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Roberts SH, Bailey J. Exergaming (physically active video gaming) for mental health service users in a community mental health care setting: an ethnographic observational feasibility study. BMC Psychiatry 2023; 23:752. [PMID: 37845683 PMCID: PMC10577994 DOI: 10.1186/s12888-023-05233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND People with severe and enduring mental illness experience health inequalities with premature mortality; lifestyle behaviours are known to be contributing factors with low levels of physical activity reported. Facilitating physical activity to help maintain or improve health for those who are disadvantaged is essential. Exergaming (gaming involving physical movement) is increasingly used to improve physical activity across the lifespan and for those with a range clinical conditions; this might offer a way to increase physical activity for those with severe mental illness. The aim of this study was to explore engagement of mental health service users with exergaming to increase physical activity in a community mental health care setting. METHODS An ethnographic observational feasibility study was undertaken through participant observation and semi-structured interviews. A gaming console was made available for 2 days per week for 12 months in a community mental health setting. A reflexive thematic analysis was performed on the data. RESULTS Twenty one mental health service users engaged with the intervention, with two thirds exergaming more than once. One participant completed the semi-structured interview. Key themes identified from the observational field notes were: support (peer and staff support); opportunity and accessibility; self-monitoring; and perceived benefits. Related themes that emerged from interview data were: benefits; motivators; barriers; and delivery of the intervention. Integrating these findings, we highlight social support; fun, enjoyment and confidence building; motivation and self-monitoring; and, accessibility and delivery in community mental health care context are key domains of interest for mental health care providers. CONCLUSIONS We provide evidence that exergaming engages people with SMI with physical activity. The value, acceptability and feasibility of open access exergaming in a community mental health service context is supported. Facilitating exergaming has the potential to increase physical activity for mental health service users leading to possible additional health benefits.
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Affiliation(s)
- Seren Haf Roberts
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, CF144XN, UK.
| | - Jois Bailey
- Betsi Cadwaladr University Health Board, Wrexham, UK
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Wu J, Siu KWM, Zhang L. Intergenerational Integration in Community Building to Improve the Mental Health of Residents—A Case Study of Public Space. Behav Sci (Basel) 2023; 13:bs13040292. [PMID: 37102807 PMCID: PMC10135891 DOI: 10.3390/bs13040292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
This study defined intergenerational integration in communities at a theoretical level and verified whether a series of measures could facilitate negotiation and communication between community residents and other stakeholders to generate a positive and healthy community environment and gradually improve intergroup relations. Specifically, we applied community psychology and used Hongqiao New Village in Shanghai, China, as a research site to explore intergenerational conflict in public community spaces. The research was divided into two stages: an input stage and an output stage. In the input stage, participatory research and tea parties were used to deeply explore residents’ public space requirements. In the output stage, we tested the validity of the theory by using the Intergenerational Attitude Scale to investigate whether the intergenerational relationships were changed by the co-creation intervention. The results showed that the intervention caused a decrease in the incidence of conflict between residents using the square and caused some children to join the older groups in their activities. We thus propose a theoretical system model of intergenerational integration strategies that incorporates elements of integration, disagreement, and synergy in intergenerational interactions. Overall, this paper provides new ideas for building a community environment that supports mental health and improves intergenerational relationships and social well-being.
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Affiliation(s)
- Jianbin Wu
- School of Design, Jiangnan University, Wuxi 214000, China
- Correspondence: ; Tel.: +86-182-6228-5261
| | | | - Linghao Zhang
- School of Design, Jiangnan University, Wuxi 214000, China
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Wu J, Zhang L, Ren X. Incorporating the Co-Creation Method into Social Innovation Design to Promote Intergenerational Integration: A Case Study of a Public Square. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12908. [PMID: 36232208 PMCID: PMC9564664 DOI: 10.3390/ijerph191912908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/02/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
With the COVID-19 pandemic sweeping the world, there is an increased focus on intergenerational relationships, community mental health issues, and well-being in community contexts. This paper assesses the effectiveness of a co-creation approach for intergenerational integration at the theoretical level. The study used a collaborative co-creation design method in the community design process to explore whether the participation of community residents of all ages in addressing community issues promoted communication and alleviated stereotyping between the various generations. This study was conducted in Shanghai's Hongqiao New Village square, where we conducted participatory research and co-creation workshops in response to the demand for the use of the public space as a location for social interactions. The results showed that intervention in community creation through collaborative design is conducive to promoting friendly relations among different age groups, forming a sense of social security and thus enhancing social well-being. Finally, this paper combines practical cases and theoretical models of collaborative co-creative design approaches to promote the intergenerational integration of communities and is summarized from the input and output parts as well as the influencing factors and constraints of the collaborative co-creative. In addition, it provides new ideas on how to improve intergenerational relationships and form a positive and sustainable community mental health environment in the future.
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The Greek Hybrid Version of the Assertive Community Treatment Model: A Perspective View between Challenges and Limitations. PSYCH 2021. [DOI: 10.3390/psych3040050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Assertive Community Treatment (ACT) model of care has been long considered to be effective in the management of patients with severe mental illness (SMI) in most Western countries. The implementation of the original ACT model may be particularly challenging in rural and remote communities with small and dispersed populations and lack of adequate mental health services. Rural programs may have to adapt the model and modify the ACT fidelity standards to accommodate these limitations, and this is the rationale for the introduction of more flexible, hybrid ACT models. In rural Greece, the so called Mobile Mental Health Units (MMHUs) are well-established community mental health services. For patients with SMI that have difficulties engaging with treatment services, the new hybrid ACT model has been recently launched. The objective of this manuscript is to present the recently launched hybrid ACT model in rural areas in Greece and to explore the challenges and limitations in its implementation from the experience of a team of mental health professionals with ACT experience. Referral criteria have not been strictly set, but the number of previous relapses and hospitalizations is taken under consideration, as well as the history of poor treatment adherence and disengagement from mental health services. The main limitation in the implementation of the hybrid ACT service is that it has been introduced in several areas in the absence of a pre-existing community mental health service. This may impact referrals and limit focus on the difficult cases of patients with SMI, thus making the evaluation of the model inapplicable.
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Decrease of Hospitalizations and Length of Hospital Stay in Patients with Schizophrenia Spectrum Disorders or Bipolar Disorder Treated in a Mobile Mental Health Service in Insular Greece. PSYCH 2021. [DOI: 10.3390/psych3040049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
In recent years serious mental health issues, such as schizophrenia spectrum disorders and bipolar disorder, have been treated in the community by community-based mental health services. In the present study our goal was to estimate the modification in the number of hospitalizations and duration of admissions in either psychotic patients or patients with bipolar disorder, treated by a Mobile Mental Health Unit in the islands of Kefalonia, Zakynthos and Ithaca (MMHU-KZI). Data were collected from a total of 108 patients with schizophrenia spectrum disorders and bipolar disorder. For each patient comparison was made for the same time interval prior and after engagement to treatment with the MMHU-KZI and not for the total hospitalizations that patients had in their history. There was a statistically significant reduction (45.9%) in hospitalizations after treatment engagement with the MMHU-KZI, as the Wilcoxon signed ranks test indicated. Furthermore, a major decrease (54.5%) of hospitalization days was noted after treatment engagement with the unit. This pattern of mental health provision may be beneficial for the reduction of the number and duration of psychiatric hospitalizations. Despite the beneficial contribution of community-based mental health units, hospital based treatment should always be available, since severe relapses are better treated in inpatient setting.
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Roth C, Wensing M, Kuzman MR, Bjedov S, Medved S, Istvanovic A, Grbic DS, Simetin IP, Tomcuk A, Dedovic J, Djurisic T, Nica RI, Rotaru T, Novotni A, Bajraktarov S, Milutinovic M, Nakov V, Zarkov Z, Dinolova R, Walters BH, Shields-Zeeman L, Petrea I. Experiences of healthcare staff providing community-based mental healthcare as a multidisciplinary community mental health team in Central and Eastern Europe findings from the RECOVER-E project: an observational intervention study. BMC Psychiatry 2021; 21:525. [PMID: 34689733 PMCID: PMC8543797 DOI: 10.1186/s12888-021-03542-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Community Mental Health Teams (CMHTs) deliver healthcare that supports the recovery of people with mental illness. The aim of this paper was to explore to what extent team members of five CMHTs newly implemented in five countries perceived that they had introduced aspects of the recovery-oriented, strength-based approach into care after a training week on recovery-oriented practice. In addition, it evaluated what the team members' perceptions on their care roles and their level of confidence with this role were. METHOD An observational intervention study using a quantitative survey that was administered among 52 health professionals (21 Nurses, 13 Psychiatrists, 9 Psychologists, 8 Social Workers) and 14 peer workers including the Recovery Self-Assessment Tool Provider Version (RSA-P), the Team Member Self-Assessment Tool (TMSA), and demographic questions was conducted. The measures were self-reported. Descriptive statistics were used to calculate the means and standard deviations for continuous variables and frequencies and percentages for categorical variables (TMSA tool and demographic data). The standard technique to calculate scale scores for each subscale of the RSA-P was used. Bivariate linear regression analyses were applied to explore the impact of predictors on the subscales of the RSA-P. Predictors with significant effects were included in multiple regression models. RESULT The RSA-P showed that all teams had the perception that they provide recovery-oriented practice to a moderately high degree after a training week on recovery-oriented care (mean scores between 3.85-4.46). Health professionals with fewer years of professional experience perceived more frequently that they operated in a recovery-oriented way (p = 0.036, B = - 0.268). Nurses and peer workers did not feel confident or responsible to fulfil specific roles. CONCLUSION The findings suggest that a one-week training session on community-based practices and collaborative teamwork may enhance recovery-oriented practice, but the role of nurses and peer workers needs further attention. TRIAL REGISTRATION Each trial was registered before participant enrolment in the clinicaltrials.gov database: Croatia, Zagreb (Trial Reg. No. NCT03862209 ); Montenegro, Kotor (Trial Reg. No. NCT03837340 ); Romania, Suceava (Trial Reg. No. NCT03884933 ); Macedonia, Skopje (Trial Reg. No. NCT03892473 ); Bulgaria, Sofia (Trial Reg. No. NCT03922425 ).
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Affiliation(s)
- Catharina Roth
- grid.5253.10000 0001 0328 4908Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130, 69120 Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany.
| | - Martina Rojnic Kuzman
- grid.412688.10000 0004 0397 9648Clinic for Psychiatry and Psychological Medicine, Zagreb University Hospital Centre, Kišpatićeva ul. 12, 10000 Zagreb, Croatia ,grid.4808.40000 0001 0657 4636Zagreb School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sarah Bjedov
- grid.412688.10000 0004 0397 9648Clinic for Psychiatry and Psychological Medicine, Zagreb University Hospital Centre, Kišpatićeva ul. 12, 10000 Zagreb, Croatia
| | - Sara Medved
- grid.412688.10000 0004 0397 9648Clinic for Psychiatry and Psychological Medicine, Zagreb University Hospital Centre, Kišpatićeva ul. 12, 10000 Zagreb, Croatia
| | - Ana Istvanovic
- grid.413299.40000 0000 8878 5439Croatian Institute of Public Health, Rockefellerova ul. 7, 10000 Zagreb, Croatia
| | - Danijela Stimac Grbic
- grid.413299.40000 0000 8878 5439Croatian Institute of Public Health, Rockefellerova ul. 7, 10000 Zagreb, Croatia
| | - Ivana Pavic Simetin
- grid.413299.40000 0000 8878 5439Croatian Institute of Public Health, Rockefellerova ul. 7, 10000 Zagreb, Croatia
| | - Aleksandar Tomcuk
- Health Institution Special Psychiatric Hospital Dobrota Kotor, Dobrota bb, 85330 Kotor, Montenegro
| | - Jovo Dedovic
- Health Institution Special Psychiatric Hospital Dobrota Kotor, Dobrota bb, 85330 Kotor, Montenegro
| | - Tatijana Djurisic
- Public Health Institute of Montenegro, Dzona Dzeksona bb, 81000 Podgorica, Montenegro
| | - Raluca Ileana Nica
- Institute Liga Romana pentru Sanatate Mintala, Sos. Mihai Bravu 90-96, Bucuresti-Sector 2, Romania
| | - Tiberiu Rotaru
- Siret Psychiatric Hospital, Strada 9 Mai 5, 725500 Siret, Romania
| | - Antoni Novotni
- grid.452081.aUniversity Clinic of Psychiatry, Мајка Тереза 17, Mother Teresa 17, Skopje, 1000 North Macedonia
| | - Stojan Bajraktarov
- grid.452081.aUniversity Clinic of Psychiatry, Мајка Тереза 17, Mother Teresa 17, Skopje, 1000 North Macedonia
| | - Milos Milutinovic
- grid.452081.aUniversity Clinic of Psychiatry, Мајка Тереза 17, Mother Teresa 17, Skopje, 1000 North Macedonia
| | - Vladimir Nakov
- National Centre of Public Health and Analyses, Directorate Mental Health and Prevention of Addictions, Acad. Ivan Evst. Geshov 15 blvd., 1431 Sofia, Bulgaria
| | - Zahari Zarkov
- National Centre of Public Health and Analyses, Directorate Mental Health and Prevention of Addictions, Acad. Ivan Evst. Geshov 15 blvd., 1431 Sofia, Bulgaria
| | - Roumyana Dinolova
- National Centre of Public Health and Analyses, Directorate Mental Health and Prevention of Addictions, Acad. Ivan Evst. Geshov 15 blvd., 1431 Sofia, Bulgaria
| | - Bethany Hipple Walters
- grid.416017.50000 0001 0835 8259Dutch Institute for Mental Health and Addiction/Trimbos Institute, Da Costakade 45, 3521 Utrecht, VS Netherlands
| | - Laura Shields-Zeeman
- grid.416017.50000 0001 0835 8259Dutch Institute for Mental Health and Addiction/Trimbos Institute, Da Costakade 45, 3521 Utrecht, VS Netherlands
| | - Ionela Petrea
- grid.416017.50000 0001 0835 8259Dutch Institute for Mental Health and Addiction/Trimbos Institute, Da Costakade 45, 3521 Utrecht, VS Netherlands ,Present Address: INSIGHT International Institute for Mental Health and Integrated Health Systems, Cornelis Anthoniszstraat 23-1, 1071VP Amsterdam, Netherlands
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Fulone I, Barreto JOM, Barberato-Filho S, Bergamaschi CDC, Silva MT, Lopes LC. Improving Care for Deinstitutionalized People With Mental Disorders: Experiences of the Use of Knowledge Translation Tools. Front Psychiatry 2021; 12:575108. [PMID: 33981256 PMCID: PMC8109270 DOI: 10.3389/fpsyt.2021.575108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/29/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The deinstitutionalization process is complex, long-term and many countries fail to achieve progress and consolidation. Informing decision-makers about appropriate strategies and changes in mental health policies can be a key factor for it. This study aimed to develop an evidence brief to summarize the best available evidence to improve care for deinstitutionalized patients with severe mental disorders in the community. Methods: We used the SUPPORT (Supporting Policy Relevant Reviews and Trials) tools to elaborate the evidence brief and to organize a policy dialogue with 24 stakeholders. A systematic search was performed in 10 electronic databases and the methodological quality of systematic reviews (SRs) was assessed by AMSTAR 2. Results: Fifteen SRs were included (comprising 378 studies and 69,736 participants), of varying methodological quality (3 high-quality SRs, 2 moderate-quality SRs, 7 low-quality SRs, 3 critically low SRs). Six strategies were identified: (i). Psychoeducation; (ii). Anti-stigma programs, (iii). Intensive case management; (iv). Community mental health teams; (v). Assisted living; and (vi). Interventions for acute psychiatric episodes. They were associated with improvements on a global status, satisfaction with the service, reduction on relapse, and hospitalization. Challenges to implementation of any of them included: stigma, the shortage of specialized human resources, limited political and budgetary support. Conclusions: These strategies could guide future actions and policymaking to improve mental health outcomes.
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Affiliation(s)
- Izabela Fulone
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, Brazil
| | | | | | | | | | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, Sorocaba, Brazil
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Poss J, Mitchell L, Mah J, Keefe J. Disparities in Utilization of Psychiatry Services Among Home Care Clients: The Tale of Two Canadian Jurisdictions. Front Psychiatry 2021; 12:712112. [PMID: 34603103 PMCID: PMC8484907 DOI: 10.3389/fpsyt.2021.712112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022] Open
Abstract
Publicly funded home care in Canada supports older adults in the community to delay institutional care, which results in complex care populations with multimorbidity that includes mental health problems. The purpose of this study is to examine prevalence of psychiatric diagnoses and other mental health symptoms among older clients in two publicly funded Home Care (HC) Programs and their psychiatry service utilization (psychiatrist visits) after being admitted to home care. This retrospective cohort study examines clients age 60 years and older in the two Canadian provinces of Manitoba (MB), specifically the Winnipeg Regional Health Authority (WRHA) (n = 5,278), and Nova Scotia (NS) (n = 5,323). Clients were admitted between 2011 and 2013 and followed up to 4 years. Linked data sources include the InterRAI Resident Assessment Instrument for Home Care (RAI-HC), physician visit/billing data and hospital admission data. Both regions had similar proportions (53%) of home care clients with one or more psychiatric diagnoses. However, we observed over 10 times the volume of psychiatry visits in the WRHA cohort (8,246 visits vs. 792 visits in NS); this translated into a 4-fold increased likelihood of receiving psychiatry visits (17.2% of WRHA clients vs. 4.2% of NS clients) and 2.5 times more visits on average per client (9.1 avg. visits in MB vs. 3.6 avg. visits in NS). The location of psychiatry services varied, with a greater number of psychiatry visits occurring while in hospital for WRHA HC clients compared to more visits in the community for NS HC clients. Younger age, psychotropic medication use, depressive symptoms, dementia, and having an unstable health condition were significantly associated with receipt of psychiatry visits in both cohorts. Access to psychiatric care differed between the cohorts despite little to no difference in need. We conclude that many home care clients who could have benefitted from psychiatrist visits did not receive them. This is particularly true for rural areas of NS. By linking the RAI-HC with other health data, our study raises important questions about differential access to psychiatry services by site of care (hospital vs. community), by geographical location (MB vs. NS and urban vs. rural) and by age. This has implications for staff training and mental health resources in home care to properly support the mental health needs of clients in care. Study results suggest the need for a mental health strategy within public home care services.
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Affiliation(s)
- Jeffrey Poss
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Lori Mitchell
- Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Jasmine Mah
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Janice Keefe
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada.,Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, NS, Canada
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Peritogiannis V, Gioti P, Gogou A, Samakouri M. Decrease of hospitalizations and length of hospital stay in patients with schizophrenia spectrum disorders treated in a community mental health service in rural Greece. Int J Soc Psychiatry 2020; 66:693-699. [PMID: 32552161 DOI: 10.1177/0020764020924462] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The treatment of severe and chronic mental disorders, such as schizophrenia and related syndromes, is largely based on community mental health services. AIMS The objective of the present study was to assess hospital admissions and length of hospital stay in patients with schizophrenia and related disorders, who are engaged to treatment with a Mobile Mental Health Unit (MMHU I-T) in a defined rural catchment area in Greece. METHOD Data were retrieved retrospectively for 76 patients with schizophrenia and related disorders. For each patient, comparison was made for the same interval prior and after engagement to treatment with the MMHU I-T. RESULTS The average age of patients was 56 years and the mean illness duration was 28 years. The mean follow-up duration was 5.3 years. There was a statistically significant decrease in the annual average of the number of voluntary and involuntary hospitalizations and on days of hospital stay after treatment engagement with the MMHU I-T. CONCLUSIONS Treatment of schizophrenia spectrum disorders in rural residents by the MMHUs may contribute to the reduction of patients' admissions and length of hospital stay. Future research should address the cost-effectiveness of such interventions.
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Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Panagiota Gioti
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Afroditi Gogou
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Maria Samakouri
- Department of Psychiatry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Marastuti A, Subandi MA, Retnowati S, Marchira CR, Yuen CM, Good BJ, Good MJD. Development and Evaluation of a Mental Health Training Program for Community Health Workers in Indonesia. Community Ment Health J 2020; 56:1248-1254. [PMID: 32062716 DOI: 10.1007/s10597-020-00579-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 02/11/2020] [Indexed: 11/28/2022]
Abstract
The treatment gap in mental health care in Indonesia is a critical issue due in large measure to the dearth of professional mental health staff. In response to this need, our team designed a mental health training program for existing community health workers. The training program was offered to 65 participants at 2 (two) community primary care center (Puskesmas); we evaluated the training program with quantitative and qualitative methods. We assessed the gains in knowledge using a 20-question knowledge assessment test. In addition, in Puskesmas 1, the test was repeated as a follow-up test 4 months after the training. Statistical analysis showed that the differences between pre-test and post-test scores were significant in both Puskesmas 1 (p = 0.004) and Puskesmas 2 (p < 0.001). This study concluded that the model of integrative training appears effective for preparing Indonesian CHWs to recognize and respond to needs for mental health care.
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Affiliation(s)
- Ariana Marastuti
- Fakultas Psikologi, Universitas Gadjah Mada, Jalan Humaniora, Bulaksumur, Yogyakarta, Indonesia, 55281
| | - M A Subandi
- Fakultas Psikologi, Universitas Gadjah Mada, Jalan Humaniora, Bulaksumur, Yogyakarta, Indonesia, 55281.
| | - Sofia Retnowati
- Fakultas Psikologi, Universitas Gadjah Mada, Jalan Humaniora, Bulaksumur, Yogyakarta, Indonesia, 55281
| | - Carla R Marchira
- Fakultas Kedokteran, Universitas Gadjah Mada, Jalan Humaniora, Bulaksumur, Yogyakarta, Indonesia, 55281
| | - Courtney M Yuen
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Byron J Good
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Mary-Jo D Good
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
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11
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Lurie I, Barnea Y, Caspi Y, Olmer L, Baruch Y. Patterns of psychiatric hospitalizations among migrant workers and asylum-seekers in Israel: a single hospital archive study, 2005-2011. Nord J Psychiatry 2020; 74:115-122. [PMID: 31621452 DOI: 10.1080/08039488.2019.1677770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aim: Migrants have increased risk for psychiatric hospitalizations. Over the last decades Israel has become a destination for migration of migrant workers and asylum-seekers.Methods: The current retrospective study retrieved socio-demographic, clinical and migration-related chart data for 117 migrants admitted to a major Israeli psychiatric hospital between 2005-2011, to delineate characteristics and risk-factors for psychiatric hospitalizations. Multivariate logistic regression analyses were performed to predict re-hospitalization.Results: Of the study sample, 61% were single men, 20% had been exposed to trauma, 15% had prior psychiatric hospitalizations and 24% had attempted suicide. Approximately, 76% were involuntarily hospitalized and diagnosed with psychosis. None were diagnosed with PTSD. Approximately, 20% were re-hospitalized. Factors significantly associated with re-hospitalization were male gender (OR = 15.2, 95%, CI 1.8-126.9, p = 0.012), prior psychiatric hospitalization (OR = 15.4, 95% CI 2.1-111.9, p < 0.01), being single (OR = 5.96, 95% CI1.14-31.07, p = 0.03) and traumatic exposure (OR = 4.75, 95% CI: 1.17-19.36, p= 0.03). Shorter duration in Israel, unemployment, asylum-seekers, no temporary-visa and use of restraints were more prevalent among those re-hospitalized.Conclusion: Identification of migrants at risk and trauma-informed, culturally relevant services can reduce hospitalizations.
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Affiliation(s)
- Ido Lurie
- Shalvata Mental Health Center, Hod Hasharon, Israel.,Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Barnea
- Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Abarbanel Mental Health Center, Bat-Yam, Israel
| | - Yael Caspi
- Veterans' Outpatient Psychiatric Clinic, Department of Psychiatry, Rambam Medical Health Care Center, Haifa, Israel
| | - Liraz Olmer
- Gertner Institute for Health Policy and Epidemiology, Tel HaShomer, Israel
| | - Yehuda Baruch
- Health Administration Department, Israel Academic College, Ramat Gan, Israel
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Very Long-Term Outcome of Community-Dwelling Patients With Schizophrenia Spectrum Disorders in Rural Greece. J Nerv Ment Dis 2019; 207:1012-1018. [PMID: 31703035 DOI: 10.1097/nmd.0000000000001068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of the present study was to measure the very long-term outcome in community-dwelling patients with a diagnosis of psychosis and to search for possible correlations of outcome with clinical factors. The sample included 55 psychotic patients with at least 15 years of disease duration (M = 32.1 years). For the estimation of the outcome, the Health of the Nations Outcome Scale and the Clinical Global Impression Scale were used. A total of 34.5% of the patients had a good outcome, whereas 27.3% had poor outcome. Outcome was found to be correlated to symptoms, and it was significantly worse in patients living with other severely mentally ill family members. In our study, outcome was good in more than a third of patients. Both symptoms and social functioning were associated with outcome. This study may have some implications for mental healthcare delivery.
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De Sutter M, De Sutter A, Sundahl N, Declercq T, Decat P. Inter-professional collaboration reduces the burden of caring for patients with mental illnesses in primary healthcare. A realist evaluation study. Eur J Gen Pract 2019; 25:236-242. [PMID: 31373254 PMCID: PMC6853250 DOI: 10.1080/13814788.2019.1640209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: The implementation of primary care for mental health is often insufficient, which leaves its mark on staff. A team-based approach of mental healthcare prevents poor staff morale. A community health centre (CHC), therefore, set up a project promoting interprofessional collaboration with a mental health team (MHT). Objectives: This study aimed to understand how an MHT would influence staff morale in a primary care setting, aiming to formulate some recommendations for future projects. Methods: In 2017, interviews and a focus group discussion were conducted among the staff of a CHC. Using a qualitative approach, we aimed to unravel contextual factors and mechanisms that determine the effect of an MHT on staff morale. Results: The project relieved the burden of the patient encounters and staff members felt more valuable to patients. Underlying mechanisms were recognition, altered attitudes towards patients and role clarity. Facilitating factors were intercultural care mediators and a positive team atmosphere, whereas inhibiting factors were inefficient time management and communicative issues. Conclusion: Our study elucidated mechanisms and the contextual factors by which an MHT in general practice improves staff morale. KEY MESSAGES An MHT improves staff morale in a CHC, through nurturing recognition, through altering staff members' attitudes and through ensuring role clarity. Pitfalls are inefficient time management and poor communication. Policymakers should stimulate interprofessional collaboration in primary mental health.
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Affiliation(s)
- Marieke De Sutter
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - An De Sutter
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Nora Sundahl
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | - Tom Declercq
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Peter Decat
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Tyrer P. Reforming care without bureaucracy. BJPsych Bull 2019; 43:104-105. [PMID: 30207261 PMCID: PMC8058883 DOI: 10.1192/bjb.2018.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 08/03/2018] [Indexed: 11/23/2022] Open
Abstract
The Care Programme Approach was a valiant attempt to improve the aftercare of people with severe mental illness after discharge from hospital. It was introduced as a response to a scandal, not an advance in knowledge, and has always suffered by being a reaction to events rather than a trailblazer for the future. It may have dragged the worst of care upwards, but at the expense of creating a bureaucratic monstrosity that has hindered good practice by excessive attention to risk, and vastly increased paperwork with intangible benefit. It needs to be simplified to allow practitioners greater scope for collaborative solutions, less minatory oversight and better use of strained resources.Declaration of interestNone.
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Affiliation(s)
- Peter Tyrer
- Centre for Psychiatry, Imperial College, London, UK
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The supporting and inhibiting factors of interprofessional collaborative practice in a newly established teaching hospital. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.xjep.2019.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Page A, Atkinson JA, Campos W, Heffernan M, Ferdousi S, Power A, McDonnell G, Maranan N, Hickie I. A decision support tool to inform local suicide prevention activity in Greater Western Sydney (Australia). Aust N Z J Psychiatry 2018; 52:983-993. [PMID: 29671335 DOI: 10.1177/0004867418767315] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study describes the development of a decision support tool to identify the combination of suicide prevention activities and service priorities likely to deliver the greatest reductions in suicidal behaviour in Western Sydney (Australia) over the period 2018-2028. METHODS A dynamic simulation model for the WentWest - Western Sydney Primary Health Network population-catchment was developed in partnership with primary health network stakeholders based on defined pathways to mental health care and suicidal behaviour, and which represented the current incidence of suicide and attempted suicide in Western Sydney. A series of scenarios relating to potential suicide prevention activities and service priorities identified by primary health network stakeholders were investigated to identify the combination of interventions associated with the largest reductions in the forecast number of attempted suicide and suicide cases for a 10-year follow-up period. RESULTS The largest number of cases averted for both suicide and attempted suicide was associated with (1) post-suicide attempt assertive aftercare (6.1% for both attempted suicide and suicide), (2) improved community support and reductions in psychological distress in the community (5.1% for attempted suicide and 14.8% for suicide), and (3) reductions in the proportion of those lost to services following a mental health service contact (10.5% for both attempted suicide and suicide). In combination, these interventions were forecast to avert approximately 29.7% of attempted suicides and 37.1% of suicides in the primary health network catchment over the 10-year period. CONCLUSION This study demonstrates the utility of dynamic simulation models, co-designed with multi-disciplinary stakeholder groups, to capture and analyse complex mental health and suicide prevention regional planning problems. The model can be used by WentWest - Western Sydney Primary Health Network as a decision support tool to guide the commissioning of future service activity, and more efficiently frame the monitoring and evaluation of interventions as they are implemented in Western Sydney.
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Affiliation(s)
- Andrew Page
- 1 Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Jo-An Atkinson
- 2 The Australian Prevention Partnership Centre, The Sax Institute, Ultimo, NSW, Australia
| | - William Campos
- 3 WentWest, Western Sydney Primary Health Network, Blacktown, NSW, Australia
| | | | - Shahana Ferdousi
- 3 WentWest, Western Sydney Primary Health Network, Blacktown, NSW, Australia
| | - Adrian Power
- 3 WentWest, Western Sydney Primary Health Network, Blacktown, NSW, Australia
| | - Geoff McDonnell
- 2 The Australian Prevention Partnership Centre, The Sax Institute, Ultimo, NSW, Australia
| | - Nereus Maranan
- 5 Health Services Planning & Development, Western Sydney Local Health District, Wentworthville, NSW, Australia
| | - Ian Hickie
- 6 Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
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Haines A, Perkins E, Evans EA, McCabe R. Multidisciplinary team functioning and decision making within forensic mental health. Ment Health Rev (Brighton) 2018; 23:185-196. [PMID: 30464703 PMCID: PMC6201820 DOI: 10.1108/mhrj-01-2018-0001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/21/2018] [Accepted: 06/29/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to investigate the operation of multidisciplinary team (MDT) meetings within a forensic hospital in England, UK. DESIGN/METHODOLOGY/APPROACH Mixed methods, including qualitative face to face interviews with professionals and service users, video observations of MDT meetings and documentary analysis. Data were collected from 142 staff and 30 service users who consented to take part in the research and analysed using the constant comparison technique of grounded theory and ethnography. FINDINGS Decisions taken within MDT meetings are unequally shaped by the professional and personal values and assumptions of those involved, as well as by the power dynamics linked to the knowledge and responsibility of each member of the team. Service users' involvement is marginalised. This is linked to a longstanding tradition of psychiatric paternalism in mental health care. RESEARCH LIMITATIONS/IMPLICATIONS Future research should explore the nuances of interactions between MDT professionals and service users during the meetings, the language used and the approach taken by professionals to enable/empower service user to be actively involved. PRACTICAL IMPLICATIONS Clear aims, responsibilities and implementation actions are a pre-requisite to effective MDT working. There is a need to give service users greater responsibility and power regarding their care. ORIGINALITY/VALUE While direct (video) observations were very difficult to achieve in secure settings, they enabled unmediated access to how people conducted themselves rather than having to rely only on their subjective accounts (from the interviews).
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Affiliation(s)
- Alina Haines
- Health Services Research, University of Liverpool, Liverpool, UK
| | | | - Elizabeth A Evans
- Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Rhiannah McCabe
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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Mufaddel A, Al Sabousi M, Takriti Y, Dawoud B, Coroza N, Belhaj H, Al Hekmani N. Community mental health services in Al Ain Hospital, United Arab Emirates. Int Psychiatry 2018. [DOI: 10.1192/s1749367600004239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper evaluates a model of community mental health service (CMHS) in Al Ain in the United Arab Emirates. The hospital records were reviewed and the total number of patient admissions and duration of in-patient care before and after enrolment in the CMHS were documented. Patient satisfaction with the CMHS was assessed using a questionnaire. The total number of admissions and the number of days that the patient spent in hospital per year were significantly reduced by the CMHS. Patients had high satisfaction rates with the information and advice they received, with their relationships with CMHS workers, with their access to mental health services and with their drug treatment.
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Brady J, McDonnell C. Service innovation: development of a primary care-based assessment service. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.29.6.222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The care of those with mental illness has moved away from asylums and in-patient care facilities. Community mental health teams (CMHTs) now deliver care but these vary widely in terms of personnel and function (Simmonds et al, 2001). Evidence suggests that CMHT management is not inferior to non-team standard care in any important respect, and that it may even be superior in promoting greater acceptance of treatment, reducing hospital admission and avoiding death by suicide (Tyrer et al, 2000). Despite this apparent improvement, there are problems for the CMHTs and the general practitioners (GPs) who refer individuals. CMHTs are often overstretched, with large workloads, increasing amounts of administration and lack of resources, leading to concerns that individuals with more severe illness may be neglected (Harrison, 2000). Various initiatives have been undertaken to combat these problems, including forging stronger links between the CMHT and GPs, by having an on-site mental health worker (Hamilton et al, 2002; Bower & Sibbald, 2003).
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Hassiotis A, Tyrer P, Oliver P. Psychiatric assertive outreach and learning disability services. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.9.5.368] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Assertive outreach is a well-established method of managing patients with severe mental illness in the community. However, there is limited application and evidence of its efficacy in services for people with learning disabilities who also have mental illness. This paper elucidates current service provision for this group of patients and illustrates the pathways to mental health care available to them.
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Abstract
Drawing on clinical data from 15 months of on-site participant observation in the only public psychiatric hospital in the state of Puebla, Mexico, this article advances our understanding of globalization in relation to psychiatry. I challenge the construction of psychiatry as only treating the individual patient and provide grounded doctor-patient-family member interaction in a Mexican psychiatric clinic in order to review what happens when doctors cannot interact with patients as atomized individuals even though in theory they are trained to think of patients that way. Challenged by severe structural constraints and bolstered by lessons from other nations' efforts at deinstitutionalization, psychiatrists in Puebla push to keep patients out of the inpatient wards and in their respective communities. To this end, psychiatrists call upon co-present kin who are identified both as the customer and part of the caretaking system outside the clinic. This modification to the visit structure changes the dynamic and content of clinical visits while doctors seamlessly respond to unspoken beliefs and values that are central to local life, ultimately showing that efforts to define a "global psychiatry" informed by global policy will fail because it cannot exist in a uniform way-interpersonal interaction and personal experience matters.
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Child Community Mental Health Services in Asia Pacific and Singapore's REACH Model. Brain Sci 2017; 7:brainsci7100126. [PMID: 28984830 PMCID: PMC5664053 DOI: 10.3390/brainsci7100126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 01/30/2023] Open
Abstract
In recent decades, there have been concerted efforts to improve mental health services for youths alongside the challenges of rising healthcare costs and increasing demand for mental health needs. One important phenomenon is the shift from traditional clinic-based care to community-based mental health services to improve accessibility to services and provide patient-centred care. In this article, we discuss the child and adolescent community mental health efforts within the Asia-Pacific region. We also discuss Singapore’s community and school-based mental health service, known as the Response, Early Intervention and Assessment in Community Mental Health (REACH). This article discusses how REACH has evolved over the years in response to the changing needs of youths in Singapore. Finally, we discuss the current challenges and future directions for youth mental health care.
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Setiadi AP, Wibowo Y, Herawati F, Irawati S, Setiawan E, Presley B, Zaidi MA, Sunderland B. Factors contributing to interprofessional collaboration in Indonesian health centres: A focus group study. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.xjep.2017.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Characteristics of people who rapidly and frequently reattend the emergency department for mental health needs. Eur J Emerg Med 2017; 23:351-5. [PMID: 26629766 DOI: 10.1097/mej.0000000000000349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This paper identifies the characteristics of emergency department (ED) attendees with a referral to their Mental Health Liaison Service (MHLS) who are at increased risk for rapidly reattending, attending frequently, or attending intensely at this service (which is defined here as rapid and frequent reattendance). METHODS A retrospective 5-year longitudinal study was conducted of all visitors (n=24 010) attending four busy EDs with a referral to their MHLS from the beginning of 2009 until the end of 2013. A Cox proportional hazards regression was used to identify factors associated with intense use, and a negative binomial regression was used to identify factors associated with frequent attendance. RESULTS People with certain characteristics were more likely to make 'intense' use of mental health emergency services, which we define as shorter time to reattendance and a higher number of visits over 5 years. The people more likely to make intense use are more likely to have certain clinical diagnoses such as substance misuse, stress disorder, personality disorder and learning disability, to have certain social characteristics such as not being in a relationship, or living alone, and to have healthcare issues such as having been detained under the Mental Health Act and having a greater number of care coordinators over 5 years. CONCLUSION Individuals with certain clinical and social characteristics were significantly more likely to reattend EDs and have referral to MHLS rapidly and frequently (i.e. intensely).
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Cook S, Howe A. Engaging People with Enduring Psychotic Conditions in Primary Mental Health Care and Occupational Therapy. Br J Occup Ther 2016. [DOI: 10.1177/030802260306600602] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
For people who have enduring psychotic conditions, interventions need to improve social functioning as well as reducing clinical problems. There is also a need to engage and keep in touch with general practitioner (GP) patients who have fallen out of contact with specialist psychiatric care. A new model of service was designed to engage this patient group: an expanded primary care team in an inner-city area. The team extended the GP role, provided occupational therapy and care management and used liaison psychiatry. A case study design with mixed methods was used to investigate the new service. This article reports the quantitative investigation of engagement, clinical and social outcomes and cost consequences. The results showed that, at the start of the study, 37 people with psychotic conditions were in the sole care of their GPs; of these, 34 (92%) engaged with the new service. The sample of 28 receiving 12 months' interventions started with low levels of social functioning, which required intervention. Following interventions, they showed significant improvements in social functioning, clinical symptoms and Health of the Nation Outcome Scales (HoNOS). The costs were favourable when compared with similar services. The study suggests that expanded primary care, with occupational therapy and care management, can be a feasible service to improve people's engagement and functioning.
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Winpenny E, Miani C, Pitchforth E, Ball S, Nolte E, King S, Greenhalgh J, Roland M. Outpatient services and primary care: scoping review, substudies and international comparisons. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04150] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AimThis study updates a previous scoping review published by the National Institute for Health Research (NIHR) in 2006 (Roland M, McDonald R, Sibbald B.Outpatient Services and Primary Care: A Scoping Review of Research Into Strategies For Improving Outpatient Effectiveness and Efficiency. Southampton: NIHR Trials and Studies Coordinating Centre; 2006) and focuses on strategies to improve the effectiveness and efficiency of outpatient services.Findings from the scoping reviewEvidence from the scoping review suggests that, with appropriate safeguards, training and support, substantial parts of care given in outpatient clinics can be transferred to primary care. This includes additional evidence since our 2006 review which supports general practitioner (GP) follow-up as an alternative to outpatient follow-up appointments, primary medical care of chronic conditions and minor surgery in primary care. Relocating specialists to primary care settings is popular with patients, and increased joint working between specialists and GPs, as suggested in the NHS Five Year Forward View, can be of substantial educational value. However, for these approaches there is very limited information on cost-effectiveness; we do not know whether they increase or reduce overall demand and whether the new models cost more or less than traditional approaches. One promising development is the increasing use of e-mail between GPs and specialists, with some studies suggesting that better communication (including the transmission of results and images) could substantially reduce the need for some referrals.Findings from the substudiesBecause of the limited literature on some areas, we conducted a number of substudies in England. The first was of referral management centres, which have been established to triage and, potentially, divert referrals away from hospitals. These centres encounter practical and administrative challenges and have difficulty getting buy-in from local clinicians. Their effectiveness is uncertain, as is the effect of schemes which provide systematic review of referrals within GP practices. However, the latter appear to have more positive educational value, as shown in our second substudy. We also studied consultants who held contracts with community-based organisations rather than with hospital trusts. Although these posts offer opportunities in terms of breaking down artificial and unhelpful primary–secondary care barriers, they may be constrained by their idiosyncratic nature, a lack of clarity around roles, challenges to professional identity and a lack of opportunities for professional development. Finally, we examined the work done by other countries to reform activity at the primary–secondary care interface. Common approaches included the use of financial mechanisms and incentives, the transfer of work to primary care, the relocation of specialists and the use of guidelines and protocols. With the possible exception of financial incentives, the lack of robust evidence on the effect of these approaches and the contexts in which they were introduced limits the lessons that can be drawn for the English NHS.ConclusionsFor many conditions, high-quality care in the community can be provided and is popular with patients. There is little conclusive evidence on the cost-effectiveness of the provision of more care in the community. In developing new models of care for the NHS, it should not be assumed that community-based care will be cheaper than conventional hospital-based care. Possible reasons care in the community may be more expensive include supply-induced demand and addressing unmet need through new forms of care and through loss of efficiency gained from concentrating services in hospitals. Evidence from this study suggests that further shifts of care into the community can be justified only if (a) high value is given to patient convenience in relation to NHS costs or (b) community care can be provided in a way that reduces overall health-care costs. However, reconfigurations of services are often introduced without adequate evaluation and it is important that new NHS initiatives should collect data to show whether or not they have added value, and improved quality and patient and staff experience.FundingThe NIHR Health Services and Delivery Research programme.
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Affiliation(s)
| | | | | | | | - Ellen Nolte
- RAND Europe, Cambridge, UK
- European Observatory on Health Systems and Policies, London School of Economics and Political Science and London School of Hygiene and Tropical Medicine, London, UK
| | | | - Joanne Greenhalgh
- Faculty of Education, Social Sciences and Law, University of Leeds, Leeds, UK
| | - Martin Roland
- Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Abstract
BACKGROUND Pressure ulcers, which are localised injury to the skin or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful and impact negatively on the individual's quality of life. The cost implications of pressure ulcer treatment are considerable, compounding the challenges in providing cost effective, efficient health service delivery. International guidelines suggest that to prevent and manage pressure ulcers successfully a team approach is required. Therefore, this review has been conducted to clarify the role of wound-care teams in the prevention and management of pressure ulcers. OBJECTIVES To assess the impact of wound-care teams in preventing and treating pressure ulcers in people of any age, nursed in any healthcare setting. SEARCH METHODS In April 2015 we searched: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We considered RCTs that evaluated the effect of any configuration of wound-care teams in the treatment or prevention of pressure ulcers. DATA COLLECTION AND ANALYSIS Two review authors independently assessed titles and, where available, abstracts of the studies identified by the search strategy for their eligibility. We obtained full versions of potentially relevant studies and two review authors independently screened these against the inclusion criteria. MAIN RESULTS We identified no studies that met the inclusion criteria. AUTHORS' CONCLUSIONS We set out to evaluate the RCT evidence pertaining to the impact of wound-care teams on the prevention and management of pressure ulcers. However, no studies met the inclusion criteria. There is a lack of evidence concerning whether wound-care teams make a difference to the incidence or healing of pressure ulcers. Well-designed trials addressing important clinical, quality of life and economic outcomes are justified, based on the incidence of the problem and the high costs associated with pressure ulcer management.
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Affiliation(s)
- Zena EH Moore
- Royal College of Surgeons in IrelandSchool of Nursing & Midwifery123 St. Stephen's GreenDublinIrelandD2
| | - Joan Webster
- Royal Brisbane and Women's HospitalCentre for Clinical NursingLevel 2, Building 34Butterfield StreetBrisbaneQueenslandAustralia4029
| | - Ray Samuriwo
- University of LeedsSchool of Healthcare, Faculty of Medicine and HealthLeedsUKLS2 9JT
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Hassan L, Frisher M, Senior J, Tully M, Webb R, While D, Shaw J. A cross-sectional prevalence survey of psychotropic medication prescribing patterns in prisons in England. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThe prevalence of mental illness is significantly higher among prisoners than among people in the wider community. Psychotropic prescribing in prisons is a complex and controversial area, where prescribers balance individual health needs against security and safety risks. However, there are no current data on prescribing patterns in prisons or how these compare with those in the wider community.AimsThe study aimed to determine the prevalence, appropriateness and acceptability of psychotropic prescribing in prisons. The objectives were to determine rates of prescribing for psychotropic medications, compared with those in the wider community; the appropriateness of psychotropic prescribing in prisons; and the perceived satisfaction and acceptability of prescribing decisions to patients and general practitioners (GPs).MethodEleven prisons, housing 6052 men and 785 women, participated in a cross-sectional survey of psychotropic prescribing. On census days, data were extracted from clinical records for all patients in receipt of hypnotics, anxiolytics, antipsychotics, antimanics, antidepressants and central nervous system stimulants. The Clinical Practice Research Datalink supplied an equivalent data set for a random sample of 30,602 patients prescribed psychotropic medicines in the community. To determine the acceptability of prescribing decisions, patients attending GP consultations at three prisons were surveyed (n = 156). Pre- and post-consultation questionnaires were administered, covering expectations and satisfaction with outcomes, including prescribing decisions. Doctors (n = 6) completed post-consultation questionnaires to explore their perspectives on consultations.ResultsOverall, 17% of men and 48% of women in prison were prescribed at least one psychotropic medicine. After adjusting for age differences, psychotropic prescribing rates were four times higher among men [prevalence ratio (PR) 4.02, 95% confidence interval (CI) 3.75 to 4.30] and six times higher among women (PR 5.95, 95% CI 5.36 to 6.61) than among community patients. There were significant preferences for certain antidepressant and antipsychotic drugs in prison, compared with in the community. In 65.3% of cases, indications for psychotropic drugs were recorded and upheld in theBritish National Formulary. Antipsychotic prescriptions were less likely than other psychotropics to be supported by a valid indication in the patient notes (PR 0.75, 95% CI 0.67 to 0.83). In the acceptability study, patients who identified mental health as their primary problem were more likely than individuals who identified other types of health problems to want to start, stop and/or change their medication (PR 1.46, 95% CI 1.23 to 1.74), and to report dissatisfaction following the consultation (PR 1.76, 95% CI 1.01 to 3.08). Doctors were more likely to issue prescriptions when they thought that the patient wanted a prescription (PR 4.2, 95% CI 2.41 to 7.28), they perceived pressure to prescribe (PR 1.66, 95% CI 1.26 to 2.19), and/or the problem related to mental health (PR 1.67, 95% CI 1.27 to 2.20).ConclusionsPsychotropic medicines were prescribed more frequently in prisons than in the community. Without current and robust data on comparative rates of mental illness, it is not possible to fully assess the appropriateness of psychotropic prescribing. Nonetheless, psychotropic medicines were prescribed for a wider range of clinical indications than currently recommended, with discernible differences in drug choice. Complex health and security concerns exist within prisons. Further research is necessary to determine the effect of psychotropic prescribing on physical health, and to determine the optimum balance between medicines and alternative treatments in prisons.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Lamiece Hassan
- Centre for Mental Health and Risk, Institute of Brain and Behaviour, The University of Manchester, Manchester, UK
| | - Martin Frisher
- School of Pharmacy and Medicines Management, Keele University, Keele, UK
| | - Jane Senior
- Centre for Mental Health and Risk, Institute of Brain and Behaviour, The University of Manchester, Manchester, UK
| | - Mary Tully
- Manchester Pharmacy School, The University of Manchester, Manchester, UK
| | - Roger Webb
- Centre for Mental Health and Risk, Institute of Brain and Behaviour, The University of Manchester, Manchester, UK
| | - David While
- Centre for Mental Health and Risk, Institute of Brain and Behaviour, The University of Manchester, Manchester, UK
| | - Jenny Shaw
- Centre for Mental Health and Risk, Institute of Brain and Behaviour, The University of Manchester, Manchester, UK
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Tremblay D, Touati N, Roberge D, Denis JL, Turcotte A, Samson B. Conditions for production of interdisciplinary teamwork outcomes in oncology teams: protocol for a realist evaluation. Implement Sci 2014; 9:76. [PMID: 24938443 PMCID: PMC4074333 DOI: 10.1186/1748-5908-9-76] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/11/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Interdisciplinary teamwork (ITW) is designed to promote the active participation of several disciplines in delivering comprehensive cancer care to patients. ITW provides mechanisms to support continuous communication among care providers, optimize professionals' participation in clinical decision-making within and across disciplines, and foster care coordination along the cancer trajectory. However, ITW mechanisms are not activated optimally by all teams, resulting in a gap between desired outcomes of ITW and actual outcomes observed. The aim of the present study is to identify the conditions underlying outcome production by ITW in local oncology teams. METHODS This retrospective multiple case study will draw upon realist evaluation principles to explore associations among context, mechanisms and outcomes (CMO). The cases are nine interdisciplinary cancer teams that participated in a previous study evaluating ITW outcomes. Qualitative data sources will be used to construct a picture of CMO associations in each case. For data collection, reflexive focus groups will be held to capture patients' and professionals' perspectives on ITW, using the guiding question, 'What works, for whom, and under what circumstances?' Intra-case analysis will be used to trace associations between context, ITW mechanisms, and patient outcomes. Inter-case analysis will be used to compare the different cases' CMO associations for a better understanding of the phenomenon under study. DISCUSSION This multiple case study will use realist evaluation principles to draw lessons about how certain contexts are more or less likely to produce particular outcomes. The results will make it possible to target more specifically the actions required to optimize structures and to activate the best mechanisms to meet the needs of cancer patients. This project could also contribute significantly to the development of improved research methods for conducting realist evaluations of complex healthcare interventions. To our knowledge, this study is the first to use CMO associations to improved empirical and theoretical understanding of interdisciplinary teamwork in oncology, and its results could foster more effective implementation in clinical practice.
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Affiliation(s)
- Dominique Tremblay
- Charles-Le Moyne Hospital Research Centre, Greenfield Park, QC J4K 0A8, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke-Campus Longueuil, Longueuil, QC J4K 0A8, Canada
| | - Nassera Touati
- École Nationale d’Administration Publique, Montréal, QC G1K 9E5, Canada
| | - Danièle Roberge
- Charles-Le Moyne Hospital Research Centre, Greenfield Park, QC J4K 0A8, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke-Campus Longueuil, Longueuil, QC J4K 0A8, Canada
| | - Jean-Louis Denis
- École Nationale d’Administration Publique, Montréal, QC G1K 9E5, Canada
| | - Annie Turcotte
- Faculty of Medicine and Health Sciences, Université de Sherbrooke-Campus Longueuil, Longueuil, QC J4K 0A8, Canada
| | - Benoît Samson
- Charles-Le Moyne Hospital Research Centre, Greenfield Park, QC J4K 0A8, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke-Campus Longueuil, Longueuil, QC J4K 0A8, Canada
- CSSS Champlain–Charles-Le Moyne, Longueuil, QC J4V 2H1, Canada
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Exploring the concept of a team approach to wound care: Managing wounds as a team. J Wound Care 2014; 23 Suppl 5b:S1-S38. [DOI: 10.12968/jowc.2014.23.sup5b.s1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Hajebi A, Sharifi V, Ghadiri Vasfi M, Moradi-Lakeh M, Tehranidoost M, Yunesian M, Amini H, Rashidian A, Malakouti SK, Mottaghipour Y. A multicenter randomized controlled trial of aftercare services for severe mental illness: study protocol. BMC Psychiatry 2013; 13:178. [PMID: 23816199 PMCID: PMC3722090 DOI: 10.1186/1471-244x-13-178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 06/25/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Severe mental illness is responsible for a significant proportion of burden of diseases in Iranian population. People with severe mental illnesses are more likely to have high rates of non-attendance at follow-up visits, and lack of an active follow-up system, particularly in the country's urban areas that has resulted in the revolving door phenomenon of rehospitalizations. Therefore, there is an increasing need for implementation of effective and cost-effective aftercare services. METHOD/DESIGN This is a randomized control trial with the primary hypothesis that aftercare services delivered to patients with severe mental illnesses in outpatient department and patient's home by a community care team would be more effective when compared to treatment as usual (TAU) in reducing length of hospital stay and any psychiatric hospitalization. Patients were recruited from three psychiatric hospitals in Iran. After obtaining informed written consent, they were randomly allocated into aftercare intervention and control (TAU) groups. Aftercare services included treatment follow-up (through either home care or telephone follow-up prompts for outpatient attendance), family psychoeducation, and patient social skills training that were provided by community mental health teams. Patients were followed for 12 months after discharge. The primary outcome measures were length of hospital stay and any hospitalization in the 12 month follow-up. Secondary outcome measures included patients' clinical global impression, global functioning, quality of life, and patient's satisfaction. The trial also allowed an assessment of direct cost-effectiveness of the aftercare services. DISCUSSION This paper presents a protocol for an RCT of aftercare services delivered to patients with severe mental illnesses within patients' home or outpatient department. The findings of this study can influence policy and program planning for people with severe mental illnesses in Iran. TRIAL REGISTRATION IRCT201009052557N2.
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Affiliation(s)
- Ahmad Hajebi
- Mental Health Research Centre, Tehran Psychiatric Institute, Iran University of Medical Sciences, Tehran 15745-344, Iran
| | - Vandad Sharifi
- Department of Psychiatry and Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran 13337-95914, Iran
| | - Mohammad Ghadiri Vasfi
- Mental Health Research Centre, Tehran Psychiatric Institute, Iran University of Medical Sciences, Tehran 15745-344, Iran
| | - Maziar Moradi-Lakeh
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Tehranidoost
- Department of Psychiatry and Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran 13337-95914, Iran
| | - Masud Yunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Homayoun Amini
- Department of Psychiatry and Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran 13337-95914, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Kazem Malakouti
- Mental Health Research Centre, Tehran Psychiatric Institute, Iran University of Medical Sciences, Tehran 15745-344, Iran
| | - Yasaman Mottaghipour
- Psychiatry Department, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
BACKGROUND For too long there have been heated debates between those who believe that mental health care should be largely or solely provided from hospitals and those who adhere to the view that community care should fully replace hospitals. The aim of this study was to propose a conceptual model relevant for mental health service development in low-, medium- and high-resource settings worldwide. Method We conducted a review of the relevant peer-reviewed evidence and a series of surveys including more than 170 individual experts with direct experience of mental health system change worldwide. We integrated data from these multiple sources to develop the balanced care model (BCM), framed in three sequential steps relevant to different resource settings. RESULTS Low-resource settings need to focus on improving the recognition and treatment of people with mental illnesses in primary care. Medium-resource settings in addition can develop 'general adult mental health services', namely (i) out-patient clinics, (ii) community mental health teams (CMHTs), (iii) acute in-patient services, (iv) community residential care and (v) work/occupation. High-resource settings, in addition to primary care and general adult mental health services, can also provide specialized services in these same five categories. CONCLUSIONS The BCM refers both to a balance between hospital and community care and to a balance between all of the service components (e.g. clinical teams) that are present in any system, whether this is in low-, medium- or high-resource settings. The BCM therefore indicates that a comprehensive mental health system includes both community- and hospital-based components of care.
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Affiliation(s)
- G Thornicroft
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, UK.
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Treatment engagement of psychotic patients with a mobile mental health unit in rural areas in Greece: a five-year study. SCHIZOPHRENIA RESEARCH AND TREATMENT 2013; 2013:613956. [PMID: 24222849 PMCID: PMC3814046 DOI: 10.1155/2013/613956] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/12/2013] [Indexed: 11/17/2022]
Abstract
Objectives. Treatment of psychotic disorders is impended by high rates of disengagement from mental health services and poor adherence to antipsychotic medication. This study examined the engagement rates of psychotic patients with a community mental health service during a 5-year period. Methods. The Mobile Mental Health Unit of Ioannina and Thesprotia (MMHU I-T) delivers services in remote, rural, mountainous areas using the resources of the primary care system. Clinical and demographic information for patients with a diagnosis of schizophrenia and related psychoses was obtained from the medical records of our unit. Results. A total of 74 psychotic patients initially engaged in treatment with our unit. In half of cases treatment was home-based. With the exclusion of patients who died or discharged, engagement rates were 67.2%. Statistical analysis was performed for 64 patients, and no differences were found between engaged and disengaged patients regarding clinical and demographic parameters. All engaged patients regularly refilled their antipsychotic prescriptions. Conclusion. Engagement rates in our study were comparable to previous research, involving urban settings and shorter follow-up duration. Community mental health teams may ensure treatment continuation for psychotic patients in deprived, remote areas. This is important for low-income countries, affected by economic crisis, such as Greece.
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[Team-based community psychiatry: importance of context factors and transferability of evidence from studies]. DER NERVENARZT 2012; 83:825-31. [PMID: 22688090 DOI: 10.1007/s00115-011-3468-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) guidelines on psychosocial interventions for people with severe mental illness appraise the transferability of results of trials evaluating community-based mental health services to the German situation. This assessment has to draw on research results on factors determining effectiveness. This must be seen against the background of a lack of high-quality trials in Germany. The article discusses system, context and setting factors related to the transfer of evidence on community-based service models from other countries. These issues are discussed on the basis of evidence concerning the models of case management, assertive community treatment and community mental health teams. International differences in study findings are highlighted and the importance of treatment-as-usual in influencing study results is emphasized. The more control services including elements of community-based care there are and the less the pressure to reduce inpatient treatment (threshold to inpatient care admission), the smaller the relative effect sizes of innovative care models will be.In the absence of direct evidence, careful examination of transferability is required before introducing health care models. Research has revealed solid evidence for several factors influencing the effects of innovative community mental health care. Among key factors in the care of people with severe mental illness, home visits and joint team responsibility for both psychiatric and social care were identified. This evidence can facilitate the adaptation of successful mental health care models in Germany.
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Nordén T, Malm U, Norlander T. Resource Group Assertive Community Treatment (RACT) as a Tool of Empowerment for Clients with Severe Mental Illness: A Meta-Analysis. Clin Pract Epidemiol Ment Health 2012; 8:144-51. [PMID: 23173010 PMCID: PMC3502888 DOI: 10.2174/1745017901208010144] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 08/15/2012] [Accepted: 08/26/2012] [Indexed: 11/22/2022]
Abstract
The aim of the current meta-analysis was to explore the effectiveness of the method here labeled Resource Group Assertive Community Treatment (RACT) for clients with psychiatric diagnoses as compared to standard care during the period 2001 - 2011. Included in the meta-analysis were 17 studies comprising a total of 2263 clients, 1291 men and 972 women, with a weighted mean age of 45.44 years. The diagnoses of 86 % of the clients were within the psychotic spectrum while 14 % had other psychiatric diagnoses. There were six randomized controlled trials and eleven observational studies. The studies spanned between 12 and 60 months, and 10 of them lasted 24 months. The results indicated a large effect-size for the "grand total measure" (Cohen´s d = 0.80). The study comprised three outcome variables: Symptoms, Functioning, and Well-being. With regard to Symptoms, a medium effect for both randomized controlled trials and non-randomized studies was found, whereas Functioning showed large effects for both types of design. Concerning Well-being both large and medium effects were evident. The conclusions of the meta-analysis were that the treatment of clients with Resource Group Assertive Community Treatment yields positive effects for clients with psychoses and that the method may be of use for clients within the entire psychiatric spectrum.
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Affiliation(s)
- Tommy Nordén
- Evidens Research and Development Center, Göteborg, Sweden
| | - Ulf Malm
- Inst. for Clinical Neuropsychiatry, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Torsten Norlander
- Depatment of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden and Evidens Research and Development Center, Göteborg, Sweden
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Abendstern M, Harrington V, Brand C, Tucker S, Wilberforce M, Challis D. Variations in structures, processes and outcomes of community mental health teams for older people: a systematic review of the literature. Aging Ment Health 2012; 16:861-73. [PMID: 22303810 DOI: 10.1080/13607863.2011.651431] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES In the UK and elsewhere, specialist community mental health teams (CMHTs) are central to the provision of comprehensive services for older people with mental ill health. Recent guidance documents suggest a core set of attributes that such teams should encompass. This article reports on a systematic literature review undertaken to collate existing evidence regarding the structures and processes of CMHTs for older people and to evaluate evidence linking approaches to effectiveness. METHOD Relevant publications were identified via systematic searches, both electronic and manual. Searches were limited to the UK for descriptions of organisation and practice but included international literature where comparisons between different CMHT arrangements were evaluated. Empirical, peer-reviewed studies from 1989 onward were included, extended to non peer-reviewed nationally or regionally representative reports, published after 1998, for the descriptive element. RESULTS Forty-five studies met inclusion criteria of which seven provided comparative outcome data. All but one were UK based. The most robust evidence related to research conducted in exemplar teams. Limited evidence was found regarding the effectiveness of many of the core attributes recommended in policy directives although their presence was reported in much of the literature. CONCLUSIONS The contrast between presentation and evaluation of attributes is stark. Whilst some gaps can be filled from related fields, further research is required that moves beyond description to evaluation of the impact of team design on service user outcomes in order to inform future policy directives and practice guidance. A framework for an evidence-based model of CMHTs for older people is provided.
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Affiliation(s)
- M Abendstern
- Personal Social Services Research Unit, University of Manchester, Manchester, UK.
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Balaji M, Chatterjee S, Koschorke M, Rangaswamy T, Chavan A, Dabholkar H, Dakshin L, Kumar P, John S, Thornicroft G, Patel V. The development of a lay health worker delivered collaborative community based intervention for people with schizophrenia in India. BMC Health Serv Res 2012; 12:42. [PMID: 22340662 PMCID: PMC3312863 DOI: 10.1186/1472-6963-12-42] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 02/16/2012] [Indexed: 11/07/2022] Open
Abstract
Background Care for schizophrenia in low and middle income countries is predominantly facility based and led by specialists, with limited use of non-pharmacological treatments. Although community based psychosocial interventions are emphasised, there is little evidence about their acceptability and feasibility. Furthermore, the shortage of skilled manpower is a major barrier to improving access to these interventions. Our study aimed to develop a lay health worker delivered community based intervention in three sites in India. This paper describes how the intervention was developed systematically, following the MRC framework for the development of complex interventions. Methods We reviewed the lierature on the burden of schizophrenia and the treatment gap in low and middle income countries and the evidence for community based treatments, and identified intervention components. We then evaluated the acceptability and feasibility of this package of care through formative case studies with individuals with schizophrenia and their primary caregivers and piloted its delivery with 30 families. Results Based on the reviews, our intervention comprised five components (psycho-education; adherence management; rehabilitation; referral to community agencies; and health promotion) to be delivered by trained lay health workers supervised by specialists. The intervention underwent a number of changes as a result of formative and pilot work. While all the components were acceptable and most were feasible, experiences of stigma and discrimination were inadequately addressed; some participants feared that delivery of care at home would lead to illness disclosure; some participants and providers did not understand how the intervention related to usual care; some families were unwilling to participate; and there were delivery problems, for example, in meeting the targeted number of sessions. Participants found delivery by health workers acceptable, and expected them to have knowledge about the subject matter. Some had expectations regarding their demographic and personal characteristics, for example, preferring only females or those who are understanding/friendly. New components to address stigma were then added to the intervention, the collaborative nature of service provision was strengthened, a multi-level supervision system was developed, and delivery of components was made more flexible. Criteria were evolved for the selection and training of the health workers based on participants' expectations. Conclusions A multi-component community based intervention, targeting multiple outcomes, and delivered by trained lay health workers, supervised by mental health specialists, is an acceptable and feasible intervention for treating schizophrenia in India.
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Ribeiro MS, Xavier Júnior JCC, Mascarenhas TR, Silva PM, Vieira EMDM, Ribeiro LC. Treatment dropout at a secondary mental health service. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2012; 34:207-14. [PMID: 25923069 DOI: 10.1590/s2237-60892012000400006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 08/10/2011] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate mental health dropout rates in secondary care and to identify possible associations between this variable and social, demographic, psychopathologic, and health care process-related variables. METHOD This prospective, observational study included 994 patients referred to a secondary service by four primary care units and evaluated by a specialist mental health team between 2004 and 2008. The dependent variable was treatment dropout. Bivariate analyses investigated possible associations between treatment dropout and 57 independent variables. RESULTS The overall dropout rate from specialist mental health treatment was relatively low (mean = 25.6%). Only four independent variables were associated with dropout: one socioeconomic, two psychopathological, and one health care process variable. All associations were marginally significant (p < 0.1). CONCLUSION Our findings suggest that family members, patients, and health care professionals are well engaged in this mental health care system based on a model of primary care. The use of this mental health model of care should be extended to other regions of our country.
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Affiliation(s)
- Mário Sérgio Ribeiro
- Department of Clinical Practice, Medical School, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
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The future of specialist community teams in the care of those with severe mental illness. ACTA ACUST UNITED AC 2011. [DOI: 10.1017/s1121189x00002323] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
SummaryAims – Specialist interventions in community psychiatry for severe mental illness are expanding and their place needs to be re-examined. Methods – Recent literature is reviewed to evaluate the advantages and disadvantages of specialist teams. Results – Good community mental health services reduce drop out from care, prevent suicide and unnatural deaths, and reduce admission to hospital. Most of these features have been also demonstrated by assertive community outreach and crisis resolution teams when good community services are not available. In well established community services assertive community teams do not reduce admission but both practitioners and patients prefer this service to other approaches and it leads to better engagement. Crisis resolution teams appear to be more successful than assertive community teams in preventing admission to hospital, although head- to-head comparisons have not yet been made. All specialist teams have the potential of fragmenting services and thereby reducing continuity of care. Conclusions – The assets of improved engagement and greater satisfaction with assertive, crisis resolution and home treatment teams are clear from recent evidence, but to improve integration of services they are probably best incorporated into community mental health services rather than standing alone.Declaration of Interest: The author has been the sole consultant in two assertive outreach teams since 1994 and might there- fore be expected to be in favour of this genre of service. He has received grants for evaluation of different services models from the Department of Health (UK) and the Medical Research Council (UK).
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Huisman A, Kerkhof AJFM, Robben PBM. Suicides in users of mental health care services: treatment characteristics and hindsight reflections. Suicide Life Threat Behav 2011; 41:41-9. [PMID: 21309823 DOI: 10.1111/j.1943-278x.2010.00015.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The current study aims to describe the patient and treatment characteristics of a sample of 505 suicides by mental health care patients, and to determine how clinicians view the care provided and what they learned. The results indicate that the quality of mental health care for suicidal patients could be improved by focusing on communication among clinicians, continuity of care, suicide risk assessment procedures, and the involvement of relatives.
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Affiliation(s)
- Annemiek Huisman
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands.
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The contribution of a mobile mental health unit to the promotion of primary mental health in rural areas in Greece: a 2-year follow-up. Eur Psychiatry 2010; 26:425-7. [PMID: 20932722 DOI: 10.1016/j.eurpsy.2010.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 07/03/2010] [Accepted: 07/14/2010] [Indexed: 11/24/2022] Open
Abstract
During the 2 years of the mobile mental-health unit's operation in Northwestern Greece, the referrals increased rapidly with 29.4% of patients never having received mental-health care before, while hospitalizations and relapses reduced significantly, indicating that community-oriented programs can contribute greatly to successfully addressing the needs of patients in remote rural areas.
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O'brien A, White S, Fahmy R, Singh SP. The development and validation of the SOLES, a new scale measuring engagement with mental health services in people with psychosis. J Ment Health 2009. [DOI: 10.3109/09638230902968225] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Bowers L, Chaplin R, Quirk A, Lelliott P. A conceptual model of the aims and functions of acute inpatient psychiatry. J Ment Health 2009. [DOI: 10.1080/09638230802053359] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cavalcanti MT, Dahl CM, Carvalho MCAD, Valencia E. Critérios de admissão e continuidade de cuidados em centros de atenção psicossocial, Rio de Janeiro, RJ. Rev Saude Publica 2009; 43 Suppl 1:23-8. [DOI: 10.1590/s0034-89102009000800005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 04/28/2009] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar os critérios de admissão, encaminhamento e continuidade de cuidado a pacientes utilizados pelas equipes dos centros de atenção psicossocial. MÉTODOS: Pesquisa qualitativa com avaliação participativa realizada em três centros de atenção psicossocial do município do Rio de Janeiro (RJ) em 2006. Foram sorteados 15 casos admitidos e 15 casos encaminhados dentre os pacientes admitidos para tratamento nos seis meses anteriores ao início da pesquisa. Os critérios apontados pela equipe para a admissão do paciente para tratamento ou encaminhamento foram analisados a partir de um roteiro estruturado. A análise da continuidade de cuidados baseou-se em pesquisa em prontuário, informações da equipe e dos próprios pacientes e/ou familiares seis meses após a absorção ou encaminhamento do paciente. RESULTADOS: Os pacientes admitidos apresentavam diagnóstico de psicose (esquizofrenia), história de internações prévias, funcionamento social pobre e rede de apoio pequena e os pacientes encaminhados apresentavam transtornos ansiosos e depressivos, boa adesão a tratamento ambulatorial, bom funcionamento social e presença de rede social. Quanto à continuidade de cuidados, oito pacientes em 27 tiveram destino desconhecido. Quanto aos encaminhamentos, dos 13 pacientes encaminhados a ambulatórios da rede, sete permaneceram em tratamento, dois retornaram aos CAPS e quatro tiveram destino desconhecido. CONCLUSÕES: Os centros admitem pacientes que se encaixam na definição de um transtorno mental severo e persistente. A continuidade de cuidado foi apontada como problema, provavelmente devido à dificuldade de acompanhar os pacientes na comunidade.
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SIMPSON ALAN, MILLER CAROLYN, BOWERS LEN. The history of the Care Programme Approach in England: Where did it go wrong? J Ment Health 2009. [DOI: 10.1080/09638230310001603555] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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O'Brien A, Fahmy R, Singh SP. Disengagement from mental health services. A literature review. Soc Psychiatry Psychiatr Epidemiol 2009; 44:558-68. [PMID: 19037573 DOI: 10.1007/s00127-008-0476-0] [Citation(s) in RCA: 186] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 11/13/2008] [Indexed: 10/21/2022]
Abstract
This paper reviews the literature on disengagement from mental health services examining how the terms engagement and disengagement are defined, what proportion of patients disengage from services, and what sociodemographic variables predict disengagement. Both engagement and disengagement appear to be poorly conceptualised, with a lack of consensus on accepted and agreed definitions. Rates of disengagement from mental health services vary from 4 to 46%, depending on the study setting, service type and definition of engagement used. Sociodemographic and clinical predictors of disengagement also vary, with only a few consistent findings, suggesting that such associations are complex and multifaceted. Most commonly reported associations of disengagement appear to be with sociodemographic variables including young age, ethnicity and deprivation; clinical variables such as lack of insight, substance misuse and forensic history; and service level variables such as availability of assertive outreach provision. Given the importance of continuity of care in serious mental disorders, there is a need for a consensual, validated and reliable measure of engagement which can be used to explore associations between patient, illness and service related variables and can inform service provision for difficult to reach patients.
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Affiliation(s)
- Aileen O'Brien
- Division of Mental Health, St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
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Valdes-Stauber J. [Treatment of chronic psychiatric disorders. Ethical and anthropological aspects]. DER NERVENARZT 2009; 80:564, 566, 568-77. [PMID: 19263031 DOI: 10.1007/s00115-009-2674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This paper outlines an approach to assessing chronicity in psychiatric disorders, which represents a challenge for clinical practice. We began by accepting conclusions from well accepted anthropological and clinical studies of patients with chronic psychiatric disorders. Based on such key conclusions, we formulated several assumptions centred round anthropological concepts as a comprehension tool. Such an anthropological framework might improve orientation in the clinical evaluation of chronic psychiatric disorders. Ethical implications resulting from the above approach are discussed, specifically those revolving around the concept of "problematic people". Based on these considerations, ten practical concepts concerning the recovery from chronic psychiatric illness are discussed.
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Kaliniecka H, Shawe-Taylor M. Promoting positive risk management: evaluation of a risk management panel. J Psychiatr Ment Health Nurs 2008; 15:654-61. [PMID: 18803740 DOI: 10.1111/j.1365-2850.2008.01289.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The purpose of this study was to evaluate whether a National Health Service Trust risk management panel (RMP) service was effective in promoting positive risk management by supporting mental health clinicians/teams in their management of people with mental health problems who presented with high risk of harm to themselves or to others. Fifteen mental health workers completed a questionnaire regarding their experience of the RMP. Content analysis revealed several themes. The majority of participants found the RMP helpful because of the support provided by shared case discussion and collective responsibility for risk management offered by the RMP. Medical records of the 23 individuals referred into the RMP were also examined. Trends in diagnoses, risks and RMP recommendations were identified. This study points to the importance of the organization's role alongside the individual clinician's in positive risk management and in supporting people with mental health problems using the recovery model. Improvements in developing a RMP are suggested.
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Affiliation(s)
- H Kaliniecka
- Tandridge Primary Care Mental Health Team, Surrey and Borders Partnership National Health Service Foundation Trust, Surrey, UK
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Chew-Graham C, Slade M, Montâna C, Stewart M, Gask L. Loss of doctor-to-doctor communication: lessons from the reconfiguration of mental health services in England. J Health Serv Res Policy 2008; 13:6-12. [PMID: 18325150 DOI: 10.1258/jhsrp.2007.006053] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the tensions across the primary-secondary interface when referral from primary care is to a team and to inform service developments in other specialties. METHODS A nested qualitative study within a randomized controlled trial of primary care and Community Mental Health Teams (CMHTs) in Croydon and Manchester, UK. For the qualitative study, interviews were carried out with general practitioners (GPs), psychiatrists and managers or clinical leads of the CMHTs. RESULTS GPs described the need for access to specialist knowledge, which they perceived to lie with the psychiatrist, and referral to a team was not perceived to allow this access. A personal threshold was identified by GPs after which they referred the patient to secondary care. CMHTs and psychiatrists recognized that this personal threshold differed between GPs, but their criteria for accepting referrals did not seem to allow for a flexible response to referral requests, leading to the referral being labelled as 'inappropriate'. The lack of direct doctor-to-doctor communication was perceived by respondents to contribute to a fragmentation of patient care. Strategies were described whereby the system was bypassed to achieve doctor-to-doctor communication, which undermined the team. CONCLUSIONS Development of intermediate or 'Tier 2' services beyond the mental health services, where the GP refers to a team rather than to a specialist (hospital consultant) could benefit from reflecting on experiences with mental health services. There is a danger that new community services for the physically ill will engender the same level of confusion and discontent described by GPs and other health professionals in this study who are concerned with mental health care. Flexibility is needed within care pathways, including the provision of direct doctor-to-doctor communication together with approaches to minimize the marginalization of non-medical professionals.
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Affiliation(s)
- Carolyn Chew-Graham
- School of Community Based Medicine, University of Manchester, Manchester, UK.
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Franx G, Kroon H, Grimshaw J, Drake R, Grol R, Wensing M. Organizational change to transfer knowledge and improve quality and outcomes of care for patients with severe mental illness: a systematic overview of reviews. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:294-305. [PMID: 18551850 DOI: 10.1177/070674370805300503] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To provide a comprehensive overview of the research on organizational changes aimed at improving health care for patients with severe mental illness and to learn lessons for mental health practice from the results. METHOD We searched for systematic literature reviews published in English during 2000 to 2007 in PubMed, PsycINFO, CINAHL, EMBASE, and the Cochrane Central Register of Systematic Reviews. Three reviewers independently selected and assessed the studies' quality. Studies involving changes of who delivers health care, how care is organized, or where care is delivered were included. We categorized the studies using an existing taxonomy of 6 broad categories of strategies for organizational change. RESULTS A total of 21 reviews were included. Among these, 17 had reasonably good methodological quality, Almost all reviews included or intended to include randomized controlled trials (RCTs), 6 reviews did not identify studies that met eligibility criteria. Multidisciplinary teams and integrated care models had been reviewed most frequently (a total of 15 reviews). In most studies, these types of changes showed better outcomes in terms of symptom severity, functioning, employment, and housing, compared with conventional services. Different results were found on cost savings. Other types of organizational changes, such as changing professional roles or introducing quality management or knowledge management, were much less frequently reviewed. Very few reviews looked at effects of organizational changes on professional performance. CONCLUSIONS There is a fairly large body of evidence of the positive impact of multidisciplinary teams and integrated care changes on symptom severity, functioning, employment, and housing of people with severe mental illness, compared with conventional services. Other strategies, such as changes in professional roles, quality or knowledge management, have either not been the subject of systematic reviews or have not been evaluated in RCTs. There is still a lack of insight in the so-called black box of change processes and the impact of change on professional performance.
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Affiliation(s)
- Gerdien Franx
- Department of Innovation of Mental Health Care, Trimbos-instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands]
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