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Busch CA, Araghi T, He J, Cooper KM, Brownell SE. Beyond Gender and Race: The Representation of Concealable Identities Among College Science Instructors at Research Institutions. CBE LIFE SCIENCES EDUCATION 2024; 23:ar9. [PMID: 38557233 PMCID: PMC11235101 DOI: 10.1187/cbe.23-09-0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/27/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
Concealable stigmatized identities (CSIs) are identities that can be kept hidden and carry negative stereotypes. To understand the potential influence instructors have as role models, we must first explore the identities instructors have and whether they disclose those identities to undergraduates. We surveyed national samples of science instructors (n = 1248) and undergraduates (n = 2428) at research institutions to assess the extent to which instructors hold CSIs, whether they reveal those identities to undergraduates, how the prevalence of CSIs among instructors compares to their prevalence among undergraduates, and the reasons instructors reveal or conceal their CSIs. The most common CSIs instructors reported were having anxiety (35%) and being a first-generation college student (29%). Relatively few instructors revealed CSIs to students. The largest mismatches of CSI prevalence were for struggling academically in college (-30%) and having anxiety (-25%); all mismatches grew when accounting for instructor CSI disclosure, highlighting that students perceive fewer role models of scientists with CSIs than actually exist.
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Affiliation(s)
- Carly A. Busch
- Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University; Tempe, AZ 85287
| | - Tala Araghi
- Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University; Tempe, AZ 85287
| | - Jingyi He
- Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University; Tempe, AZ 85287
| | - Katelyn M. Cooper
- Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University; Tempe, AZ 85287
| | - Sara E. Brownell
- Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University; Tempe, AZ 85287
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Oh H, Cho Y, Bae J, Holley LC, Shafer M, Kim K, Lee Y. Impact of statutory revisions to family-petitioned civil commitment in South Korea. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 94:101982. [PMID: 38603975 DOI: 10.1016/j.ijlp.2024.101982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION This study examined the impact of statutory revisions in 2016 which aimed to enhance procedural justice within the process of civil commitment for persons diagnosed with mental illnesses (PDMI) in South Korea. These changes included requiring that PDMI pose a threat of danger to self or others and the need for treatment simultaneously as criteria for petitioning civil commitment. Additionally, the revision established a public entity to oversee the legitimacy of petitions to involuntarily commit PDMI to inpatient treatment. Despite these statutory changes, families providing care for PDMI still appear to depend on civil commitment as a way to seek respite from care burden, not necessarily to respond to psychiatric emergencies involving dangerousness. This practice seems to be aided by processes within the public entity providing oversight. Due to such barriers we hypothesized that, even after the statutory revision in 2016, PDMI who had been civilly committed following petitions from families will not exhibit elevated dangerousness compared to PDMI who had never been hospitalized during the same period. METHODS Trained interviewers recruited 331 participants self-identified as PDMI from psychiatric rehabilitation agencies in the community and aided them in completing a survey including measures of self-reported hospitalization history, suicidality, and aggression toward others. Participants were classified into four groups: Family-petition committed (FPC) group (n = 30, 9.1%), voluntarily hospitalized (VH) group (n = 34, 10.3%), public-petition committed (PPC) group (n = 31, 9.4%), and never hospitalized (NH) group (n = 236, 71.3%). We conducted logistic regression analyses to compare self-reported dangerousness between groups with the NH group as the reference group. RESULTS In the past 12 months, 43.5% of PDMI participants had self-reported behaviors that may have met the dangerousness criteria for civil commitment. Controlling for confounding factors, the PPC group was 2.96 times and 3.02 times as likely to report suicidal ideation and physical aggression, respectively, compared to the NH group. However, as hypothesized, the FPC group did not differ from the NH group on any indicator of self-reported dangerousness. CONCLUSION The findings were based on cross-sectional correlational data and should not be viewed as conclusive evidence that the 2016 statutory revision is ineffective in preventing family-petitioned civil commitment in cases where dangerousness is not apparent. Nevertheless, these findings encourage further empirical studies that illuminate the etiology of procedural justice in civil commitments petitioned by family members and that assess factors and contexts that promote the consideration of least coercive treatments, rather than resorting to involuntary hospitalization when psychiatric emergencies arise.
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Affiliation(s)
- Hyunsung Oh
- School of Social Work, Arizona State University
| | - Yunhwa Cho
- Korea Disabled People's Development Institute.
| | - Jinyeong Bae
- Department of Social Welfare, Catholic University of Korea
| | | | | | - Kyejung Kim
- Department of Social Welfare, Yonsei University School
| | - Yongpyo Lee
- Department of Social Welfare, Catholic University of Korea
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Stewart K, Hancock N, Chapparo C, Stancliffe ERJ. Supports that help me to live well in the community: experiences of people living with schizophrenia. Aust Occup Ther J 2024; 71:340-351. [PMID: 38151285 DOI: 10.1111/1440-1630.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 10/05/2023] [Accepted: 11/12/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION People with schizophrenia are more likely to be hospitalised than any other psychiatric diagnosis. Occupational therapists working in mental health are often required to assess and recommend supports that will assist people with schizophrenia to live successfully in the community. There is little research exploring consumer perspectives regarding the support they find useful to stay out of the hospital. The aim of this study was to explore what supports people living with schizophrenia identify as helping them to live in the community and stay out of the hospital. METHOD Qualitative data were collected via semi-structured interviews with adult consumers (N = 18) diagnosed with schizophrenia. Data were thematically analysed using constant comparative analysis methods. Inductive analysis was followed by a deductive phase of analysis. FINDINGS Participants highlighted personal-, occupational- and environmental-focused supports. Person-focused supports addressed cognitive and psychological needs. Occupation-focused supports included assisting people to manage daily life with a mental illness; engage in social activities; and engage in meaningful activities. Environment-focused supports included access to financial security; accommodation security; and community of choice. In addition to types of support, participants highlighted the importance of quality of support including the need for flexible; timely; and non-judgemental support. CONCLUSION These results emphasise the multifaceted nature of support required by people living with schizophrenia to stay out of the hospital. Both type and quality of support are important. People in this study were able to clearly articulate the types and qualities of support that were important to them. Occupational therapists may benefit from greater collaboration with consumers during assessments of support needs and the development of recommendations. Further exploration of how occupational therapists identify people's multifaceted support needs is required.
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Affiliation(s)
- Kylie Stewart
- The University of Sydney, Faculty of Health Sciences, Centre for Disability Research and Policy, Sydney, Australia
- South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nicola Hancock
- The University of Sydney, Faculty of Health Sciences, Centre for Disability Research and Policy, Sydney, Australia
| | - Christine Chapparo
- The University of Sydney, Faculty of Health Sciences, Centre for Disability Research and Policy, Sydney, Australia
| | - Emeritus Roger J Stancliffe
- The University of Sydney, Faculty of Health Sciences, Centre for Disability Research and Policy, Sydney, Australia
- University of Minnesota, Institute of Community Integration, Minneapolis, Minnesota, USA
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Carcavilla-González N, Escalada San Adrián G, Minobes-Molina E, Pàmies-Tejedor S, Roncal-Belzunce V, Atarés-Rodríguez L, García-Navarro JA. A Paradigm Shift on Deinstitutionalization and Dementia Care: A Narrative Review. J Alzheimers Dis 2024; 99:829-841. [PMID: 38759003 DOI: 10.3233/jad-231180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
This narrative explores the impact of deinstitutionalization policies on the quality of life and care outcomes for individuals with Alzheimer's disease and related dementias. We offer a historical perspective on these policies, their implications on dementia care, and the barriers to deinstitutionalization. The potential benefits of deinstitutionalization, such as improved quality of life and access to community-based support and services, are highlighted. Challenges and controversies surrounding safety, caregiver burden, and resource allocation are also examined. Ethical considerations related to the autonomy and decision-making capacity of people living with dementia are discussed. We present best practices and innovative models in dementia care that balance deinstitutionalization with appropriate care. We further put forth recommendations for future research and policy development in dementia care and deinstitutionalization, emphasizing the need for a balanced approach that respects the autonomy and preferences of people living with dementia while ensuring their safety and well-being.
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Affiliation(s)
- Nuria Carcavilla-González
- Department of Health Sciences, Public University of Navarra, Campus de Arrosadia, Pamplona, Spain
- Spanish Society of Geriatrics and Gerontology, Madrid, Spain
| | | | - Eduard Minobes-Molina
- Spanish Society of Geriatrics and Gerontology, Madrid, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Victoria, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Victoria, Spain
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Honyashiki M, Decoster J, Lo WTL, Shimazu T, Usuda K, Nishi D. Mental Health Reform Processes and Service Delivery Shift From the Hospital to the Community in Belgium and Hong Kong. Health Serv Insights 2023; 16:11786329231211777. [PMID: 37953915 PMCID: PMC10637138 DOI: 10.1177/11786329231211777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 09/19/2023] [Indexed: 11/14/2023] Open
Abstract
Aim We aimed to illustrate and compare the processes of mental health policies aiming at a service delivery shift from the hospital to the community using implementation science, and to identify important implementation strategies. Methods This study had a comparative case study design. The cases were the Belgian mental health reform, and the person-centered model of mental health in Hong Kong, China. Several documentary sources were reviewed, including the published literature and websites. Data on policy processes were extracted, analyzed using directed content analysis, and categorized into constructs of the conceptual model for evidence-informed policy formulation and implementation arranged for the mental health policy. Results Several similarities were identified in the strategies for active implementation and dissemination; official staff allocation, and training to the community psychiatric services, an approach to adjust the number of psychiatric hospital beds, and promoting collaboration between health care sectors and social welfare sectors. Under distinct social contexts, differences were found in all processes. Conclusions Each of the described policy processes can serve as a model for countries in similar social contexts seeking to shift their psychiatric service delivery. Furthermore, our findings suggest widely applicable implementation strategies for policies aiming at a service delivery shift.
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Affiliation(s)
- Mina Honyashiki
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
- Department of Public Mental Health Research, Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | | | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Kentaro Usuda
- Department of Public Mental Health Research, Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Daisuke Nishi
- Department of Public Mental Health Research, Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Gossip K, Pagliaro C, Comben C, Fjeldsoe K, Whiteford H, Diminic S. Using the National Mental Health Service Planning Framework to inform integrated regional planning: a case study in Tasmania, Australia. Int J Ment Health Syst 2023; 17:23. [PMID: 37481600 PMCID: PMC10362704 DOI: 10.1186/s13033-023-00591-w] [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: 12/20/2022] [Accepted: 06/27/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND The aim of this study was to demonstrate the application of a needs-based mental health service planning model in Tasmania, Australia to identify indicative directions for future service development that ensure the equitable provision of mental health services across the State. METHODS The activity and capacity of Tasmania's 2018-19 mental health services were compared to estimates of required care by: (1) generating estimates of required care using the National Mental Health Service Planning Framework (NMHSPF); (2) collating administrative mental health services data; (3) aligning administrative data to the NMHSPF; and (4) comparing aligned administrative data and NMHSPF estimates to identify priority areas for service development. Findings were contextualised using information about service location, population demographics, and upcoming service development. RESULTS Bed-based services capacity reached 85% of the NMHSPF estimate. However, access to certain bed types was inequitable across regional areas. Access to jurisdictional clinical ambulatory team-based services was lowest in the South, while overall full-time equivalent staff capacity reached 58% of the NMHSPF estimate. Access to Primary Health Tasmania (PHT) primary care services was highest in the North West; access to Medicare services was highest in the South. Collectively, activity across primary care (PHT, headspace and Medicare) reached 43% of the NMHSPF estimate. Over half of Community Managed Mental Health Support Services were state-wide services. CONCLUSIONS This study demonstrates the application of a needs-based planning model for mental health services. Findings revealed service priority areas across Tasmania and highlight considerations for needs-based planning.
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Affiliation(s)
- Kate Gossip
- Queensland Centre for Mental Health Research The Park - Centre for Mental Health, Locked Bag 500, Sumner Park, BC, QLD, 4074, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Claudia Pagliaro
- Queensland Centre for Mental Health Research The Park - Centre for Mental Health, Locked Bag 500, Sumner Park, BC, QLD, 4074, Australia.
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia.
| | - Charlotte Comben
- Queensland Centre for Mental Health Research The Park - Centre for Mental Health, Locked Bag 500, Sumner Park, BC, QLD, 4074, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Kevin Fjeldsoe
- Queensland Centre for Mental Health Research The Park - Centre for Mental Health, Locked Bag 500, Sumner Park, BC, QLD, 4074, Australia
| | - Harvey Whiteford
- Queensland Centre for Mental Health Research The Park - Centre for Mental Health, Locked Bag 500, Sumner Park, BC, QLD, 4074, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Sandra Diminic
- Queensland Centre for Mental Health Research The Park - Centre for Mental Health, Locked Bag 500, Sumner Park, BC, QLD, 4074, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
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Montenegro C, Irarrázaval M, González J, Thomas F, Urrutia J. Moving psychiatric deinstitutionalization forward: A scoping review of barriers and facilitators. Glob Ment Health (Camb) 2023; 10:e29. [PMID: 37808271 PMCID: PMC7615177 DOI: 10.1017/gmh.2023.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 10/10/2023] Open
Abstract
Psychiatric deinstitutionalization (PDI) processes aim to transform long-term psychiatric care by closing or reducing psychiatric hospitals, reallocating beds, and establishing comprehensive community-based services for individuals with severe and persistent mental health difficulties. This scoping review explores the extensive literature on PDI, spanning decades, regions, socio-political contexts, and disciplines, to identify barriers and facilitators of PDI implementation, providing researchers and policymakers with a categorization of these factors. To identify barriers and facilitators, three electronic databases (Medline, CINAHL, and Sociological Abstracts) were searched, yielding 2,250 references. After screening and reviewing, 52 studies were included in the final analysis. Thematic synthesis was utilized to categorize the identified factors, responding to the review question. The analysis revealed that barriers to PDI include inadequate planning, funding, and leadership, limited knowledge, competing interests, insufficient community-based alternatives, and resistance from the workforce, community, and family/caregivers. In contrast, facilitators encompass careful planning, financing and coordination, available research and evidence, strong and sustained advocacy, comprehensive community services, and a well-trained workforce engaged in the process. Exogenous factors, such as conflict and humanitarian disasters, can also play a role in PDI processes. Implementing PDI requires a multifaceted strategy, strong leadership, diverse stakeholder participation, and long-term political and financial support. Understanding local needs and forces is crucial, and studying PDI necessitates methodological flexibility and sensitivity to contextual variation. At the same time, based on the development of the review itself, we identify four limitations in the literature, concerning "time," "location," "focus," and "voice." We call for a renewed research and advocacy agenda around this neglected aspect of contemporary global mental health policy is needed.
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Affiliation(s)
- Cristian Montenegro
- Wellcome Centre for Cultures and Environments of Health,
University of Exeter, Exeter,
UK
- Millennium Institute for Research in Depression and Personality,
Santiago, Chile
- Nursing School, Pontificia Universidad Católica de
Chile, Santiago, Chile
| | - Matías Irarrázaval
- Millennium Institute for Research in Depression and Personality,
Santiago, Chile
- Department of Psychiatry and Mental Health,
Universidad de Chile, Santiago,
Chile
| | - Josefa González
- Section of Child and Adolescent Psychiatry,
Pontificia Universidad Católica de Chile,
Santiago, Chile
| | - Felicity Thomas
- Wellcome Centre for Cultures and Environments of Health,
University of Exeter, Exeter,
UK
| | - Jorge Urrutia
- Departamento de Psicología, Universidad de
Chile, Santiago, Chile
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Kim AM, Sohn JH. The impact of the Mental Health Act revision for deinstitutionalization in Korea on the crime rate of people with schizophrenia. Psychiatry Res 2023; 321:115089. [PMID: 36764121 DOI: 10.1016/j.psychres.2023.115089] [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: 06/27/2022] [Revised: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 02/02/2023]
Abstract
This study examined changes in the crime rates of people with schizophrenia in Korea in comparison with the general population after the Mental Health Act revision for deinstitutionalization in 2017. The crime rates of people with schizophrenia and the general population were calculated from 2012 to 2021 using the Korean National Policy Agency crime statistics. The effects of the law revision in 2017 on the crime rates were assessed using the interrupted time series and difference-in-difference analyses. The crime rates of people with schizophrenia tended to be lower than the general population except for murder and arson, which were 5.3 and 11.4 times, respectively, that of the general population. While no significant effect of the revision was found in the interrupted times series analysis, the difference-in-differences analysis indicated that the total crime rates and the rates of violence and public order crime increased among people with schizophrenia compared with the general population. The revision of the Mental Health Act for deinstitutionalization did not lead to an increase in the murder rate of people with schizophrenia as is commonly thought. However, the increases in overall crime and violence rates of people with schizophrenia suggest that the deinstitutionalized patients may not have been successfully relocated into the community. The increase in crime after the revision should be interpreted as a call for well-resourced community care rather than the reason for re-transfer of patients to hospitals.
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Affiliation(s)
- Agnus M Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Jee Hoon Sohn
- Public Healthcare Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Psychiatry, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Hoffmann MS, Rocha KB, Evans-Lacko S, Gosmann NP, Becker N, Magalhães PVDS, Razzouk D, Spanemberg L, Fleck MPDA, Mari JDJ, Thornicroft G, Salum GA. Latent structure and factor reliability of the National Health Service Community Mental Health Service User Questionnaire. J Ment Health 2022; 31:809-815. [PMID: 33978546 DOI: 10.1080/09638237.2021.1922655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND National Health Service use the Community Mental Health Service User Questionnaire (NHS-CMH) to assess care quality. However, its reliability and internal validity is uncertain. AIMS To test the NHS-CMH structure, reliability and item-level characteristics. METHODS We used data from 11,373 participants who answered the 2017 NHS-CMH survey. First, we estimated the NHS-CMH structure using Exploratory Factor Analysis (EFA) in half of the dataset. Second, we tested the best EFA-derived model with Confirmatory Factor Analysis (CFA). We tested the internal validity, construct reliability (omega - ω), explained common variance of each factor (ECV), and item thresholds. RESULTS EFA suggested a 4-factor solution. The structure derived from the EFA was confirmed, demonstrating good reliability for the four correlated dimensions: "Relationship with Staff" (ω = 0.952, ECV = 40.1%), "Organizing Care" (ω = 0.855, ECV = 21.4%), "Medication and Treatments" (ω = 0.837, ECV = 13.3%), and "Support and Well-being" (ω = 0.928, ECV = 25.3%). A second-order model with a high-order domain of "Quality of Care" is also supported. CONCLUSIONS The NHS-CMH can be used to reliably assess four user-informed dimensions of mental health care quality. This model offers an alternative for its current use (item-level and untested sum scores analysis).
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Affiliation(s)
- Mauricio Scopel Hoffmann
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Neuropsiquiatria, Universidade Federal de Santa Maria, Santa Maria, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Katia Bones Rocha
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Natan Pereira Gosmann
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Natalia Becker
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Pedro Vieira da Silva Magalhães
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Denise Razzouk
- Department of Psychiatry, Univerisdade Federal de São Paulo, São Paulo, Brazil
| | - Lucas Spanemberg
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo Pio de Almeida Fleck
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Jair de Jesus Mari
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry, Univerisdade Federal de São Paulo, São Paulo, Brazil
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Giovanni Abrahão Salum
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
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Sacchetto B, Ornelas J, Calheiros MM. The Achieved Capabilities Questionnaire for Community Mental Health (ACQ-CMH): A consumer-based measure for the evaluation of community mental health interventions. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 70:327-339. [PMID: 35499287 PMCID: PMC10083923 DOI: 10.1002/ajcp.12599] [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: 04/29/2021] [Accepted: 02/19/2022] [Indexed: 06/14/2023]
Abstract
The capabilities approach offers a multidimensional, ecological, and agent-centered framework that may inspire models of intervention and evaluation. A growing number of measures grounded on the capabilities approach for outcome measurement are appearing. Regarding community mental health, new consumer-valued measures-constructed in collaboration with consumers-are here considered crucial for a transformative shift. Meanwhile, new measurements need to provide psychometric evidence to enable proper choice and application. The Achieved Capabilities Questionnaire for Community Mental Health (ACQ-CMH) was developed in collaboration with consumers of community mental health services. It aims to assess consumers' capabilities achieved through program support. The present paper shows advancements in the measure validation through a confirmatory factor analysis within a sample of community mental health consumers (N = 225). Reliability and construct-related validity were also observed. A structural solution composed of five factors and 43 items revealed a better model fit than that obtained in a previous exploratory study. Findings support the reliability, sensibility, and both convergent and discriminant validity of using the ACQ-CMH in the evaluation of community mental health interventions. The ACQ-CMH offers a consumer-valued framework with specific dimensions and indicators of capabilities for use in a routine service evaluation setting.
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Affiliation(s)
- Beatrice Sacchetto
- Applied Psychology Research Center Capabilities & Inclusion (APPsyCI)ISPA‐Instituto Universitário (ISPA‐IU)LisbonPortugal
| | - José Ornelas
- Applied Psychology Research Center Capabilities & Inclusion (APPsyCI)ISPA‐Instituto Universitário (ISPA‐IU)LisbonPortugal
| | - Maria M. Calheiros
- Centro de Investigação em Ciência Psicológica (CICPSI), Faculdade de PsicologiaUniversidade de LisboaLisboaPortugal
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Mayer RCF, Alves MR, Yamauti SM, Silva MT, Lopes LC. Quality of Life and Functioning of People With Mental Disorders Who Underwent Deinstitutionalization Using Assisted Living Facilities: A Cross-Sectional Study. Front Psychol 2021; 12:622973. [PMID: 34113278 PMCID: PMC8185360 DOI: 10.3389/fpsyg.2021.622973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Context People with mental disorders can acquire long-term disabilities, which could impair their functioning and quality of life (QoL), requiring permanent care and social support. Systematic data on QoL and functioning, which could support a better management of these people, were not available. Objective To analyze the QoL, level of functioning and their association with sociodemographic and clinical factors of people with mental disorders who underwent deinstitutionalization using assisted living facilities. Methods A Cross-sectional study was conducted between July 2018 and July 2019, through interviews using the World Health Organization Quality of Life (WHOQOL-BREF) to determine the QoL scores, and the World Health Organization Disability Assessment Schedule (WHODAS 2.0) to determine the level of functioning. All adults (≥18 years old) with mental disorders, who underwent deinstitutionalization, users of assisted living facilities and assisted by the Psychosocial Assistance Centers III, in a city in the state of São Paulo, Brazil, were selected. For statistical analysis of the associated factors, Student’s t-test was used for dichotomous variables and ANOVA for polynomial variables. Pearson correlation coefficient was used to measure the association between QoL and functioning scores. Results Out of 359 people who underwent deinstitutionalization with mental disorders, 147 met the eligibility criteria. The mean total score for the WHOQOL-BREF was 66.5 ± 13.4 and the mean score for WHODAS 2.0 was 10.4 ± 7.6. An association was found between people who were studying (n = 65.8; 95%CI, 63.5–68.1 vs. n = 73.9; 95%CI, 67.5–80.3; p = 0.04) and better WHOQOL-BREF QoL scores or WHODAS 2.0 levels of functioning (n = 10.9; 95%CI, 9.6–12.2 vs. n = 5.1; 95%CI, 2.5–7.7; p = 0.01). A weak negative correlation (r = 0.41) emerged between higher QoL scores and functioning improvement. Conclusion This study indicates that the QoL of the sample is associated by their functioning levels, which, in turn, may reflect on their social interactions. Public policies that favor interventions increasing socialization of this population can result in better health outcomes. The QoL and functioning scores provide valuable insights to develop public policies more suited to this population profile.
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Affiliation(s)
| | - Maíra Ramos Alves
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | - Sueli Miyuki Yamauti
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
| | | | - Luciane Cruz Lopes
- Graduate Program in Pharmaceutical Sciences, University of Sorocaba, Sorocaba, Brazil
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12
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Krieger I, Bitan DT, Sharon-Garty R, Baloush-Kleinman V, Zamir L. The Effect of Community-Based Mental Health Rehabilitation Services for Schizophrenia: a Retrospective Cohort Study. Psychiatr Q 2020; 91:1453-1463. [PMID: 32424545 DOI: 10.1007/s11126-020-09772-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Deliberative efforts are constantly made to provide community-based mental health rehabilitation services to people with mental health disabilities nationwide. In this study we aimed to assess the effectiveness of rehabilitation services in Israel by assessing the impact of utilization of rehabilitation services on hospitalization rates among a cohort of patients diagnosed with schizophrenia. Data derived from the Clalit Health Services were crossed with the Ministry of Health rehabilitation and psychiatric hospitalization case registries. Patients utilizing rehabilitation services were assessed for rates and durations of hospitalizations before and after the utilization of the rehabilitation services, and were compared to patients who did not use these services (n = 185). Mixed-model analyses of covariance (ANCOVA) were conducted to assess changes in rates and durations of hospitalizations at the beginning and end of the cohort period. Patients who used rehabilitation services showed higher rates and durations of hospitalizations prior to utilization of rehabilitation services, as well as higher decreases in number and duration of hospitalizations after utilizing their rights to rehabilitation services, as compared to patients who did not receive these services. Schizophrenia patients tend to show a decreasing trend in number and duration of hospitalizations over time. Nonetheless, the utilization of rehabilitation services offers larger gains in hospitalization prevention, primarily to schizophrenia patients who experience high rates and durations of hospitalizations at the beginning of illness. These findings provide additional support for the necessity of rehabilitation services, primarily for patients with severe onset.
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Affiliation(s)
- Israel Krieger
- Shalvata Mental Health Center, Hod Hasharon, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Tzur Bitan
- Shalvata Mental Health Center, Hod Hasharon, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Behavioral Sciences, Ariel University, 40700, Ariel, Israel.
| | | | | | - Leora Zamir
- Shalvata Mental Health Center, Hod Hasharon, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Echebarrena RC, Silva PRFD. Leitos de saúde mental em hospitais gerais: o caso do Rio de Janeiro. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-11042020e319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo deste artigo foi analisar o modelo de provisão de leitos de saúde mental em três hospitais gerais da cidade do Rio de Janeiro e sua relação com a Rede de Atenção Psicossocial. Foram realizadas entrevistas com gestores locais, um gestor municipal e dois ex-coordenadores nacionais de saúde mental. Os resultados apontaram que os hospitais estudados oferecem espaços restritivos, com predomínio de terapia farmacológica e forte influência do modelo biomédico. A presença dos leitos de saúde mental nos hospitais tem-se mostrado uma experiência bem-sucedida na melhoria do cuidado integral aos usuários. A interação com a Rede de Atenção Psicossocial foi apresentada como modelo de assistência preconizado, mas ainda enfrentando fragilidades em sua implementação. Os achados da pesquisa evidenciaram que a baixa implantação de leitos de saúde mental em hospital geral na cidade se deve a lacunas na formação de profissionais e ao estigma que faz com que gestores resistam em receber usuários com transtornos mentais em suas instituições. Modificações recentes na política nacional de saúde mental, no sentido de interromper o fechamento de leitos em hospitais psiquiátricos, devem acarretar alterações na direção da reforma psiquiátrica no País.
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14
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Affiliation(s)
- Dermot J. Hurley
- School of Social Work, King’s University College, Western University, Canada
| | - Martin Agrest
- Department of Research, Proyecto Suma, Buenos Aires, Argentina
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15
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Geerts K, Bongers I, Buitenweg D, van Nieuwenhuizen C. Quality of Life of People with Severe Mental Health Problems: Testing an Interactive Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113866. [PMID: 32485956 PMCID: PMC7313010 DOI: 10.3390/ijerph17113866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 06/11/2023]
Abstract
Improvement of subjective quality of life (QoL) is seen as an important treatment outcome in clinical practice. The aim of this study is to test the theoretical model of Cummins, which includes a homeostatic management system. According to this model, objective variables are almost irrelevant to general well-being, while the feeling of having an influence on one's circumstances (perceived deficit) is related to subjective QoL. The variables of the Cummins model were operationalised based on the Lancashire Quality of Life Profile, a structured interview to assess the subjective QoL of people with severe mental health problems. The Cummins model was tested using structural equation modelling and a mediator model between Objective QoL, Subjective QoL and Perceived Deficit. Subjective QoL and General Well-Being were significantly related and having a meaningful perspective in life was related to General Well-Being. Contrary to the Cummins model, both Objective QoL and Perceived Deficit had a significant relation to Subjective QoL and Perceived Deficit was a partial mediator between Objective QoL and Subjective QoL. Cummins' theoretical model was partially confirmed. The current study suggests that meaningful (treatment) evaluation of subjective QoL can only be performed if objective QoL, General Well-Being and subjective evaluation (Perceived Deficit and Framework) are taken into account.
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Affiliation(s)
- Karen Geerts
- GGZ Breburg Institute for Mental Health Care, 5000 AT Tilburg, The Netherlands;
| | - Ilja Bongers
- GGzE Institute for Mental Health Care, 5600 AX Eindhoven, The Netherlands; (I.B.); (D.B.)
- Scientific Center for Care and Wellbeing (Tranzo), Tilburg University, 5000 LE Tilburg, The Netherlands
| | - David Buitenweg
- GGzE Institute for Mental Health Care, 5600 AX Eindhoven, The Netherlands; (I.B.); (D.B.)
| | - Chijs van Nieuwenhuizen
- GGzE Institute for Mental Health Care, 5600 AX Eindhoven, The Netherlands; (I.B.); (D.B.)
- Scientific Center for Care and Wellbeing (Tranzo), Tilburg University, 5000 LE Tilburg, The Netherlands
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16
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Padmakar A, de Wit EE, Mary S, Regeer E, Bunders-Aelen J, Regeer B. Supported Housing as a recovery option for long-stay patients with severe mental illness in a psychiatric hospital in South India: Learning from an innovative de-hospitalization process. PLoS One 2020; 15:e0230074. [PMID: 32271784 PMCID: PMC7144972 DOI: 10.1371/journal.pone.0230074] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 02/20/2020] [Indexed: 12/16/2022] Open
Abstract
Individuals with severe mental illness have long been segregated from living in communities and participating in socio- cultural life. In recent years, owing to progressive legislations and declarations (in India and globally), there has been a growing movement towards promoting social inclusion and community participation, with emphasis on the need to develop alternative and inclusive care paradigms for persons with severe mental illness. However, transitions from inpatient care to community settings is a complex process involving implications at multiple levels involving diverse stakeholders such as mental health service users, care providers, local communities and policy makers. This article studies how the transition from a hospital setting to a community-based recovery model for personals with severe mental illness can be facilitated. It reflects on the innovative process of creating a Supported Housing model in South India, where 11 MH Service users transitioned from a psychiatric ECRC to independent living facilities. Experiences in various phases of the project development, including care provider- and community level responses and feedback were scrutinised to understand the strategies that were employed in enabling the transition. Qualitative methods (including in-depth interviews and naturalistic observations) were used with residents and staff members to explore the challenges they encountered in stabilizing the model, as well as the psychosocial benefits experienced by residents in the last phase. These were complemented with a Brief Psychiatric Rating Scale (BPRS) and WHO Quality of Life scale to compare baseline and post-assessment results and an increase of quality of life. Results display a significant reduction of psychiatric symptoms in patients (p< 0.5). It also describes the challenges encountered in the current context, and strategies that were used to respond and adapt the model to address these concerns effectively. Positive behavioural and psycho-emotional changes were observed amongst the residents, significant amongst those being enhanced in their mobility and participation. The article concludes by discussing the implications of this study for the development of innovative community-based models in wider contexts.
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Affiliation(s)
- Archana Padmakar
- The Banyan Academy of Leadership in Mental Health (BALM), Chennai, India
| | - Emma Emily de Wit
- Athena Institute, Faculty of Science, Vrije University, Amsterdam, Netherlands
- * E-mail:
| | - Sagaya Mary
- The Banyan Academy of Leadership in Mental Health (BALM), Chennai, India
| | - Eline Regeer
- Altrecht, Mental Health Care, Utrecht, Netherlands
| | - Joske Bunders-Aelen
- Athena Institute, Faculty of Science, Vrije University, Amsterdam, Netherlands
| | - Barbara Regeer
- Athena Institute, Faculty of Science, Vrije University, Amsterdam, Netherlands
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17
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Adu J, Oudshoorn A. The Deinstitutionalization of Psychiatric Hospitals in Ghana: An Application of Bronfenbrenner's Social-Ecological Model. Issues Ment Health Nurs 2020; 41:306-314. [PMID: 31999531 DOI: 10.1080/01612840.2019.1666327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Institutionalization of people living with mental illness has evolved over the years, especially in the 19th and early 20th century. This has created over crowdedness in various psychiatric institutions, specifically in low and-middle-income countries, including Ghana. The objective of this study is to use Bronfenbrenner's Social-Ecological Model (1979) to propose a process for deinstitutionalizing psychiatric services in Ghana while supporting a transition to community-based mental health care. Using the concept of Bronfenbrenner's Social-Ecological Model, this article explores some benefits and difficulties with the concept of deinstitutionalization with regards to mental health care services in Ghana. Individuals living with mental illness will be more comfortable in various communities in Ghana where education on stigmatization and discrimination is heightened to subsequently prevent it. Education and intervention policies are required to intensify the campaign to win the support of all people in the community. Residents of Ghana should learn to say no to stigma and discrimination among people living with mental illness.
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Affiliation(s)
- Joseph Adu
- Health and Rehabilitation Sciences, Elborn College, Western University, London, Ontario, Canada
| | - Abram Oudshoorn
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
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18
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Clesse C, Salime S, Dumand I, Concetta-Ciciarelli SB, Lavenir S, Kacemi K, Heckel-Chalet P, Sissung F, Poinsignon A, Simon A, Decker M, Batt M. The French Integrative Psychosocial Rehabilitation Assessment for Complex Situations (FIPRACS): Modelization of an Adapted Assessment Method Toward Long-Term Psychiatric Inpatients With Disabling, Severe and Persistent Mental Illness. Front Psychiatry 2020; 11:540680. [PMID: 33192655 PMCID: PMC7531021 DOI: 10.3389/fpsyt.2020.540680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
For the past forty years, the generalization of community-based approaches has prompted psychiatry into promoting a deinstitutionalization movement and a psychosocial rehabilitation approach (PSR) for individuals with schizophrenia and related difficulties. Unfortunately, this approach generally does not involve the most severe cognitive and psycho-affective clinical situations among this population despite an increasing number of publications advocating that all individuals should be included in PSR and deinstitutionalization programs. In this context, considering the absence of an assessment battery designed for French individuals with particularly disabling, severe, and persistent mental illness (IDSPMI), we constructed an integrative assessment model adapted to this specific population. To select the most suitable tools for this population, a literature review (inspired by the PRISMA protocol) and a systematic review were combined with a clinical assessment study. The literature review first identified the cognitive and psycho-affective functions which mainly influence the day-to-day life adaptation of individuals engaged in a PSR/deinstitutionalization program. The systematic review then gathered all of the useable French validated tools to assess the initially selected dimensions (n = 87). To finish, for each dimension, the selected 87 tools were included in a clinical assessment study performed within a French psychiatric hospital. The authors collected and verified the characteristics of each tool (validity, French norms, French version, the average speed of the test, ease of use, ability to assess other dimensions). Their suitability was also assessed when applied to IDSPMI. Based on this final clinical evaluation, the authors selected one tool per function to create the French Integrative Psychosocial Rehabilitation Assessment for Complex Situations (FIPRACS). This battery is an assessment tailored to the neurocognitive and psycho-affective potentials of IDSPMI. While further validation studies of this battery are ultimately required, the practical/clinical implications of this battery are presented and discussed.
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Affiliation(s)
- Christophe Clesse
- Center for Psychiatry, Wolfson Institute of Preventive Medicine, Barth & The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.,Centre Hospitalier de Jury-les-Metz, Metz, France.,Laboratoire INTERPSY (EA 4432), Université de Lorraine, Nancy, France.,IREPS Grand-Est, Laxou, France
| | - S Salime
- Laboratoire INTERPSY (EA 4432), Université de Lorraine, Nancy, France.,Association Espoir 54, Nancy, France
| | - I Dumand
- Centre Hospitalier de Jury-les-Metz, Metz, France
| | | | - S Lavenir
- Centre Hospitalier de Jury-les-Metz, Metz, France
| | - K Kacemi
- Centre Hospitalier de Jury-les-Metz, Metz, France
| | | | - Frank Sissung
- Association d'Information et d'Entraide Mosellane, Metz, France
| | - Aurore Poinsignon
- Association d'Information et d'Entraide Mosellane, Metz, France.,Association Famille Rurale de Moselle, Solgne, France
| | - Anthony Simon
- Laboratoire INTERPSY (EA 4432), Université de Lorraine, Nancy, France
| | - M Decker
- Centre Hospitalier de Jury-les-Metz, Metz, France
| | - M Batt
- Laboratoire INTERPSY (EA 4432), Université de Lorraine, Nancy, France
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19
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Muusse C, Kroon H, Mulder CL, Pols J. Working on and with Relationships: Relational Work and Spatial Understandings of Good Care in Community Mental Healthcare in Trieste. Cult Med Psychiatry 2020; 44:544-564. [PMID: 32246246 PMCID: PMC7497456 DOI: 10.1007/s11013-020-09672-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Deinstitutionalization is often described as an organizational shift of moving care from the psychiatric hospital towards the community. This paper analyses deinstitutionalization as a daily care practice by adopting an empirical ethics approach instead. Deinstitutionalization of mental healthcare is seen as an important way of improving the quality of lives of people suffering from severe mental illness. But how is this done in practice and which different goods are strived for by those involved? We examine these questions by giving an ethnographic description of community mental health care in Trieste, a city that underwent a radical process of deinstitutionalization in the 1970s. We show that paying attention to the spatial metaphors used in daily care direct us to different notions of good care in which relationships are central. Addressing the question of how daily care practices of mental healthcare outside the hospital may be constituted and the importance of spatial metaphors used may inform other practices that want to shape community mental health care.
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Affiliation(s)
- Christien Muusse
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands. .,Section of Medical Ethics, Department of General Practice, UMC Amsterdam, Amsterdam, The Netherlands.
| | - Hans Kroon
- grid.416017.50000 0001 0835 8259Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands ,grid.12295.3d0000 0001 0943 3265Tranzo, School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
| | - Cornelis L. Mulder
- grid.5645.2000000040459992XErasmus MC, Rotterdam, The Netherlands ,Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Jeannette Pols
- Section of Medical Ethics, Department of General Practice, UMC Amsterdam, Amsterdam, The Netherlands ,grid.7177.60000000084992262Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
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Use of psychiatric hospitals and social integration of patients with psychiatric disorders: a prospective cohort study in five European countries. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1425-1438. [PMID: 32409885 PMCID: PMC7578147 DOI: 10.1007/s00127-020-01881-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 05/02/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE Long lengths of stay (LoS) in psychiatric hospitals or repeated admission may affect the social integration of patients with psychiatric disorders. So far, however, studies have been inconclusive. This study aimed to analyse whether long LoS or repeated admissions in psychiatric wards were associated in different ways with changes in the social integration of patients. METHODS Within a prospective cohort study, data were collected on 2181 patients with a main ICD-10 diagnosis of psychotic, affective, or anxiety disorder, hospitalised in the UK, Italy, Germany, Poland, and Belgium in 2015. Social integration was measured at baseline and 1 year after admission using the SIX index, which includes four dimensions: employment, housing, family situation, and friendship. Regression models were performed to test the association between LoS, the number of admissions, and the change in social integration over the study period, controlling for patients' characteristics (trial registration ISRCTN40256812). RESULTS A longer LoS was significantly associated with a decrease in social integration (β = - 0.23, 95%CI - 0.32 to - 0.14, p = 0.03), particularly regarding employment (OR = 2.21, 95%CI 1.18-3.24, p = 0.02), housing (OR = 3.45, 95%CI 1.74-5.16, p < 0.001), and family situation (OR = 1.94, 95%CI 1.10-2.78, p = 0.04). In contrast, repeated admissions were only associated with a decrease in friendship contacts (OR = 1.15, 95CI% 1.08-1.22, p = 0.03). CONCLUSIONS Results suggest that a longer hospital LoS is more strongly associated with a decrease in patients' social integration than repeated admissions. Special attention should be paid to helping patients to find and retain housing and employment while hospitalised for long periods.
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21
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Forchuk C, Martin ML, Corring D, Sherman D, Srivastava R, Harerimana B, Cheng R. Cost-effectiveness of the implementation of a transitional discharge model for community integration of psychiatric clients: Practice insights and policy implications. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2019. [DOI: 10.1080/00207411.2019.1649237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Cheryl Forchuk
- Lawson Health Research Institute, London, ON, Canada
- Arthur Labatt School of Nursing, Western University, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Mary-Lou Martin
- St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | | | | | | | - Boniface Harerimana
- Lawson Health Research Institute, London, ON, Canada
- Arthur Labatt School of Nursing, Western University, London, ON, Canada
| | - Raymond Cheng
- Ontario Peer Development Initiative, Toronto, ON, Canada
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Halcomb EJ, McInnes S, Patterson C, Moxham L. Nurse-delivered interventions for mental health in primary care: a systematic review of randomized controlled trials. Fam Pract 2019; 36:64-71. [PMID: 30364968 DOI: 10.1093/fampra/cmy101] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Mental health issues are increasingly prevalent within the community. Many people experiencing mental health issues have established relationships with primary care providers, including general practice nurses (GPNs). With the recent growth of general practice nursing, it is timely to explore the evidence for GPNs to provide mental health interventions for adults with mental illness within their scope of practice. OBJECTIVE To synthesize the evidence about nurse-delivered interventions in primary care for adults with mental illness. METHODS A systematic review of randomized control trials (RCTs) retrieved from the CINAHL, Ovid MEDLINE and EBSCO electronic databases between 1998 and 2017. RESULTS Nine randomized controlled trials were identified, which reported nurse-delivered interventions in primary care for the management of mental health in adults with mental illness. The heterogeneity of interventions and outcomes made comparison of studies difficult. Seven studies demonstrated significant improvement in at least one outcome following the intervention. In some studies, these improvements were sustained well beyond the intervention. Additionally, consumers were satisfied with the interventions and the role of the GPN. CONCLUSION There is currently limited evidence of the impact of nurse-delivered interventions in primary care for adults with mental illness. Given the significant improvements in symptoms and the acceptability of interventions seen in included studies, there is a need for further robust research exploring the role of the GPN both individually and within the multidisciplinary team. Such research will enable stronger conclusions to be drawn about the impact of nurse-delivered interventions in primary care for adults with mental illness.
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Affiliation(s)
| | - Susan McInnes
- School of Nursing, University of Wollongong, Wollongong, Australia
| | | | - Lorna Moxham
- School of Nursing, University of Wollongong, Wollongong, Australia
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23
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Tucker IM, Brown SD, Kanyeredzi A, McGrath L, Reavey P. Living ‘in between’ outside and inside: The forensic psychiatric unit as an impermanent assemblage. Health Place 2019; 55:29-36. [DOI: 10.1016/j.healthplace.2018.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/10/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
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Wong YLI, Huangfu Y, Hadley T. Place and community inclusion: Locational patterns of supportive housing for people with intellectual disability and people with psychiatric disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 83:108-119. [PMID: 30193159 DOI: 10.1016/j.ridd.2018.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/05/2018] [Accepted: 08/20/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE This study examines the locational patterns of publicly-funded supportive housing for people with intellectual disability (people with ID) and people with psychiatric disorders (people with PD). METHODS Administrative data provided housing locations of 4599 people with ID and people with PD in one urban county and one suburban county in the United States. Census tract data captured neighborhood characteristics. Descriptive statistics and spatial analysis were used to analyze the distribution of supportive housing sites. RESULTS People with ID were more dispersed across a larger number of census tracts with smaller number of residents per tract than people with PD. While spatial dispersion in favor of people with ID was consistent across both counties, difference in dispersion was more pronounced in the urban county. People with PD were concentrated in neighborhoods with more socio-economic disadvantage, more residential instability, and a higher level of race/ethnic diversity than people with ID. CONCLUSION This study suggests that spatial-analytic method can serve as a useful tool for assessing the extent to which integrated housing is achieved for people with ID and people with PD. Interpretation of findings should be given due consideration of the policy context and neighborhood characteristics of the study communities.
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Affiliation(s)
- Yin-Ling Irene Wong
- School of Social Policy & Practice, University of Pennsylvania 3701 Locust Walk, Philadelphia, PA 19104-6214, USA.
| | - Yiyue Huangfu
- Department of Sociology, University of Wisconsin-Madison 1180 Observatory Drive, Madison, WI 53706-1393, USA.
| | - Trevor Hadley
- Center for Mental Health Policy and Services Research, University of Pennsylvania 3535 Market Street, 3/F, Philadelphia, PA 19104, USA.
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25
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O'Donoghue B. Inpatient care for emerging adults affected by mental health disorders. Early Interv Psychiatry 2018; 12:771-773. [PMID: 29372619 DOI: 10.1111/eip.12539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 12/17/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
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Janse van Rensburg A, Petersen I, Wouters E, Engelbrecht M, Kigozi G, Fourie P, van Rensburg D, Bracke P. State and non-state mental health service collaboration in a South African district: a mixed methods study. Health Policy Plan 2018; 33:516-527. [PMID: 29462292 DOI: 10.1093/heapol/czy017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2018] [Indexed: 12/15/2022] Open
Abstract
The Life Esidimeni tragedy in South Africa showed that, despite significant global gains in recognizing the salience of integrated public mental health care during the past decade, crucial gaps remain. State and non-state mental health service collaboration is a recognized strategy to increase access to care and optimal use of community resources, but little evidence exist about how it unfolds in low- to middle-income countries. South Africa's Mental Health Policy Framework and Strategic Plan 2013-20 (MHPF) underlines the importance of collaborative public mental health care, though it is unclear how and to what extent this happens. The aim of the study was to explore the extent and nature of state and non-state mental health service collaboration in the Mangaung Metropolitan District, Free State, South Africa. The research involved an equal status, sequential mixed methods design, comprised of social network analysis (SNA) and semi-structured interviews. SNA-structured interviews were conducted with collaborating state and non-state mental health service providers. Semi-structured interviews were conducted with collaborating partners and key stake holders. Descriptive network analyses of the SNA data were performed with Gephi, and thematic analysis of the semi-structured interview data were performed in NVivo. SNA results suggested a fragmented, hospital centric network, with low average density and clustering, and high authority and influence of a specialist psychiatric hospital. Several different types of collaborative interactions emerged, of which housing and treatment adherence a key point of collaboration. Proportional interactions between state and non-state services were low. Qualitative data expanded on these findings, highlighting the range of available mental health services, and pointed to power dynamics as an important consideration in the mental health service network. The fostering of a well-integrated system of care as proposed in the MHPF requires inter-institutional arrangements that include both clinical and social facets of care, and improvements in local governance.
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Affiliation(s)
- André Janse van Rensburg
- Health and Demographic Research Unit, Department of Sociology, Ghent University, Ghent 9000, Belgium.,Department of Political Science, Stellenbosch University, Stellenbosch 7600, South Africa.,Centre for Health Systems Research & Development, University of the Free State Main Campus, Steyn Annex Building 309, Nelson Mandela Road, Bloemfontein 9300, South Africa
| | - Inge Petersen
- Centre for Rural Health, School of Nursing & Public Health, Howard College Campus, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Edwin Wouters
- Centre for Health Systems Research & Development, University of the Free State Main Campus, Steyn Annex Building 309, Nelson Mandela Road, Bloemfontein 9300, South Africa.,Centre for Longitudinal and Life Course Studies, Department of Sociology, University of Antwerp 2000, Belgium
| | - Michelle Engelbrecht
- Centre for Health Systems Research & Development, University of the Free State Main Campus, Steyn Annex Building 309, Nelson Mandela Road, Bloemfontein 9300, South Africa
| | - Gladys Kigozi
- Centre for Health Systems Research & Development, University of the Free State Main Campus, Steyn Annex Building 309, Nelson Mandela Road, Bloemfontein 9300, South Africa
| | - Pieter Fourie
- Faculty of Arts and Social Sciences & Department of Political Science, Stellenbosch University, Stellenbosch 7600, South Africa
| | - Dingie van Rensburg
- Centre for Health Systems Research & Development, University of the Free State Main Campus, Steyn Annex Building 309, Nelson Mandela Road, Bloemfontein 9300, South Africa
| | - Piet Bracke
- Health and Demographic Research Unit, Department of Sociology, Ghent University, Ghent 9000, Belgium
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Global lessons for deinstitutionalisation from the ill-fated transfer of mental health-care users in Gauteng, South Africa. Lancet Psychiatry 2018; 5:765-768. [PMID: 30026060 DOI: 10.1016/s2215-0366(18)30211-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 11/20/2022]
Abstract
South Africa witnessed a national tragedy between October, 2015, and June, 2016, when the Department of Health in Gauteng province moved 1711 mental health-care users with severe mental illness or severe and profound intellectual disability out of facilities managed by a private company, Life Esidimeni, mainly into the care of non-governmental organisations. The plan was called the Gauteng Mental Health Marathon Project. In a rushed and flawed process, 144 people died, and the whereabouts of another 44 remain unknown. The report of an extensive arbitration process, released in March, 2018, raises important ethical, moral, political, legal, governance, accountability, and clinical issues. The events from the tragedy and findings that were made also serve as lessons for future deinstitutionalisation globally.
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McPherson P, Krotofil J, Killaspy H. Mental health supported accommodation services: a systematic review of mental health and psychosocial outcomes. BMC Psychiatry 2018; 18:128. [PMID: 29764420 PMCID: PMC5952646 DOI: 10.1186/s12888-018-1725-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 05/04/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Post-deinstitutionalisation, mental health supported accommodation services have been implemented widely. The available research evidence is heterogeneous in nature and resistant to synthesis attempts, leaving researchers and policy makers with no clear summary what works and for whom. In this context, we undertook a comprehensive systematic review of quantitative studies in order to synthesise the current evidence on mental health and psychosocial outcomes for individuals residing in mental health supported accommodation services. METHODS Using a combination of electronic database searches, hand searches, forward-backward snowballing and article recommendations from an expert panel, 115 papers were identified for review. Data extraction and quality assessments were conducted, and 33 articles were excluded due to low quality, leaving 82 papers in the final review. Variation in terminology and service characteristics made the comparison of service models unfeasible. As such, findings were presented according to the following sub-groups: 'Homeless', 'Deinstitutionalisation' and 'General Severe Mental Illness (SMI)'. RESULTS Results were mixed, reflecting the heterogeneity of the supported accommodation literature, in terms of research quality, experimental design, population, service types and outcomes assessed. There is some evidence that supported accommodation is effective across a range of psychosocial outcomes. The most robust evidence supports the effectiveness of the permanent supported accommodation model for homeless SMI in generating improvements in housing retention and stability, and appropriate use of clinical services over time, and for other forms of supported accommodation for deinstitutionalised populations in reducing hospitalisation rates and improving appropriate service use. The evidence base for general SMI populations is less developed, and requires further research. CONCLUSIONS A lack of high-quality experimental studies, definitional inconsistency and poor reporting continue to stymie our ability to identify effective supported accommodation models and practices. The authors recommend improved reporting standards and the prioritisation of experimental studies that compare outcomes across different service models.
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Affiliation(s)
- Peter McPherson
- Division of Psychiatry, Faculty of Brain Sciences, UCL, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Joanna Krotofil
- 0000000121901201grid.83440.3bDivision of Psychiatry, Faculty of Brain Sciences, UCL, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Helen Killaspy
- 0000000121901201grid.83440.3bDivision of Psychiatry, Faculty of Brain Sciences, UCL, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
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Miglietta E, Belessiotis-Richards C, Ruggeri M, Priebe S. Scales for assessing patient satisfaction with mental health care: A systematic review. J Psychiatr Res 2018; 100:33-46. [PMID: 29482063 DOI: 10.1016/j.jpsychires.2018.02.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Patient satisfaction with mental health care has become an important construct in research and routine care. Both as a process measure and as an outcome criterion in its own right, it needs to be assessed with appropriate scales. PURPOSE To provide a review of scales for assessing patient satisfaction in different settings, their characteristics and the content of care that they cover. METHOD A systematic search of electronic databases was conducted to identify studies that used a scale to assess patient satisfaction with care in mental health services. Peer reviewed articles were screened by two independent reviewers and included when they met predetermined criteria. Data on the characteristics of scales found in at least two studies were extracted and a qualitative analysis was performed to identify the contents of included scales. RESULTS Twenty-eight scales were identified. They vary substantially in terms of structure, length, focus and quality. The qualitative analyses identified a total of 19 contents of care that were covered in the scales. The most consistent contents across scales were overall satisfaction, followed by relationship with staff and staff skills. DISCUSSION A wide range of scales have been used to assess patient satisfaction with mental health care in different settings. Whilst some scales have been frequently used, there is no consensus on a gold standard one. The choice of the most appropriate scale depends on the aim of the assessment, the setting, the content that should be covered, and the time available for the assessment.
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Affiliation(s)
- Elisabetta Miglietta
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy.
| | - Clara Belessiotis-Richards
- Unit for Social and Community Psychiatry (World Health Organisation Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK
| | - Mirella Ruggeri
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (World Health Organisation Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK
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Predictors of length of stay in psychiatric inpatient units: Does their effect vary across countries? Eur Psychiatry 2018; 48:6-12. [PMID: 29331601 DOI: 10.1016/j.eurpsy.2017.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/10/2017] [Accepted: 11/10/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Previous studies in individual countries have identified inconsistent predictors of length of stay (LoS) in psychiatric inpatient units. This may reflect methodological inconsistencies across studies or true differences of predictors. In this study we assessed predictors of LoS in five European countries and explored whether their effect varies across countries. METHODS Prospective cohort study. All patients admitted over 14 months to 57 psychiatric inpatient units in Belgium, Germany, Italy, Poland and United Kingdom were screened. Putative predictors were collected from medical records and in face-to-face interviews and tested for their association with LoS. RESULTS Average LoS varied from 17.9days in Italy to 55.1days in Belgium. In the overall sample being homeless, receiving benefits, social isolation, diagnosis of psychosis, greater symptom severity, substance use, history of previous admission and being involuntarily admitted predicted longer LoS. Several predictors showed significant interaction effects with countries in predicting LoS. One variable, homelessness, predicted a different LoS even in opposite directions, whilst for other predictors the direction of the association was the same, but the strength of the association with LoS varied across countries. CONCLUSIONS The same patient characteristics have a different impact on LoS in different contexts. Thus, although some predictor variables related to clinical severity and social dysfunction appear of generalisable relevance, national studies on LoS are required to understand the complex influence of different patient characteristics on clinical practice in the given contexts.
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Hotzy F, Kerner J, Maatz A, Jaeger M, Schneeberger AR. Cross-Cultural Notions of Risk and Liberty: A Comparison of Involuntary Psychiatric Hospitalization and Outpatient Treatment in New York, United States and Zurich, Switzerland. Front Psychiatry 2018; 9:267. [PMID: 29973889 PMCID: PMC6020767 DOI: 10.3389/fpsyt.2018.00267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/31/2018] [Indexed: 01/01/2023] Open
Abstract
Involuntary hospitalization is a frequently discussed intervention physicians must sometimes execute. Because this intervention has serious implications for the citizens' civil liberties it is regulated by law. Every country's health system approaches this issue differently with regard to the relevant laws and the logistical processes by which involuntary hospitalization generally is enacted. This paper aims at analyzing the regulation and process of involuntary hospitalization in New York (United States) and Zurich (Switzerland). Comparing the respective historical, political, and economic backgrounds shows how notions of risk and liberty are culture-bound and consequently shape legislation and local practices. It is highly relevant to reconsider which criteria are required for involuntary hospitalization as this might shape the view of society on psychiatric patients and psychiatry itself. Furthermore, this article discusses the impact that training and experience of the person authorized to conduct and maintain an involuntary hospitalization has on the outcome.
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Affiliation(s)
- Florian Hotzy
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Jeff Kerner
- Montefiore Medical Center, Bronx, NY, United States.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, United States
| | - Anke Maatz
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Matthias Jaeger
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Andres R Schneeberger
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, United States.,Psychiatrische Dienste Graubünden, Chur, Switzerland.,Universitäre Psychiatrische Kliniken Basel, Universität Basel, Basel, Switzerland
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32
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Roos E, Bjerkeset O, Svavarsdóttir MH, Steinsbekk A. Like a hotel, but boring: users' experience with short-time community-based residential aftercare. BMC Health Serv Res 2017; 17:832. [PMID: 29246222 PMCID: PMC5732432 DOI: 10.1186/s12913-017-2777-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 12/05/2017] [Indexed: 11/26/2022] Open
Abstract
Background The discharge process from hospital to home for patients with severe mental illness (SMI) is often complex, and most are in need of tailored and coordinated community services at home. One solution is to discharge patients to inpatient short-stay community residential aftercare (CRA). The aim of this study was to explore how patients with SMI experience a stay in CRA established in a City in Central Norway. Methods A descriptive qualitative study with individual interviews and a group interview with 13 persons. The CRA aims to improve the discharge process from hospital to independent supported living by facilitating the establishment of health and social services and preparing the patients. The philosophy is to help patients use community resources by e.g. not offering any organized in-house activities. The main question in the interviews was “How have you experienced the stay at the CRA?” The interviews were analyzed with a thematic approach using systematic text condensation. Results The participants experienced the stay at the CRA “Like a hotel” but also boring, due to the lack of organized in-house activities. The patients generally said they were not informed about the philosophy of the CRA before the stay. The participants had to come up with activities outside the CRA and said they got active help from the staff to do so; some experienced this as positive, whereas others wanted more organized in-house activities like they were used to from mental health hospital stays. Participants described the staff in the CRA to be helpful and forthcoming, but they did not notice the staff being active in organizing the aftercare. Conclusions The stay at the CRA was experienced as different from other services, with more freedom and focus on self-care, and lack of in-house activities. This led to increased self-activity among the patients, but some wanted more in-house activities. To prepare the patients better for the stay at the CRA, more information about the philosophy is needed in the pre-admission process. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2777-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eirik Roos
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, 7491, Trondheim, Norway. .,, Municipality of Trondheim, Norway.
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Margrét Hrönn Svavarsdóttir
- Department of Health Sciences, Norwegian University of Sciences and Technology, Gjøvik, Norway.,School of Health Sciences, University of Akureyri, Akureyri, Iceland
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, 7491, Trondheim, Norway
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Abstract
Abstract-Global consensus and national policies have emphasized deinstitutionalization, or a shift in providing mental health care from institutional to community settings. Yet, psychiatric hospitals and asylums receive the majority of mental health funding in many countries, at odds with research evidence that suggests that services should be delivered in the community. Our aim is to investigate the norms, actors, and strategies that influence the uptake of deinstitutionalization internationally. Our study is informed by prior literature on management and implementation science. The success and failure of mental health care operations depend on identifying and overcoming challenges related to implementing innovations within national contexts. We surveyed 78 experts spanning 42 countries on their knowledge and experiences in expanding community-based mental health care and/or downsizing institution-based care. We also asked them about the contexts in which said methods were implemented in a country. We found that mental health care, whether it is provided in institutions or in the community, does not seem to be standardized across countries. Our analysis also showed that moving deinstitutionalization forward requires meaningful engagement of three types of actors: government officials, health care professionals, and local experts. Progress toward deinstitutionalization depends on the partnerships formed among these actors and with diverse stakeholders, which have the potential to garner resources and to scale-up pilot projects. In conclusion, different countries have adapted deinstitutionalization in ways to meet idiosyncratic situations and population needs. More attention should be given to the management and implementation strategies that are used to augment treatment and preventive services.
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Affiliation(s)
- Gordon C Shen
- a Department of Health Policy and Management, Graduate School of Public Health and Health Policy , City University of New York , New York , NY , USA
| | - Julian Eaton
- b Centre for Global Mental Health, London School of Hygiene and Tropical Medicine , London , UK.,c CBM International , Cambridge , UK
| | - Lonnie R Snowden
- d School of Public Health , University of California at Berkeley , Berkeley , CA , USA
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Hopia H, Raitio K. Gamification in Healthcare: Perspectives of Mental Health Service Users and Health Professionals. Issues Ment Health Nurs 2016; 37:894-902. [PMID: 27905826 DOI: 10.1080/01612840.2016.1233595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this descriptive qualitative study is to explore the perceptions and experiences that mental health service users (n = 10) and healthcare professionals (n = 32) have regarding the use of gamification in mental health care. Data was gathered by interviews. The mental health service users described promoting and retarding factors in the use of gamification, while professionals described the requirements for using gamification and changes occurring in the work culture. Additional research is needed on how game-playing elements could be integrated as a systematic part of mental health practice and how the digital skills of professionals could be effectively developed.
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Affiliation(s)
- Hanna Hopia
- a JAMK University of Applied Sciences, School of Health and Social Studies , Jyvaskyla , Finland
| | - Katja Raitio
- a JAMK University of Applied Sciences, School of Health and Social Studies , Jyvaskyla , Finland
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35
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Kalapos MP. Penrose's law: Methodological challenges and call for data. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 49:1-9. [PMID: 27143118 DOI: 10.1016/j.ijlp.2016.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 04/18/2016] [Indexed: 06/05/2023]
Abstract
The investigation of the relationship between the sizes of the mental health population and the prison population, outlined in Penrose's Law, has received renewed interest in recent decades. The problems that arise in the course of the deinstitutionalization have repeatedly drawn attention to this issue. This article presents methodological challenges to the examination of Penrose's Law and retrospectively reviews historical data from empirical studies. A critical element of surveys is the sampling method; longitudinal studies seem appropriate here. The relationship between the numbers of psychiatric beds and the size of the prison population is inverse in most cases. However, a serious failure is that almost all of the data were collected in countries historically belonging to a Christian or Jewish cultural community. Only very limited conclusions can be drawn from these sparse and non-comprehensive data: a reduction in the number of psychiatric beds seems to be accompanied by increases in the numbers of involuntary admissions and forensic treatments and an accumulation of mentally ill persons in prisons. A kind of transinstitutionalization is currently ongoing. A pragmatic balance between academic epidemiological numbers and cultural narratives should be found in order to confirm or refute the validity of Penrose's Law. Unless comprehensive research is undertaken, it is impossible to draw any real conclusion.
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Ala-Nikkola T, Sadeniemi M, Kaila M, Saarni S, Kontio R, Pirkola S, Joffe G, Oranta O, Wahlbeck K. How size matters: exploring the association between quality of mental health services and catchment area size. BMC Psychiatry 2016; 16:289. [PMID: 27520368 PMCID: PMC4983042 DOI: 10.1186/s12888-016-0992-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/03/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The diversity of mental health and substance abuse services (MHS) available to service users is seen as an indicator of the quality of the service system. In most countries MHS are provided by a mix of public, private and third sector providers. In Finland, officially, the municipalities are responsible for organizing the services needed, but the real extent and roles of private and third sector service providers are not known. Our previous study showed that the catchment area population size was strongly associated with diversity of mental health services. It is not known whether this was due to some types of services or some provider types being more sensitive to the size effect than others. The aim of this study was to investigate the association between area population size and diversity of mental health services, i.e. which types of services and which service providers' contributions are sensitive to population size. METHODS To map and classify services, we used the ESMS-R. The diversity of services was defined as the count of main types of care. Providers were classified as public, private or third sectors. RESULTS The diversity of outpatient, residential and voluntary services correlated positively with catchment area population size. The strongest positive correlation between the size of population and services available was found in third sector activities followed by public providers, but no correlation was found for diversity of private services. The third sector and public corporations each provided 44 % of the service units. Third sector providers produced all self-help services and most of the day care services. Third sector and private companies provided a significant part (59 %) of the residential care service units. CONCLUSIONS Significant positive correlations were found between size of catchment area population and diversity of residential, outpatient and voluntary services, indicating that these services concentrate on areas with larger population bases. The third sector seems to significantly complement the public sector in providing different services. Thus the third sector be needs to be functionally integrated with other MHS services to achieve a diversified and integrated service system.
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Affiliation(s)
- Taina Ala-Nikkola
- University of Helsinki and Helsinki University Hospital, Psychiatry, Välskärinkatu 12, FI-00029, Helsinki, Finland. .,Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270, Helsinki, Finland.
| | - Minna Sadeniemi
- Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270 Helsinki, Finland ,Department of Social Services and Health Care, City of Helsinki, FI-00099 Helsinki, Finland ,Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, FI-00029 Helsinki, Finland
| | - Minna Kaila
- Department of Public Health, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, FI-000014 Helsinki, Finland
| | - Samuli Saarni
- Turku University Central Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
| | - Raija Kontio
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, FI-00029 Helsinki, Finland
| | - Sami Pirkola
- University of Tampere and Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-33014 Tampere, Finland
| | - Grigori Joffe
- University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, FI-00029 Helsinki, Finland
| | - Olli Oranta
- Turku University Central Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
| | - Kristian Wahlbeck
- Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270 Helsinki, Finland
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37
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Hudson CG. A Model of Deinstitutionalization of Psychiatric Care across 161 Nations: 2001–2014. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2016. [DOI: 10.1080/00207411.2016.1167489] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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38
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Roos E, Bjerkeset O, Søndenaa E, Antonsen DØ, Steinsbekk A. A qualitative study of how people with severe mental illness experience living in sheltered housing with a private fully equipped apartment. BMC Psychiatry 2016; 16:186. [PMID: 27267590 PMCID: PMC4895881 DOI: 10.1186/s12888-016-0888-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 05/27/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There are a number of supported housing options for people with severe mental illness (SMI), but limited knowledge about residents' experiences. The aim of this study was to explore how people with SMI experienced sheltered housing consisting of both a private fully equipped apartment and a shared accommodation room for socializing. METHODS Fourteen people with SMI living in sheltered housing apartments participated in a qualitative study with semi-structured face to face individual or group interviews. RESULTS Residents' access to the service providers in the sheltered housing, who were seen as both "ordinary people" and skilled to observe symptom changes at an early stage, were major factors for the perception of security. In addition, residents highlighted the possibility of living in a fully equipped apartment, and having access to a shared accommodation room to connect with other residents. Having a fully equipped apartment including their own equipment such as a washing machine was said to help reduce conflicts. Short tenancy agreements made some informants feel insecure. It was also essential to have meaningful daily activities outside the residence to avoid re-hospitalization. CONCLUSIONS The positive experience was connected to having a fully private equipped apartment including shared accommodation room. The service providers should be aware of the dilemma with in-house support, to make residents feel secure versus increased dependency on service providers.
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Affiliation(s)
- Eirik Roos
- Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway. .,Municipality of Trondheim, Trondheim, Norway.
| | | | - Erik Søndenaa
- St. Olavs Hospital, Regional Centre for Child and Youth Mental Health and Child Welfare, Trondheim, Norway
| | - Dag Øyvind Antonsen
- Resource Center for Service User Experience and Service Development (KBT Mid-Norway), Mental Health, Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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39
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Taylor Salisbury T, Killaspy H, King M. An international comparison of the deinstitutionalisation of mental health care: Development and findings of the Mental Health Services Deinstitutionalisation Measure (MENDit). BMC Psychiatry 2016; 16:54. [PMID: 26926473 PMCID: PMC4772656 DOI: 10.1186/s12888-016-0762-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 02/22/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Despite its inclusion as a key aspect of successful mental health care service provision by the World Health Organization, there exists a lack of consensus regarding the definition, key components and implementation of deinstitutionalisation. This lack of consensus has also contributed to subjectivity in assessments of countries' progress towards deinstitutionalisation which act as a barrier to its evaluation and success. In order to provide for reliable within and cross country evaluations of the success of deinstitutionalisation we aimed to develop a quantitative measure of country-level progress towards deinstitutionalisation through the (1) identification of key markers of deinstitutionalisation; (2) development of an assessment tool based on the identified markers; (3) evaluation of the tool's psychometric properties; and (4) comparison of progress towards deinstitutionalisation across Europe. METHODS National care standards from 10 European countries and World Health Organization recommendations were used to identify items for the tool. A draft version was reviewed by an international expert panel and assessed for test-retest reliability and internal consistency. Once a final version had been agreed, progress towards deinstitutionalisation was assessed for 30 European countries. We used this opportunity to test convergent validity through comparison with local experts' assessments. Country total as well as individual item scores were described and compared. RESULTS The five-item Mental Health Services Deinstitutionalisation Measure (MENDit) is an objective tool with moderate to very good test-retest reliability (Kappa range: 0.46-1.00) and internal consistency (α = 0.70, 95 % CI 0.25, 0.92). A statistically significant difference between groups was found by one-way ANOVA (F(3,26) = 6.77, p = 0.002). Post-hoc testing found significant differences between MENDit scores of countries categorised as having advanced levels of deinstitutionalisation and not started or just started. Across Europe, MENDit scores suggest substantial variety in progress towards deinstitutionalisation. CONCLUSIONS The MENDit has good psychometric properties which support its use in research and as a benchmarking tool to measure national progress towards deinstitutionalisation by policy makers. Across Europe a high proportion of psychiatric beds are still located in psychiatric hospitals. Additionally, low numbers of mental health professionals in many countries may hinder further deinstitutionalisation. These findings corroborate previous mental health systems research and highlight some of the difficulties of deinstitutionalisation.
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Affiliation(s)
- Tatiana Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK. .,Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, W1C 7HT, UK. .,Division of Psychiatry, UCL, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Helen Killaspy
- Division of Psychiatry, UCL, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Michael King
- Division of Psychiatry, UCL, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
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Zakaria Kiaei M, Moradi R, Hasanpoor E, Mohammadi M, Taheri A, Ahmadzadeh MS. Hospital Managers’ Perception of Recent Health Care Reform in Teaching Hospitals of Qazvin, Iran. ACTA ACUST UNITED AC 2015. [DOI: 10.17795/bhs-33196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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