted frequently with psychiatrists, had more interventions in local community health service centers, more prior hospitalizations and lower continuity of medical care. Three consecutive years of high ED use may be a benchmark for identifying high users needing better ambulatory care. As most have multiple and complex health problems, higher continuity and adequacy of medical care should be prioritized.
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Affiliation(s)
- Lia Gentil
- Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC H3A 1A1, Canada;
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada;
- Centre Intégré Universitaire de Santé et des Services Sociaux du Centre-Sud-de-l’Île-de-Montréal, Institut Universitaire sur les Dépendances, 950 Louvain Est, Montréal, QC H2M 2E8, Canada;
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada;
| | - Helen-Maria Vasiliadis
- Département Des Sciences de la Santé Communautaire, Université de Sherbrooke, Longueuil, QC J4K 0A8, Canada;
- Centre de Recherche Charles-Le Moyne-Saguenay–Lac-Saint-Jean sur les Innovations en Santé (CR-CSIS), Campus de Longueuil-Université de Sherbrooke, 150 Place Charles-Lemoyne, Longueuil, QC J4K 0A8, Canada
| | - Christophe Huỳnh
- Centre Intégré Universitaire de Santé et des Services Sociaux du Centre-Sud-de-l’Île-de-Montréal, Institut Universitaire sur les Dépendances, 950 Louvain Est, Montréal, QC H2M 2E8, Canada;
| | - Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC H3A 1A1, Canada;
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC H4H 1R3, Canada;
- Correspondence:
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Trane K, Aasbrenn K, Rønningen M, Odden S, Lexén A, Landheim A. Flexible assertive community treatment teams can change complex and fragmented service systems: experiences of service providers. Int J Ment Health Syst 2021; 15:38. [PMID: 33892769 PMCID: PMC8067287 DOI: 10.1186/s13033-021-00463-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/15/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Implementing innovative health service models in existing service systems is complicated and context dependent. Flexible assertive community treatment (FACT) is a multidisciplinary service model aimed at providing integrated care for people with severe mental illness. The model was developed in the Netherlands and is now used in several countries, such as Norway. The Norwegian service system is complex and fragmented, with challenges in collaboration. Limited research has been performed on FACT teams and other new integrative health service models as part of such systems. However, such knowledge is important for future adjustments of innovation processes and service systems. Our aim was to explore how FACT teams are integrated into the existing formal public service system, how they function and affect the system, and describe some influencing factors to this. We sought to address how service providers in the existing service system experience the functioning of FACT teams in the system. METHODS Five focus group interviews were undertaken 3 years after the FACT teams were implemented. Forty service providers representing different services from both levels of administration (primary and specialist healthcare) from different Norwegian regions participated in this study. Team leaders of the FACT teams also participated. Service providers were recruited through purposeful sampling. Interviews were analysed using thematic text analysis. RESULTS The analysis revealed five main themes regarding FACT teams: (1) They form a bridge between different services; (2) They collaborate with other services; (3) They undertake responsibility and reassure other services; (4) They do not close all gaps in service systems; and (5) They are part of a service system that hampers their functioning. CONCLUSIONS The FACT teams in this study contributed to positive changes in the existing service system. They largely contributed to less complex and fragmented systems by forming a bridge and undertaking responsibility in the system and by collaborating with and reassuring other services; this has reduced some gaps in the system. The way FACT teams function and needs of the existing system appear to have contributed positively to these findings. However, complexity and fragmentation of the system partly hamper functioning of the FACT teams.
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Affiliation(s)
- Kristin Trane
- Inland Hospital Trust, The Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Hamar, Norway.
| | | | | | - Sigrun Odden
- Inland Hospital Trust, The Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Hamar, Norway
| | - Annika Lexén
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Anne Landheim
- Inland Hospital Trust, The Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Hamar, Norway
- Inland Norway University of Applied Sciences, Hamar, Norway
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Louie E, Giannopoulos V, Baillie A, Uribe G, Wood K, Teesson M, Childs S, Rogers D, Haber PS, Morley KC. Barriers and Facilitators to the Implementation of the Pathways to Comorbidity Care (PCC) Training Package for the Management of Comorbid Mental Disorders in Drug and Alcohol Settings. FRONTIERS IN HEALTH SERVICES 2021; 1:785391. [PMID: 36926478 PMCID: PMC10012778 DOI: 10.3389/frhs.2021.785391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022]
Abstract
Background: We have previously reported that the Pathways to Comorbidity Care (PCC) training program for alcohol and other drug (AOD) clinicians improved identification of comorbidity, self-efficacy, and attitudes toward screening and monitoring of comorbidity. We aimed to identify barriers and facilitators of implementation of the PCC training program in drug and alcohol settings. Methods: The PCC training program was implemented across 6 matched sites in Australia as per (1), and 20 clinicians received training. PCC training included seminar presentations, workshops conducted by local "clinical champions," individual clinical supervision, and access to an online information portal. We examined barriers and facilitators of implementation according to the Consolidated Framework for Implementation Research. Results: Barriers included inner setting (e.g., allocated time for learning) and characteristics of individuals (e.g., resistance). Facilitators included intervention characteristics (e.g., credible sources), inner setting (e.g., leadership), and outer setting domains (e.g., patient needs). Clinical champions were identified as an important component of the implementation process. Conclusions: Barriers included limited specific allocated time for learning. A credible clinical supervisor, strong leadership engagement and an active clinical champion were found to be facilitators of the PCC training program.
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Affiliation(s)
- Eva Louie
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Vicki Giannopoulos
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Andrew Baillie
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gabriela Uribe
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW, Australia
| | - Katie Wood
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW, Australia
| | - Steven Childs
- Central Coast Local Health District, Drug and Alcohol Clinical Services, Gosford, NSW, Australia
| | - David Rogers
- Drug and Alcohol Services, Mid North Coast Local Health District, Port Macquarie, NSW, Australia
| | - Paul S Haber
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kirsten C Morley
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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12
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Shepherd N, Meehan T. Negotiating the boundaries between clinical and non-clinical work within a supported housing program. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2019. [DOI: 10.1080/00207411.2019.1651606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Nicole Shepherd
- School of Social Science, University of Queensland, St Lucia, Australia
| | - Tom Meehan
- Faculty of Medicine, University of Queensland and Service Evaluation and Research Unit, The Park Centre for Mental Health, Wacol, Australia
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13
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Isaacs AN, Beauchamp A, Sutton K, Maybery D. Unmet needs of persons with a severe and persistent mental illness and their relationship to unmet accommodation needs. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e246-e256. [PMID: 30848020 DOI: 10.1111/hsc.12729] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Abstract
This is a cross-sectional study of unmet needs of persons enrolled in Australia's Partners in Recovery (PIR) initiative. It aimed to explore the unmet needs reported by persons with a severe and persistent mental illness (SPMI) and to examine the associations between unmet accommodation needs and other unmet needs. The study was undertaken in the Gippsland region of Victoria from February to May 2015. Data were collected from the administrative database for the PIR initiative in Gippsland, which was held by the Gippsland Primary Health Network. Data on unmet needs, as measured by the Camberwell Assessment of Needs Short Appraisal Schedule, were analysed using proportions and logistic regression. Psychological distress, daytime activities, company/someone to spend time with and employment and volunteering were the most commonly reported unmet needs. Participants with unmet accommodation needs were less likely to receive information on their condition or access other services. They also had unmet needs relating to food, money, transport, childcare, looking after home, physical health, psychological distress and self-care. Supported accommodation may not be enough for persons with SPMI who have poor functioning skills and are incapable of looking after themselves. Services such as Housing First that have shown promising results need to be part of a comprehensive strategy to care for persons with severe and enduring mental illness.
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Affiliation(s)
- Anton N Isaacs
- School of Rural Health, (Traralgon and West Gippsland), Monash University, Traralgon, Vic., Australia
| | - Alison Beauchamp
- School of Rural Health (UDRH), Monash University, Moe, Vic., Australia
| | - Keith Sutton
- School of Rural Health (UDRH), Monash University, Moe, Vic., Australia
| | - Darryl Maybery
- School of Rural Health (UDRH), Monash University, Moe, Vic., Australia
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14
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Reilly J, McDermott B, Dillon J. Standardized drug and alcohol questions at admission to an acute adult mental health unit: clarifying the burden of dual diagnoses across a five-year period. Australas Psychiatry 2019; 27:270-274. [PMID: 30382749 DOI: 10.1177/1039856218810161] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We aimed to report substance use across a five-year period in individuals admitted to an acute mental health unit, utilizing data from a routine clinical measure, diagnoses, and findings related to gender, ethnicity and the implementation of a new dual-diagnosis policy. METHODS Data was extracted from the electronic records of 2118 individuals who had consecutive admissions to the acute inpatient unit. Analysis focused on demographic and diagnosis variables and the drug and alcohol question in the Health of the Nations Outcome Scale. RESULTS Some 57.6% of the sample was in the at-risk drug and alcohol category. Male and indigenous inpatients were most at risk. More than 50% of patients with schizophrenia, anxiety and personality disorders were deemed at-risk. Following implementation of the dual-diagnosis policy, recorded primary and secondary substance use disorder (SUD) diagnoses significantly increased. CONCLUSIONS The study replicated previous findings of a high proportion of patients with co-morbid drug and alcohol use. In this sample it seems likely that the dual-diagnosis policy and related activities increased the rate of SUD diagnoses recorded, although it is likely to still be under-reported.
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Affiliation(s)
- John Reilly
- Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Division, Queensland Health, Townsville, QLD, Australia
| | - Brett McDermott
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - John Dillon
- Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Division, Queensland Health, Townsville, QLD, Australia
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15
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Lamanna D, Stergiopoulos V, Durbin J, O'Campo P, Poremski D, Tepper J. Promoting continuity of care for homeless adults with unmet health needs: The role of brief interventions. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:56-64. [PMID: 28569397 DOI: 10.1111/hsc.12461] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 06/07/2023]
Abstract
Promoting timely and continuous care for people experiencing homelessness has been a challenge in many jurisdictions, plagued by access barriers and service fragmentation. As part of a larger programme evaluation, this study used qualitative methods to examine the role of a brief interdisciplinary intervention in supporting continuity of care for this population in a large Canadian urban centre. The intervention provides time-limited case management, primary and psychiatric care, and peer accompaniment to homeless adults with unmet health needs discharged from hospital. Data were collected from 52 study participants between July 2013 and December 2014. Three focus groups were conducted with service providers and people with lived experience of homelessness, and 29 individual, semi-structured interviews were conducted with service users and other key informants. Transcripts were analysed using thematic analysis. Analysis was informed by existing frameworks for continuity of care, while remaining open to additional or unexpected findings. Findings suggest that brief interdisciplinary interventions can promote continuity of care by offering low-barrier access, timely and responsive service provision, including timely connection to long-term services and supports, appropriate individualised services and effective co-ordination of services. Although brief interdisciplinary interventions were perceived to promote access, timeliness and co-ordination of care for this population with complex health and social needs, gaps in the local service delivery context can present persisting barriers to care comprehensiveness and continuity.
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Affiliation(s)
- Denise Lamanna
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Janet Durbin
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Performance Measurement and Evaluation Research, Provincial System and Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Patricia O'Campo
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Poremski
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Mental Health, Singapore, Singapore
| | - Joshua Tepper
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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Murphy K, Coombes I, Moudgil V, Patterson S, Wheeler A. Clozapine and concomitant medications: Assessing the completeness and accuracy of medication records for people prescribed clozapine under shared care arrangements. J Eval Clin Pract 2017; 23:1164-1172. [PMID: 28471043 DOI: 10.1111/jep.12743] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/24/2017] [Accepted: 02/24/2017] [Indexed: 12/18/2022]
Abstract
RATIONALE, AIM, AND OBJECTIVE The objective of the study is to assess the completeness and accuracy of medication records held by stakeholders (secondary care, general practice, and community pharmacy) for clozapine consumers managed in a shared care programme. METHODS This was an exploratory, descriptive study examining secondary and primary care medication records in a large, urban, public mental health service setting in Queensland, Australia. Consumers (18-65 years old) prescribed clozapine under shared care management with capacity to consent were eligible (n = 55) to participate. Information from medication and dispensing records was used by a pharmacist to compile a best possible medication history for each consumer. Discrepancies were identified through reconciliation of stakeholder records with the history. Discrepancies were defined as an omission, addition, or administration discrepancy (difference in dose, frequency, or clozapine brand). RESULTS Thirty-five (63.6%) consumers consented for records to be reviewed. Overall, 32 (91.4%) consumers had at least 1 discrepancy in their records with a mean of 4.9 discrepancies per consumer. Of 172 discrepancies, 127 (73.8%) were omissions. Primarily, concomitant medicines were omitted in 19/35 (54%) of secondary care records while clozapine was omitted in 13/32 (40.6%) of community pharmacies records. CONCLUSIONS Discrepancies were highly prevalent in the shared care medication records of clozapine consumers of this service. Where there is incomplete and inaccurate medication information, there is a risk of suboptimal clinical decision making, increasing the likelihood of adverse drug events. This study demonstrates a need for improved documentation and timely access to accurate and complete medication records for shared care stakeholders. Expanding the pharmacist's role in this setting could improve medication accuracy in documentation and related communication.
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Affiliation(s)
- Kate Murphy
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Ian Coombes
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Vikas Moudgil
- Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Susan Patterson
- Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Amanda Wheeler
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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17
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Martin RM, Ridley SC, Gillieatt SJ. Family inclusion in mental health services: Reality or rhetoric? Int J Soc Psychiatry 2017; 63:480-487. [PMID: 28653545 DOI: 10.1177/0020764017716695] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Contemporary mental health policies require family inclusion in the design, implementation and evaluation of services. MATERIALS This scoping review considers the factors in mental health practice which either mediate or promote family inclusion. A wide range of factors are reported to obstruct family inclusion, while a smaller number of studies report that meaningful family inclusion rests on a partnership approach which values the input of families and services users. DISCUSSION When it comes to family inclusion, there is a gap between policy and service delivery practice. Changes in service delivery attitudes, values and culture are necessary to meaningfully and systematically include families and service users.
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Affiliation(s)
- Robyn M Martin
- School of Occupational Therapy and Social Work, Curtin University, Perth, WA, Australia
| | - Sophie C Ridley
- School of Occupational Therapy and Social Work, Curtin University, Perth, WA, Australia
| | - Sue J Gillieatt
- School of Occupational Therapy and Social Work, Curtin University, Perth, WA, Australia
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18
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Savic M, Best D, Manning V, Lubman DI. Strategies to facilitate integrated care for people with alcohol and other drug problems: a systematic review. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:19. [PMID: 28388954 PMCID: PMC5384147 DOI: 10.1186/s13011-017-0104-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/30/2017] [Indexed: 01/09/2023]
Abstract
Background There is a growing body of research highlighting the potential benefits of integrated care as a way of addressing the needs of people with alcohol and other drug (AOD) problems, given the broad range of other issues clients often experience. However, there has been little academic attention on the strategies that treatment systems, agencies and clinicians could implement to facilitate integrated care. Methods We synthesised the existing evidence on strategies to improve integrated care in an AOD treatment context by conducting a systematic review of the literature. We searched major academic databases for peer-reviewed articles that evaluated strategies that contribute to integrated care in an AOD context between 1990 and 2014. Over 2600 articles were identified, of which 14 met the study inclusion criteria of reporting on an empirical study to evaluate the implementation of integrated care strategies. The types of strategies utilised in included articles were then synthesised. Results We identified a number of interconnected strategies at the funding, organisational, service delivery and clinical levels. Ensuring that integrated care is included within service specifications of commissioning bodies and is adequately funded was found to be critical in effective integration. Cultivating positive inter-agency relationships underpinned and enabled the implementation of most strategies identified. Staff training in identifying and responding to needs beyond clinicians’ primary area of expertise was considered important at a service level. However, some studies highlight the need to move beyond discrete training events and towards longer term coaching-type activities focussed on implementation and capacity building. Sharing of client information (subject to informed consent) was critical for most integrated care strategies. Case-management was found to be a particularly good approach to responding to the needs of clients with multiple and complex needs. At the clinical level, screening in areas beyond a clinician's primary area of practice was a common strategy for facilitating referral and integrated care, as was joint care planning. Conclusion Despite considerable limitations and gaps in the literature in terms of the evaluation of integrated care strategies, particularly between AOD services, our review highlights several strategies that could be useful at multiple levels. Given the interconnectedness of integrated care strategies identified, implementation of multi-level strategies rather than single strategies is likely to be preferable. Electronic supplementary material The online version of this article (doi:10.1186/s13011-017-0104-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael Savic
- Turning Point, Eastern Health, 54-62 Gertrude St, Fitzroy, VIC, 3065, Australia. .,Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC, 3128, Australia.
| | - David Best
- Department of Law and Criminology, Sheffield Hallam University, Heart of the Campus Building, Collegiate Crescent, Collegiate Campus, Sheffield, S10 2BQ, UK
| | - Victoria Manning
- Turning Point, Eastern Health, 54-62 Gertrude St, Fitzroy, VIC, 3065, Australia.,Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC, 3128, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, 54-62 Gertrude St, Fitzroy, VIC, 3065, Australia.,Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC, 3128, Australia
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19
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Happell B, Wilson K, Platania-Phung C, Stanton R. Filling the gaps and finding our way: family carers navigating the healthcare system to access physical health services for the people they care for. J Clin Nurs 2017; 26:1917-1926. [DOI: 10.1111/jocn.13505] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 01/28/2023]
Affiliation(s)
- Brenda Happell
- Synergy, Nursing and Midwifery Research Centre; Faculty of Health; University of Canberra; Canberra ACT Australia
- Canberra Hospital; ACT Health; Canberra ACT Australia
| | - Karen Wilson
- Canberra Hospital; ACT Health; Canberra ACT Australia
- Synergy, Nursing and Midwifery Research Centre; University of Canberra; Canberra ACT Australia
- Carers ACT; Holt ACT Australia
| | - Chris Platania-Phung
- Synergy, Nursing and Midwifery Research Centre; Faculty of Health; University of Canberra; Canberra ACT Australia
- Canberra Hospital; ACT Health; Canberra ACT Australia
| | - Robert Stanton
- Synergy, Nursing and Midwifery Research Centre; Faculty of Health; University of Canberra; Canberra ACT Australia
- Canberra Hospital; ACT Health; Canberra ACT Australia
- School of Medical and Applied Sciences; Central Queensland University; Rockhampton Qld Australia
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20
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The effect of context in rural mental health care: Understanding integrated services in a small town. Health Place 2017; 45:70-76. [PMID: 28288445 DOI: 10.1016/j.healthplace.2017.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/05/2017] [Accepted: 03/05/2017] [Indexed: 11/20/2022]
Abstract
Unequal health care outcomes for those with mental illness mean that access to integrated models is critical to supporting good physical and mental health care. This is especially so in rural areas where geographic and structural issues constrain the provision of health services. Guided by a conceptual framework about rural and remote health, this study draws on interviews with health providers and other staff and examines the dynamics of integrated primary and community-based specialist care for people with severe and persistent mental illnesses living in rural Australia. Findings show that the facilitation of sustainable linkages between general practice and community mental health requires the skilful exercise of power, knowledge, and resources by partners in order to address the social and structural factors that influence local health situations. These findings suggest that incremental processes of integration that are responsive to patients' and stakeholders' needs and that build on success and increased trust may be more effective than those imposed from the 'top down' that pay insufficient attention to local contexts.
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21
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Martyres K, Townshend P. Addressing the Needs of Problem Gamblers With Co-Morbid Issues: Policy and Service Delivery Approaches. JOURNAL OF GAMBLING ISSUES 2016. [DOI: 10.4309/jgi.2016.33.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Most people with gambling problems have at least one co-occurring condition and many experience multiple co-occurring conditions simultaneously. In many Western jurisdictions, a specialist service response has developed, with separate agencies and workforces established to respond to gambling problems. Despite the number of co-occurring issues that occur alongside gambling, research is limited on the prevalence of problem gambling across some service systems, such as mental health and family service sectors. However, it is reasonable to conclude that significant numbers of people with gambling problems are currently engaged in other health and welfare service sectors. Partnership work with other service sectors is therefore vital to respond to the needs of these people. In Victoria, Australia, a partnership program was established in gambling help services to improve integration and co-ordination between gambling, alcohol and drug, family support, and mental health service sectors. From the experience acquired in developing the program, we seek in this article to outline the benefits and challenges of implementing a cross-sector approach in gambling treatment service systems and to recommend effective strategies to develop a cross-sector approach, including creating an authorising environment at the government policy level.
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22
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Lubman DI, Garfield JBB, Manning V, Berends L, Best D, Mugavin JM, Lam T, Buykx P, Larner A, Lloyd B, Room R, Allsop S. Characteristics of individuals presenting to treatment for primary alcohol problems versus other drug problems in the Australian patient pathways study. BMC Psychiatry 2016; 16:250. [PMID: 27435013 PMCID: PMC4950603 DOI: 10.1186/s12888-016-0956-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 07/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People seeking treatment for substance use disorders often have additional health and social issues. Although individuals presenting with alcohol as the primary drug of concern (PDOC) account for nearly half of all treatment episodes to the Australian alcohol and other drug (AOD) service system, previous treatment cohort studies have focused only on the profile of Australian heroin or methamphetamine users. While studies overseas indicate that clients seeking treatment primarily for their drinking are less likely to experience social and economic marginalisation than those seeking treatment primarily for illicit or pharmaceutical drug use, very little research has directly compared individuals presenting with alcohol as the PDOC to those primarily presenting with other drugs as their PDOC. METHODS Seven hundred and ninety-six participants were recruited at entry to specialist AOD treatment in Victoria and Western Australia, and completed measures of demographic and social factors, substance use, quality of life, service use, and criminal justice involvement. We compared those with alcohol as their PDOC to those with other drugs as their PDOC using Pearson chi-square and Mann-Whitney U tests. RESULTS Rates of social disadvantage, poor quality of life, high severity of substance dependence, and past-year AOD, mental health, acute health, and social service use were high in all groups. However, participants with alcohol as the PDOC were older; more likely to have an educational qualification; less likely to report criminal justice involvement, housing/homelessness service use, tobacco smoking, or problems with multiple substances; and reported better environmental quality of life; but were more likely to have used ambulance services, than those with other drugs as their PDOC. CONCLUSIONS While those seeking treatment primarily for alcohol problems appear less likely to suffer some forms of social and economic disadvantage or to use multiple substances than those with a primary drug problem, they experience similarly high levels of substance dependence severity and mental health and AOD service use. These findings reinforce the need for AOD services to integrate or coordinate care with programs that address the many complexities clients frequently present with, while also acknowledging differences between those seeking treatment for alcohol versus other drug problems.
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Affiliation(s)
- Dan I. Lubman
- Turning Point and Monash University, 54-62 Gertrude Street, Fitzroy, VIC 3065 Australia
| | - Joshua B. B. Garfield
- Turning Point and Monash University, 54-62 Gertrude Street, Fitzroy, VIC 3065 Australia
| | - Victoria Manning
- Turning Point and Monash University, 54-62 Gertrude Street, Fitzroy, VIC 3065 Australia
| | - Lynda Berends
- Centre for Health and Social Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC 3000 Australia
| | - David Best
- Room HC.2.14, Heart of the Campus Building, Collegiate Crescent, Collegiate Campus, Sheffield, S10 2BQ UK
| | - Janette M. Mugavin
- Centre for Alcohol Policy Research, La Trobe University, 215 Franklin St., Melbourne, 3000 VIC Australia
| | - Tina Lam
- National Drug Research Institute, 10 Selby Street, Shenton Park, WA 6008 Australia
| | - Penny Buykx
- University of Sheffield School of Health and Related Research (ScHARR), Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Andrew Larner
- Turning Point and Monash University, 54-62 Gertrude Street, Fitzroy, VIC 3065 Australia
| | - Belinda Lloyd
- Turning Point and Monash University, 54-62 Gertrude Street, Fitzroy, VIC 3065 Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, 215 Franklin St., Melbourne, 3000 VIC Australia
| | - Steve Allsop
- National Drug Research Institute, 10 Selby Street, Shenton Park, WA 6008 Australia
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23
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Happell B, Wilson K, Platania-Phung C, Stanton R. Physical health nurse consultant role to improve physical health in mental health services: A carer's perspective. Int J Ment Health Nurs 2016; 25:243-50. [PMID: 26876094 DOI: 10.1111/inm.12208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 12/16/2015] [Accepted: 12/21/2015] [Indexed: 01/02/2023]
Abstract
The physical health of people diagnosed with a mental illness is significantly poorer in comparison with the general population. Awareness of this health disparity is increasing; however, strategies to address the problem are limited. Carers play an important role in the physical health care of people with mental illness, particularly in facilitating navigation of and advocating in the health care system. A specialist physical health nurse consultant position has been suggested as a way to address the physical health care disparity and limited research available suggests that positive outcomes are possible. In the present study, a qualitative exploratory research project was undertaken, involving in-depth interviews with people identifying as mental health carers. Two focus groups and one individual interview were conducted involving a total of 13 carers. The resulting data were analyzed thematically. Views and opinions about the proposed physical health nurse consultant (PHNC) position were sought during these interviews and are reported in this paper. Two main sub-themes were evident relating to characteristics of this role: reliability and consistency; and communication and support. Essentially carers expressed a need for support for themselves and consumers in addressing physical health concerns. Successful implementation of this position would require a consistent and reliable approach. Carers are significant stakeholders in the physical health of consumers of mental health services and their active involvement in identifying and tailoring services, including development of the physical health nurse consultant must be seen as a priority.
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Affiliation(s)
- Brenda Happell
- Synergy, Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Woden, Australian Capital Territory, Australia
| | - Karen Wilson
- Synergy, Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Woden, Australian Capital Territory, Australia
| | - Chris Platania-Phung
- Synergy, Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Woden, Australian Capital Territory, Australia
| | - Robert Stanton
- Central Queensland University, School of Medical and Applied Sciences, Rockhampton, Queensland, Australia
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24
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Happell B, Wilson K, Platania-Phung C, Stanton R. Physical health and mental illness: listening to the voice of carers. J Ment Health 2016; 26:127-133. [PMID: 27102585 DOI: 10.3109/09638237.2016.1167854] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Shortened life expectancy of people with mental illness is now widely known and the focus of research and policy activity. To date, research has primarily reflected perspectives of health professionals with limited attention to the views and opinions of those most closely affected. The voice of carers is particularly minimal, despite policy stipulating carer participation is required for mental health services. AIM To present views and opinions of carers regarding physical health of the people they care for. METHODS Qualitative exploratory. Two focus groups and one individual interview were conducted with 13 people identifying as carers of a person with mental illness. Research was conducted in the Australian Capital Territory. Data analysis was based on the thematic framework of Braun and Clarke. RESULTS Two main themes were interaction between physical and mental health; and, carers' own physical and mental health. Participants described the impact of mental illness and its treatments on physical health, including their own. CONCLUSIONS Carers are acknowledged as crucial for the delivery of high quality mental health services. Therefore they have an important role to play in addressing the poor physical health of people with mental illness. Hearing their views and opinions is essential.
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Affiliation(s)
- Brenda Happell
- a Synergy, Nursing and Midwifery Research Centre, University of Canberra and ACT Health , Australian Capital Territory , Australia and
| | - Karen Wilson
- a Synergy, Nursing and Midwifery Research Centre, University of Canberra and ACT Health , Australian Capital Territory , Australia and
| | - Chris Platania-Phung
- a Synergy, Nursing and Midwifery Research Centre, University of Canberra and ACT Health , Australian Capital Territory , Australia and
| | - Robert Stanton
- b Central Queensland University, School of Medical and Applied Sciences , Rockhampton , Queensland , Australia
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25
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Abstract
Introduction: Meeting the complex health needs of people often
requires interaction among numerous different sectors. No one service can
adequately respond to the diverse care needs of consumers. Providers working
more effectively together is frequently touted as the solution. Cross-sector
service provision is defined as independent, yet interconnected sectors working
together to better meet the needs of consumers and improve the quality and
effectiveness of service provision. Cross-sector service provision is expected,
yet much remains unknown about how it is conceptualised or its impact on health
status. This umbrella review aims to clarify the critical attributes that shape
cross-sector service provision by presenting the current state of the literature
and building on the findings of the 2004 review by Sloper. Methods: Literature related to cross-sector service provision is
immense, which poses a challenge for decision makers wishing to make
evidence-informed decisions. An umbrella review was conducted to articulate the
overall state of cross-sector service provision literature and examine the
evidence to allow for the discovery of consistencies and discrepancies across
the published knowledge base. Findings: Sixteen reviews met the inclusion criteria. Seven themes
emerged: Focusing on the consumer, developing a shared vision of care,
leadership involvement, service provision across the boundaries, adequately
resourcing the arrangement, developing novel arrangements or aligning with
existing relationships, and strengthening connections between sectors. Future
research from a cross-organisational, rather than individual provider,
perspective is needed to better understand what shapes cross-sector service
provision at the boundaries. Conclusion: Findings aligned closely with the work done by Sloper
and raise red flags related to reinventing what is already known. Future
researchers should look to explore novel areas rather than looking into areas
that have been explored at length. Evaluations of out-comes related to
cross-sector service provision are still needed before any claims about
effectiveness can be made.
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26
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Webber A, Clark J, Kelly D. Treating substance abuse and mental health issues as 'mutually-exclusive' entities: Best practice or an outmoded approach to intervention? Int J Ment Health Nurs 2016; 25:27-32. [PMID: 26777611 DOI: 10.1111/inm.12202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/30/2015] [Accepted: 11/04/2015] [Indexed: 11/29/2022]
Abstract
Addressing the psychological distress of individuals experiencing substance use disorders has too often been relegated to the 'too hard basket', leaving those affected with little choice but to receive treatments aimed solely at addressing their drug and alcohol issues. Conversely, individuals receiving support for psychological issues are often underdiagnosed with regards to any comorbid substance misuse problems. In fact, to date, no definitive treatment model exists that gives equal focus to the treatment of both psychological well-being and substance-related addictions. This is not to suggest, however, that existing treatment programmes for substance misuse are not impacting positively on clients' mental health, rather that further research is needed in order to determine what it is that is supporting such improvements. The aim of this study, therefore, was to address this imbalance by examining the correlation between substance dependence and psychological well-being. Using a descriptive correlation design, the Severity of Dependence and Kessler 10 scales were administered to 37 inpatient and outpatient clients at a rural drug and alcohol rehabilitation service, at intake and 2 months into treatment. Data were analysed using descriptive statistics and paired-samples t-tests. Positive correlative factors of improvement between substance dependence and psychological well-being were found for both groups. In light of these findings, the authors recommend that future research be undertaken to investigate the causal factors for this correlation.
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Affiliation(s)
- Adrian Webber
- School of Health, University of New England, Armidale
| | - Jane Clark
- School of Health, University of New England, Armidale
| | - David Kelly
- St Vincent de Paul Support Services, Woolloomooloo, New South Wales, Australia
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Spicer B, Smith DI, Conroy E, Flatau PR, Burns L. Mental illness and housing outcomes among a sample of homeless men in an Australian urban centre. Aust N Z J Psychiatry 2015; 49:471-80. [PMID: 25526944 DOI: 10.1177/0004867414563187] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The over-representation of mental illness among homeless people across the globe is well documented. However, there is a dearth of Australian literature on the mental health needs of homeless individuals. Furthermore, longitudinal research examining the factors that contribute to better housing outcomes among this population is sparse. The aim of this research is to describe the mental illness profile of a sample of homeless men in an Australian urban centre (in Sydney) and examine the factors associated with better housing outcomes at 12-month follow-up. METHODS A longitudinal survey was administered to 253 homeless men who were involved in the Michael Project: a 3-year initiative which combined existing accommodation support services with assertive case management and access to coordinated additional specialist allied health and support services. A total of 107 participants were followed up 12 months later. The survey examined the demographics of the sample and lifetime mental disorder diagnoses, and also included psychological screeners for current substance use and dependence, psychological distress, psychosis, and post-traumatic stress. RESULTS Consistent with existing literature, the prevalence of mental illness was significantly greater amongst this sample than the general Australian population. However, mental illness presentation was not associated with housing situation at 12-month follow-up. Instead, type of support service at baseline was the best predictor of housing outcome, wherein participants who received short to medium-term accommodation and support were significantly more likely to be housed in stable, long-term housing at the 12-month follow-up than participants who received outreach or emergency accommodation support. CONCLUSIONS This study provides evidence to support an innovative support model for homeless people in Australia and contributes to the limited Australian research on mental illness in this population.
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Affiliation(s)
- Bridget Spicer
- School of Health Sciences, RMIT University, Bundoora, Australia
| | - David I Smith
- School of Health Sciences, RMIT University, Bundoora, Australia
| | - Elizabeth Conroy
- Centre for Health Research, University of Western Sydney, Penrith, Australia
| | - Paul R Flatau
- Centre for Social Impact, University of Western Australia, Crawley, Australia
| | - Lucy Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Intersectoral policy for severe and persistent mental illness: review of approaches in a sample of high-income countries. Glob Ment Health (Camb) 2015; 2:e18. [PMID: 28596866 PMCID: PMC5269620 DOI: 10.1017/gmh.2015.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 04/02/2015] [Accepted: 06/20/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND It is increasingly recognised that intersectoral linkages between mental health and other health and support sectors are essential for providing effective care for individuals with severe and persistent mental illness. The extent to which intersectoral collaboration and approaches to achieve it are detailed in mental health policy has not yet been systematically examined. METHODS Thirty-eight mental health policy documents from 22 jurisdictions in Australia, New Zealand, the United Kingdom, Ireland and Canada were identified via a web search. Information was extracted and synthesised on: the extent to which intersectoral collaboration was an objective or guiding principle of policy; the sectors acknowledged as targets for collaboration; and the characteristics of detailed intersectoral collaboration efforts. RESULTS Recurring themes in objectives/guiding principles included a whole of government approach, coordination and integration of services, and increased social and economic participation. All jurisdictions acknowledged the importance of intersectoral collaboration, particularly with employment, education, housing, community, criminal justice, drug and alcohol, physical health, Indigenous, disability, emergency and aged care services. However, the level of detail provided varied widely. Where detailed strategies were described, the most common linkage mechanisms were joint service planning through intersectoral coordinating committees or liaison workers, interagency agreements, staff training and joint service provision. CONCLUSIONS Sectors and mechanisms identified for collaboration were largely consistent across jurisdictions. Little information was provided about strategies for accountability, resourcing, monitoring and evaluation of intersectoral collaboration initiatives, highlighting an area for further improvement. Examples of collaboration detailed in the policies provide a useful resource for other countries.
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Martin L, Hirdes JP. Exploring the impact of common assessment instrumentation on communication and collaboration in inpatient and community-based mental health settings: a focus group study. BMC Health Serv Res 2014; 14:457. [PMID: 25277136 PMCID: PMC4282495 DOI: 10.1186/1472-6963-14-457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 09/29/2014] [Indexed: 11/19/2022] Open
Abstract
Background Recognition that integrated services can lead to more efficient and effective care has made the principle of integration a priority for health systems worldwide for the last decade. However, actually bringing fully integrated services to life has eluded most health care organizations. Mental health has followed the rule, rather than the exception, when it comes integrating services. The lack of effective mechanisms to evaluate the needs of persons across mental health care services has been an important barrier to communication between professionals involved in care. This study sought to understand communication among inpatient and community-based mental health staff during transfers of care, before and after implementation of compatible assessment instrumentation. Methods Two focus groups were held with staff from inpatient (n = 10) and community (n = 10) settings in an urban, specialized psychiatric hospital in Ontario (Canada) – prior to and one year after implementation of compatible instrumentation in the community program. Transcripts were coded and aggregated into themes. Results Very different views of current communication patterns during transfers of care emerged. Inpatient mental health staff described a predictable, well-known process, whereas community-based staff emphasized unpredictability. Staff also discussed issues related to trust and the circle of care. All agreed that compatible assessments in inpatient and community mental health settings would facilitate communication through use of a common assessment language. However, no change in communication patterns was reported one year post implementation of compatible instrumentation. Conclusions Though all participants agreed on the potential for compatible instrumentation to improve communication during transfers of care, this cannot happen overnight. A number of issues related to trust, evidence-based practice, and organizational factors act as barriers to communication. In particular, staff noted the need for the results of comprehensive mental health assessments to be transformed into meaningful, user-friendly clinical summaries to facilitate uptake of assessment information, and consequently use of a common assessment language across mental health settings.
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Affiliation(s)
- Lynn Martin
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada.
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Affiliation(s)
- David J Castle
- St Vincent's Hospital and The University of Melbourne, Fitzroy, VIC, Australia.
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