Effectiveness and cost-effectiveness of a community-based mental health care programme (GBV) for people with severe mental illness in Germany: study protocol for a randomised controlled trial

Feasibility of online psychosocial interventions to promote mental health recovery and well-being

BACKGROUND

Amid the increasing trend and huge impact of mental illness, psychosocial support (PSS) has been asserted to support individuals' recovery. Unfortunately, about 80% of affected people cannot access care as needed. Meanwhile, digital technology has a considerable role in closing service gaps.

AIMS

This convergent parallel mixed methods study examines existing mental health service utilization, users' needs for PSS, and feasibility of online PSS development.

METHODS

A cross-sectional interview survey was conducted using a semi-structured questionnaire at a super tertiary psychiatric hospital in Thailand from March to May 2023, with three groups of service users, having self-perceived conditions/diagnosis of schizophrenia (n = 100), mood disorders (n = 84), and others including alcohol and substance use, anxiety and personality disorders (n = 52). Four focus group discussions with three user groups (n = 16) and one multidisciplinary provider group (n = 7) were parallelly executed. Quantitative and qualitative data were convergently analyzed using descriptive and inferential statistics, and thematic and content analysis.

RESULTS

Critical shortcomings of PSS were indicated by 75.8% of user participants. Six common types of self-determined PSS were psychoeducational program, support group, skills training, counseling, supported employment, and complimentary therapy. While psychoeducational program was feasible, support group, and counseling were possibly featured within the 'all-at-once' online intervention development.

CONCLUSIONS

PSS development based on users' needs can promote clinical and personal recovery outcomes, and close the service gaps. Users with mood disorders have the potential for online interventions. Peer-provider formalization, co-production approach, community engagement, digital literacy, infrastructures, and equal access factors are crucial for sustainable development.

Building an implementation strategy for community-based rehabilitation for mental health in Colombia

INTRODUCTION

Scientific evidence indicates that the community-based rehabilitation (CBR) model is recommended for recovery from mental disorders. However, this approach encounters barriers and often lacks implementation strategies.

AIM

The aim of this study was to create a strategy for the implementation of CBR for mental health in Colombia through the identification of barriers and facilitators, together with the expected outcomes, from the perspective of mental health decision-makers in Colombia.

METHODS

This study adopts a qualitative descriptive approach, using focus group data collection methods and thematic analysis to code and analyze the data.

RESULTS

A total of 208 individuals participated in the study, including mental health decision-makers and health care professionals. Intersectoral collaboration, contextualization, financial resources, and community commitment and autonomy were identified as barriers and facilitators. The element that was considered a priority for successful implementation was the contextualization of strategies.

CONCLUSIONS

CBR needs to be strengthened through implementation science if these strategies are to be successfully developed and implemented in various contexts.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A210.

[An Experience Report on the Evaluation of New Forms of Care for People with Mental Illness: Pros and Cons of the Use of SHI Claims Data]

The present article describes the special features of an evaluation of research in mental health services in Germany. The experiences of the evaluation of flexible and integrated treatment options with a global treatment budget in psychiatric hospitals based on routine data of more than 70 statutory health insurance (SHI) funds (EVA64 study) are systematically presented. Using the EVA64 study as an example, recommendations for the use of claims data in the field of mental health services research and in general are derived. (1) First, the study and its use of claims data is described and classified. (2) The individual outcomes of the study are presented and evaluated in order to (3) derive criteria, identify strengths and suggest potential uses of claims data. (4) Finally, recommendations for the further development of claims data from SHI funds as a basis for evaluation are described.

Subjective quality of life and schizophrenia: results from a large cohort study based in Chinese primary care

INTRODUCTION

Much confusion exists between health-related QoL (HRQoL) scales and subjective QoL (SQoL) scales. One method to avoid confusion is use of a single question that asks What is your quality of life? or similar. This study explored the relationship between biopsychosocial factors and high SQoL, SQoL stability, and factors associated with improving SQoL.

METHOD

We conducted a large cohort study of community-dwelling Chinese adults with schizophrenia, with two data points (2015-2016 (N = 742), 2017-2018 (N = 491)). Demographic and clinically related items and a comprehensive suite of published measures were collected. Direct logistic regressions were used to explore links between biopsychosocial factors and high SQoL and Improvement in SQoL across time.

RESULTS

Sample at Baseline: Male = 62.3%; Med age = 38.5 years; Med Age at illness onset = 24 years; SQoL Mode = neither poor nor good. Three independent variables predicted high SQoL at T1. Contemporary age and the presence of clinically relevant symptoms had a negative relationship with high SQoL; insight had a positive relationship with high SQoL. SQoL changed significantly across time with a modest effect size. Age at illness onset was the single independent variable linked to improving SQoL favoring being older at the time of illness onset.

DISCUSSION/CONCLUSIONS

SQoL can be high and changeable. While symptomology and illness insight may affect SQoL self-appraisals at single points in time, only age of illness onset was connected with improving SQoL. Thus, public health measures to delay illness onset are important. In addition, care about the distinction between HRQoL and SQoL in study design and choice of measures is necessary and will depend on the purpose and context.

Evaluation of Met and Unmet Needs in Patients with Severe Psychiatric Disorders and its Relation to the Quality of Life: A Cross-Sectional Study

Background

Paying attention to the needs of patients with psychiatric disorders has recently come into focus. Failure to meet the needs of patients can affect their quality of life. This study aimed to determine the main areas of the needs of patients with severe psychiatric disorders and evaluate their relationship with the quality of life.

Methods

In this cross-sectional study, 174 patients with severe mental illness who were referred to Iran Psychiatric Hospital for hospitalization or outpatient treatment were enrolled in this study (68 with schizophrenia and schizoaffective disorder, 106 with bipolar disorder type 1). A qualified psychiatry resident conducted interviews with each patient to determine their needs using the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) and the severity of their illness using the Hamilton Depression Rating Scale (HAM-D), Positive and Negative Syndrome Scale (PANSS), and Young Mania Rating Scale. A checklist for demographic data and the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire was completed by patients. Data were analyzed using descriptive statistics. Since the number of needs distribution was not normal, we used the Mann-Whitney, Kruskal-Wallis, and chi-square tests for qualitative variables.

Results

The total number of patient needs was 9 (mean = 9.1, SD = 3.7). The most unmet needs were intimate relationships (69.5%), sexual expression (65.5%), and information on condition and treatment (51.1%). Unmet needs showed a negative correlation with the quality of life (P < 0.001) and a positive correlation with the severity of depression (P = 0.045), negative symptoms (P = 0.001), and general psychopathology (P < 0.001).

Conclusion

A higher number of unmet needs of severe psychiatric patients is associated with lower quality of life and more severe disorders.

Perceived empowerment and the impact of negative effects of the COVID-19 pandemic on the quality of life of persons with severe mental illness

Purpose

Beyond its direct effects on physical health the COVID-19 pandemic has been shown to have negative effects on the living situation of people with severe mental illness (SMI). To date, there has been little research on resilience factors preventing people with SMI from experiencing negative effects of the COVID-19 pandemic.

The objective of this study was to investigate the role of perceived empowerment (PE) as a resilience factor, preventing people with SMI from experiencing negative effects of the COVID-19 pandemic on daily living.

Methods

We investigated negative effects of the COVID-19 pandemic on daily living in 931 persons with SMI at two times within six month between June 2020 and Mai 2021. To take into account the longitudinal structure of the data we applied mixed effects regression analyses and longitudinal path models.

Results

A majority of participants experienced negative effects of the COVID-19 pandemic on several dimensions of daily living. Negative effects increased with rising levels of illness-related impairment but decreased as the level of PE rose. While negative effects of the COVID-19 pandemic at follow-up were negatively associated with overall subjective quality of life baseline, PE was negatively associated with the negative impact of the pandemic and positively with quality of life.

Conclusion

Patients with SMI need support to reduce negative effects of the COVID-19 pandemic on their quality of life. The promotion of PE could help strengthen resilience in this target group.

Trial registration

German Clinical Trial Register, DRKS00019086, registered on 3 January 2020. (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00019086).

The Cost-Effectiveness Analysis of an Integrated Mental Health Care Programme in Germany

The network for mental health (NWpG = Netzwerk psychische Gesundheit) is an umbrella association for non-medical community mental health care facilities across Germany which are enabled to provide multi-professional mental health care packages including medical and psychosocial services reimbursed by German statutory health insurances since 2009. The aim of this study is to analyse the cost-effectiveness of providing NWpG mental health care packages plus treatment as usual (NWpG) to treatment as usual alone (TAU) in Germany. In a prospective, multicenter, controlled trial over 18 months, a total of 511 patients (NWpG = 251; TAU = 260) were observed in five regions, four times at six-month intervals. The EQ-5D-3L and the Client Sociodemographic and Service Receipt Inventory (CSSRI) were used to estimate quality-adjusted life-years and total costs of illness. Propensity score-adjusted cost–utility analysis was applied using the net benefit approach. No significant differences in costs and QALYs between NWpG and TAU groups were identified. The probability of NWpG being cost-effective compared to TAU was estimated below 75% for maximum willingness to pay (MWTP) values between 0 and 125,000 EUR. The additional provision of the NWpG package is not cost-effective compared to TAU alone.

Integration of Care in Complex and Fragmented Service Systems: Experiences of Staff in Flexible Assertive Community Treatment Teams

Introduction

To provide more integrated care, several countries have implemented the Flexible Assertive Community Treatment (FACT) model. However, this model does not guarantee full integration, especially in complex and fragmented service systems like in Norway. Hence, we investigated which barriers that might reduce the potential for integrated care in the Norwegian system, as described by staff in FACT teams, and how they adjust their way of working to increase the opportunities for integration.

Methods

Online focus group interviews involving 35 staff members of five Norwegian FACT teams were conducted using a semi-structured interview guide. The material was analysed using thematic text analysis.

Results

Six themes described the barriers to integrated care in the service system: fragmentation, different legislation and digital systems, challenges in collaboration, bureaucracy and limited opening hours. Three themes described adjustments in the teams' way of working to enhance integration: working as the responsible co-ordinator, being a collaborator, and the only entry channel into the service system.

Conclusion

The FACT team staff described several barriers to integration within the system. However, they made some adjustments in their way of working that might provide opportunities for integrated care within complex and fragmented service systems.

[DNVF-Discussion paper - Specificities, Challenges and Aims of Mental Health Service Research in Germany]

Research in mental health services in Germany is of increasing relevance. To this end, the recently founded "Mental Health Working Group" as part of the German Network of Health Services Research (DNVF) has written a discussion paper presenting key specifics, challenges, and goals of health service research in the field of mental health. Some research-relevant specifics in the area of mental health care, pragmatic challenges of research organization, ethical problems, and particular research topics in this field are presented and discussed critically.

Flexible assertive community treatment teams can change complex and fragmented service systems: experiences of service providers

BACKGROUND

Implementing innovative health service models in existing service systems is complicated and context dependent. Flexible assertive community treatment (FACT) is a multidisciplinary service model aimed at providing integrated care for people with severe mental illness. The model was developed in the Netherlands and is now used in several countries, such as Norway. The Norwegian service system is complex and fragmented, with challenges in collaboration. Limited research has been performed on FACT teams and other new integrative health service models as part of such systems. However, such knowledge is important for future adjustments of innovation processes and service systems. Our aim was to explore how FACT teams are integrated into the existing formal public service system, how they function and affect the system, and describe some influencing factors to this. We sought to address how service providers in the existing service system experience the functioning of FACT teams in the system.

METHODS

Five focus group interviews were undertaken 3 years after the FACT teams were implemented. Forty service providers representing different services from both levels of administration (primary and specialist healthcare) from different Norwegian regions participated in this study. Team leaders of the FACT teams also participated. Service providers were recruited through purposeful sampling. Interviews were analysed using thematic text analysis.

RESULTS

The analysis revealed five main themes regarding FACT teams: (1) They form a bridge between different services; (2) They collaborate with other services; (3) They undertake responsibility and reassure other services; (4) They do not close all gaps in service systems; and (5) They are part of a service system that hampers their functioning.

CONCLUSIONS

The FACT teams in this study contributed to positive changes in the existing service system. They largely contributed to less complex and fragmented systems by forming a bridge and undertaking responsibility in the system and by collaborating with and reassuring other services; this has reduced some gaps in the system. The way FACT teams function and needs of the existing system appear to have contributed positively to these findings. However, complexity and fragmentation of the system partly hamper functioning of the FACT teams.

Effect of patient-controlled intravenous analgesia combined with flurbiprofen axetil and dezocine on postoperative analgesia for lobectomy (EPIC-FAD): a trial protocol

BACKGROUND

The optimal analgesic strategy for surgical pain after lobectomy remains undefined. To compare the combination of flurbiprofen axetil and dezocine with flurbiprofen axetil alone and dezocine alone, in post-lobectomy patients.

METHODS

A single-center, parallel-design double-blind superiority trial, with 5 groups (1:1:1:1:1 ratio) with different combinations of flurbiprofen and dezocine. Patients scheduled for lobectomy will be recruited. The primary outcome is total sufentanil use in patient-controlled intravenous analgesia within the first 24 postoperative hours. Secondary outcomes include pain numeric rating scales at 6th, 12th, 24th, 48th, and 72th postoperative hours, and on the 1st, 3rd, and 6th postoperative months at rest and during coughing, adverse effects from experimental drug treatment, sufentanil use at other time points, analgesia cost, time to chest tube removal, length of hospital stay, time to pass first flatus, and serum level of cytokines. Doctors, patients, and nurses are blinded, and only the manager is unblinded. Analysis is intention-to-treat. Statistical analysis is pre-specified. Statistical comparison of the treatment groups includes one-way analysis of variance followed by Tukey's post hoc test.

DISCUSSION

Trial did not begin to recruit. Participant recruitment start date is planned to be June 1, 2020. Approximate recruitment end date is May 31, 2021. If successful, the trial may shed light on the use of certain analgesic combinations in post-lobectomy pain control.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR1800018563 . Registered on September 25, 2018.