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van Everdingen C, Peerenboom PB, van der Velden K, Delespaul P. Vital Needs of Dutch Homeless Service Users: Responsiveness of Local Services in the Light of Health Equity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2546. [PMID: 36767905 PMCID: PMC9915996 DOI: 10.3390/ijerph20032546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Healthcare and social services aim to ensure health equity for all users. Despite ongoing efforts, marginalized populations remain underserved. The Dutch HOP-TR study intends to expand knowledge on how to enable the recovery of homeless service users. METHODS A naturalistic meta-snowball sampling resulted in a representative sample of homeless services (N = 16) and users (N = 436). Interviews collected health and needs from user and professional perspectives in a comprehensive, rights-based ecosystem strategy. We calculated the responsiveness to needs in four domains (mental health, physical health, paid work, and administration). RESULTS Most service users were males (81%) with a migration background (52%). In addition to physical (78%) and mental health needs (95%), the low education level (89%) and functional illiteracy (57%) resulted in needs related to paid work and administration support. Most had vital needs in three or four domains (77%). The availability of matching care was extremely low. For users with needs in two domains, met needs ranged from 0.6-13.1%. Combined needs (>2 domains) were hardly met. CONCLUSIONS Previous research demonstrated the interdependent character of health needs. This paper uncovers some causes of health inequity. The systematic failure of local services to meet integrating care needs demonstrates the urgency to expand recovery-oriented implementation strategies with health equity in mind.
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Affiliation(s)
- Coline van Everdingen
- Department of Psychiatry and Neuropsychology, Maastricht University, 6200 MD Maastricht, The Netherlands
- Van Everdingen Health Care Consultancy, 6132 TP Sittard, The Netherlands
| | | | - Koos van der Velden
- Department of Primary and Community Care, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, Maastricht University, 6200 MD Maastricht, The Netherlands
- Mondriaan Mental Health Trust, 6401 CX Heerlen, The Netherlands
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Van Everdingen C, Bob Peerenboom P, Van Der Velden K, Delespaul PAEG. A Comprehensive Assessment to Enable Recovery of the Homeless: The HOP-TR Study. Front Public Health 2021; 9:661517. [PMID: 34307275 PMCID: PMC8299205 DOI: 10.3389/fpubh.2021.661517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/09/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Homelessness is an increasing problem in Western European countries. In the Netherlands, policy reforms and austerity measures induced an urgent need for management information on local homeless citizens. Municipal authorities initiated cross-sectional reviews of Homeless Service (HS) users. The resulting Homeless People Treatment and Recovery (HOP-TR) study developed a health and needs assessment strategy over different domains to comprehensively assess individuals and care networks with the perspective on recovery. Methods: Dutch HS users were selected using a naturalistic meta-snowball sampling. Semi-structured interviews provided the primary data source. The interview content was partly derived from the InterRAI Community Mental Health questionnaire and the “Homelessness Supplement.” Using the raw interview data, algorithmic summary scores were computed and integrating clinical parameters assessed. The data describe health and needs in a rights-based, recovery-oriented frame of reference. The mental health approach is transdiagnostic. The positive health framework is used for structuring health and needs aspects in relation to the symptomatic (physical and mental health), social (daily living, social participation), and personal (quality of life, meaning) dimensions of recovery. Results: Recruitment (between 2015 and 2017) resulted in a saturated sample of 436 HS users in 16 facilities and seven cities. Most participants were long-term or intermittently homeless. The sample characteristics reveal the multi domain character of needs and the relevance of a broad, comprehensive approach. Local authorities used the reports to reflect and discuss needs, care provision, access, and network cooperation. These dialogs incited to improve the quality of care at various ecosystem levels. Discussion: This paper describes new recruitment strategies and data collections of comprehensive data domains, to improve our knowledge in the field of homelessness. Traditional epidemiological literature on homelessness is often domain specific and relies on administrative sources. The HOP-TR study uses an analytical epidemiological approach. It shifts the assessment focus from problem-centered marginalization processes toward a comprehensive, three-dimensional recovery-oriented vision of health. Different perspectives are integrated to explore the interaction of homeless people with care networks.
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Affiliation(s)
- Coline Van Everdingen
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | | | - Koos Van Der Velden
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Philippe A E G Delespaul
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands.,Department of Adult Psychiatry, Mondriaan Mental Health Trust, Heerlen, Netherlands
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van Everdingen C, Peerenboom PB, van der Velden K, Delespaul P. Health Patterns Reveal Interdependent Needs of Dutch Homeless Service Users. Front Psychiatry 2021; 12:614526. [PMID: 33841201 PMCID: PMC8027245 DOI: 10.3389/fpsyt.2021.614526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/24/2021] [Indexed: 01/15/2023] Open
Abstract
Background: Homelessness is an increasing problem in Western European countries. Dutch local authorities initiated cross-sectional reviews to obtain accurate health and needs information on Homeless Service (HS) users. Methods: The Homeless People Treatment and Recovery (HOP-TR) study uses a comprehensive assessment strategy to obtain health data. Using a naturalistic meta-snowball sampling in 2015-2017, 436 Dutch HS users were assessed. The lived experience of HS users was the primary data source and was enriched with professional assessments. The InterRAI Community Mental Health questionnaire and "Homelessness Supplement" provided information in different areas of life. The approach for mental health assessments was transdiagnostic. Raw interview data were recoded to assess health and needs. The positive health framework structured symptomatic, social, and personal health domains relevant to recovery. Results: Most subjects were males, low educated, with a migration background. The majority were long-term or intermittently homeless. Concurrent health problems were present in two domains or more in most (95.0%) subjects. Almost all participants showed mental health problems (98.6%); for a significant share severe (72.5%). Frequent comorbid conditions were addiction (78%), chronic physical conditions (59.2%), and intellectual impairments (39.9%). Conclusion: The HOP-TR study reveals significant concurrent health problems among Dutch HS users. The interdependent character of different needs requires an integrated 3-D public health approach to comprehensively serve symptomatic, social, and personal dimensions, required to facilitate recovery.
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Affiliation(s)
- Coline van Everdingen
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | | | - Koos van der Velden
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands.,Department of Adult Psychiatry, Mondriaan Mental Health Trust, Heerlen, Netherlands
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4
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Abstract
PURPOSE OF REVIEW The aim of this article is to provide a framework and analysis of a series of critical components to inform the future design, development, sustaining, and monitoring of community mental health services. RECENT FINDINGS Many mental health services remain too hospital-centric, often without adequate outreach services. On the basis of outcome evidence, we need to shift the balance of mental health services from hospital-centered with community outreach when convenient for staff, to community-centered and mobile, with in-reach to hospital only when necessary. Too few training programs those with emphasize the macroskills of public advocacy, working with service users, families, social movements, and the media to improve mental health and wellbeing of regional and local communities. SUMMARY We should adopt a health ecosystems approach to mental healthcare and training, encompassing nano to macrolevels of service in every region. Catchment mental health services should be rebuilt as community-centric mental health services, integrating all community and inpatient components, but led and integrated from community sites. Community psychiatrists and mental health professionals of the future will need to be well trained in the nano to macroskills required to take responsibility for the mental health and wellbeing of their catchment communities and to provide leadership in service-planning, management, and continuing revision on the basis of rigorous evaluation. These approaches should be the core of all training in psychiatry and all mental health professions prior to any subspecialization.
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Wijnen BFM, Smit F, Uhernik AI, Istvanovic A, Dedovic J, Dinolova R, Nica R, Velickovski R, Wensing M, Petrea I, Shields-Zeeman L. Sustainability of Community-Based Specialized Mental Health Services in Five European Countries: Protocol for Five Randomized Controlled Trial-Based Health-Economic Evaluations Embedded in the RECOVER-E Program. JMIR Res Protoc 2020; 9:e17454. [PMID: 32476658 PMCID: PMC7296406 DOI: 10.2196/17454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/06/2020] [Accepted: 03/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background Community-based recovery-oriented mental health services for people with severe mental disorders have not been fully implemented in Bulgaria, Croatia, Macedonia, Montenegro, and Romania. The RECOVER-E project facilitates the implementation of specialized mental health care delivered by setting up services, implementing the services, and evaluating multidisciplinary community mental health teams. The outcomes of the RECOVER-E project are assessed in a trial-based outcome evaluation in each of the participating countries with a health-economic evaluation linked to these trials. Objective The aim of this protocol paper is to describe the methodology that will be used for the health-economic evaluation alongside the trials. Methods Implementation sites have been selected in each of the five countries where hospital-based mental health services are available (care as usual [CAU]) for patients with severe mental disorders (severe depression, bipolar disorder, schizophrenia, and other psychotic disorders). The newly implemented health care system will involve community-based recovery-oriented mental health care (CMHC). At each site, 180 consenting patients will be randomized to either CAU or CMHC. Patient-level outcomes are personal and social functioning and quality-adjusted life years (QALYs). Data on participants’ health care use will be collected and corresponding health care costs will be computed. This enables evaluation of health care costs of CMHC as compared with CAU, and these costs can be related to patient-level outcomes (functioning and QALY gains) in health-economic evaluation. Results Data collection was started in December 2018 (Croatia), February 2019 (Montenegro), April 2019 (Romania), June 2019 (North Macedonia), and October 2019 (Bulgaria). The findings of the outcome evaluations will be reported for each of the five countries separately, and the five trials will be pooled for multilevel analysis on a combined dataset. Conclusions The results of the health-economic evaluation of the RECOVER-E project will contribute to the growing evidence base on the health and economic benefits of recovery-oriented and community-based service models for health systems in transition. Trial Registration (1) ClinicalTrials.gov NCT03922425 (Bulgaria); https://clinicaltrials.gov/ct2/show/NCT03922425 (2) ClinicalTrials.gov NCT03862209 (Croatia); https://clinicaltrials.gov/ct2/show/NCT03862209 (3) ClinicalTrials.gov NCT03892473 (Macedonia); https://clinicaltrials.gov/ct2/show/NCT03892473 (4) ClinicalTrials.gov NCT03837340 (Montenegro); https://clinicaltrials.gov/ct2/show/NCT03837340 (5) ClinicalTrials.gov NCT03884933 (Romania); https://clinicaltrials.gov/ct2/show/NCT03884933 International Registered Report Identifier (IRRID) DERR1-10.2196/17454
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Affiliation(s)
- Ben F M Wijnen
- Center for Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, Netherlands.,Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Filip Smit
- Center for Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, Netherlands.,Department of Biostatistics and Epidemiology and Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | | | - Ana Istvanovic
- Division of Public Health, Croatian Institute of Public Health, Zagreb, Croatia
| | | | - Roumyana Dinolova
- National Centre of Public Health Protection-Mental Health, Sofia, Bulgaria
| | - Raluca Nica
- Romanian League for Mental Health, Bucharest, Romania
| | - Robert Velickovski
- University Clinic of Psychiatry, Skopje, the Former Yugoslav Republic of Macedonia
| | - Michel Wensing
- Department of General Practice and Health Service Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Ionela Petrea
- Department of Public Mental Health, Trimbos Institute, Utrecht, Netherlands
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6
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Arya DK. Case management, care-coordination and casework in community mental health services. Asian J Psychiatr 2020; 50:101979. [PMID: 32151981 DOI: 10.1016/j.ajp.2020.101979] [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] [Received: 12/15/2019] [Revised: 01/22/2020] [Accepted: 02/23/2020] [Indexed: 10/24/2022]
Abstract
The key to the provision of appropriate care to consumers experiencing mental disorders is to ensure that resources are appropriate to their needs. A model that streams mental health clinicians into case management, care coordination and key work streams would be helpful for services to provide appropriate case management support to consumers enrolled in their program.
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Affiliation(s)
- Dinesh K Arya
- ACT Health, 2 Bowes Street, Woden, ACT 2606, Australia.
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7
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O'Reilly CL, Paul D, McCahon R, Shankar S, Rosen A, Ramzy T. Stigma and discrimination in individuals with severe and persistent mental illness in an assertive community treatment team: Perceptions of families and healthcare professionals. Int J Soc Psychiatry 2019; 65:570-579. [PMID: 31379239 DOI: 10.1177/0020764019867358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To explore family member and staff perceptions of clients' experiences of stigma and discrimination, in those living with severe and persistent mental illness in an Assertive Community Treatment Team. METHOD This qualitative study used the Discrimination and Stigma Scale to conduct structured face-to-face and telephone interviews of family members and healthcare professionals, working with the Assertive Outreach Team (AOT) (an Assertive Community Treatment Team) of a northern inner suburban catchment of Sydney, New South Wales, Australia. RESULTS Forty-one people participated in the study (23 AOT clinical staff members and 18 family members). Family and clinical staff commonly reported stigma and discrimination amongst their relatives and clients, respectively. Four overarching themes emerged from the data: (1) appearance and behaviour, (2) avoidance and being shunned, (3) key areas of life affected by discrimination and (4) impacts of discrimination and skills to cope with discrimination. CONCLUSION Reports of stigma and discrimination were common, yet varied between groups with clinical staff commonly witnessing experiences and impacts of discrimination in everyday life, with families' reports being substantially less. Due to the strong advocacy and support provided by the AOT model, clinical staff often buffered experiences of stigma and discrimination. Further research is needed to explore effective interventions to reduce experiences of discrimination in this population group.
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Affiliation(s)
- Claire L O'Reilly
- 1 Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Diane Paul
- 2 Lower North Shore Assertive Outreach Team, North Shore Ryde Mental Health Service, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Rebecca McCahon
- 2 Lower North Shore Assertive Outreach Team, North Shore Ryde Mental Health Service, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Sumitra Shankar
- 2 Lower North Shore Assertive Outreach Team, North Shore Ryde Mental Health Service, Northern Sydney Local Health District, St Leonards, NSW, Australia.,3 Private Practice, Brunswick, VIC, Australia
| | - Alan Rosen
- 4 Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,5 Illawarra Institute of Mental Health, University of Wollongong, Wollongong, NSW, Australia
| | - Thomas Ramzy
- 1 Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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8
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Williams TM, Smith GP. Laying new foundations for 21st century community mental health services: An Australian perspective. Int J Ment Health Nurs 2019; 28:1008-1014. [PMID: 30903646 DOI: 10.1111/inm.12590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2019] [Indexed: 11/30/2022]
Abstract
While there has been a significant increase in investment in community mental health in Australia since the advent of the National Mental Health Strategy in the early 1990s, there has been little guidance on service design and delivery. This has led to a growing diversity of approaches and concern about the adequacy of care with repeated calls for a system overhaul. Consumers and carers have very largely been absent from decision-making about service design and development which has led to a system primarily designed by healthcare professionals. However, with the emergence of recovery as a core principle in mental health, it is time for consumers and carers to be centrally engaged in co-designing services with service providers. This raises the question of whether dominant service delivery models - such as the growth of specialist teams/services, the changing balance between profession-specific and generic case management roles in multidisciplinary teams, and the separation of inpatient from community care - will prevail. Contentious issues in these three service delivery areas are outlined to stimulate debate and highlight the pressing need for national guidance on the configuration of community mental health services. Building on the lessons learned from the first National Mental Health Strategy, we outline a proposal for a co-designed National Framework for Community Mental Health Services to guide the delivery of care in a way which satisfies the aspirations of consumers, carers, and mental health professionals alike.
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Affiliation(s)
- Theresa Maureen Williams
- Research and Strategy, Office of the Chief Psychiatrist, Perth, Western Australia, Australia.,Division of Psychiatry, University of Western Australia, Perth, Western Australia, Australia
| | - Geoffrey Paul Smith
- Research and Strategy, Office of the Chief Psychiatrist, Perth, Western Australia, Australia.,Division of Psychiatry, University of Western Australia, Perth, Western Australia, Australia
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Abstract
SummaryThe Five Year Forward View for Mental Health (FYFVMH) was a welcome development in the emerging 'Parity of Esteem' agenda, but focused mainly on a select few specialist services; much more limited attention was given to 'core' general adult and older age mental health services, such as community mental health teams, crisis teams and in-patient units. This relative policy vacuum, when combined with prolonged financial pressures and limited informatics, has left core services vulnerable and struggling to meet growing demands, with little sense of hope, in contrast to some of the newer, 'shiny' specialist services growing around them. Policy makers need to recognise the growing crisis and take action, ensuring that any sequel to the FYFVMH redresses this imbalance by clearly prioritising core services as the vital foundations of the larger whole-system. The potential benefits are huge and wide-ranging, but the harms of a second missed opportunity are perhaps even greater.Declaration of interestA.M. works in a National Health Service general adult community mental health team and is an elected member of the Royal College of Psychiatrists General Adult Faculty Executive Committee.
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Affiliation(s)
- Andrew Moore
- North Devon Community Mental Health Services (Sector A Team),Devon Partnership NHS Trust,UK
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10
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Rosen A, Mezzina R, Shiers D. The Future of Psychiatry Commission. Lancet Psychiatry 2018; 5:16-17. [PMID: 29277203 DOI: 10.1016/s2215-0366(17)30499-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 12/03/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Alan Rosen
- Institute of Mental Health, University of Wollongong and Brain & Mind Centre, University of Sydney, Sydney, Australia.
| | - Roberto Mezzina
- WHO Collaborating Centre for Research and Training in Mental Health, Trieste, Italy
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Sood L, Owen A, Onyon R, Sharma A, Nigriello J, Markham D, Seabrook H. Flexible assertive community treatment (FACT) model in specialist psychosis teams: an evaluation. BJPsych Bull 2017; 41:192-196. [PMID: 28811912 PMCID: PMC5537572 DOI: 10.1192/pb.bp.116.053967] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims and method The impact of flexible assertive community treatment (FACT) has been observed in people previously supported by assertive community treatment (ACT) teams, but its effect on those previously with a community mental health team (CMHT) has not been studied in the UK. An observational study was conducted of 380 people from 3 CMHTs and 95 people from an ACT team, all with a history of psychosis, following service reconfiguration to 3 FACT teams. Results People previously with a CMHT required less time in hospital when the FACT model was introduced. A smaller reduction was observed in people coming from the ACT team. Both groups required less crisis resolution home treatment (CRHT) team input. Clinical implications FACT may be a better model than standard CMHT care for people with a history of psychosis, as a result of reduced need for acute (CRHT and in-patient) services.
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Affiliation(s)
- Loopinder Sood
- Coventry & Warwickshire Partnership NHS Trust, Stratford-upon-Avon, UK
| | - Andy Owen
- Coventry & Warwickshire Partnership NHS Trust, Stratford-upon-Avon, UK
| | - Richard Onyon
- Coventry & Warwickshire Partnership NHS Trust, Stratford-upon-Avon, UK
| | - Aarohi Sharma
- Coventry & Warwickshire Partnership NHS Trust, Stratford-upon-Avon, UK
| | | | - Dominic Markham
- Coventry & Warwickshire Partnership NHS Trust, Stratford-upon-Avon, UK
| | - Hannah Seabrook
- Coventry & Warwickshire Partnership NHS Trust, Stratford-upon-Avon, UK
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Harvey C, Brophy L, Parsons S, Moeller-Saxone K, Grigg M, Siskind D. People living with psychosocial disability: Rehabilitation and recovery-informed service provision within the second Australian national survey of psychosis. Aust N Z J Psychiatry 2016; 50:534-47. [PMID: 26466606 DOI: 10.1177/0004867415610437] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE People with psychosocial disability are an important, although often neglected, subgroup of those living with severe and persistent mental illness. Rehabilitation, provided through clinical and non-government organisations in Australia, may contribute to their personal recovery goals. We hypothesised that people with psychoses with the greatest disability and complex needs would receive services from both sectors, reflecting treatment and rehabilitation needs. METHOD Participants in the 2010 Australian national survey of psychosis (n = 1825) were interviewed to assess demographic, functional, mental and physical health characteristics and service use in the previous year. Two subgroups were created and compared: those using services from community mental health with, and without, non-governmental organisation involvement. Group membership was predicted by hierarchical logistic regression using variables selected on a priori grounds. Usefulness of the final model was examined by calculating improvement over the rate of accuracy achievable by chance alone. RESULTS The model was statistically significant but fell just short of useful (criterion 71.6%, model achieved 70.6%). Four independent variables contributed uniquely to predicting whether participants received both services (never married, childhood trauma, group accommodation, poor global functioning) consistent with the hypothesis. However, severe dysfunction in socialising was less likely to predict membership of the combined services group when compared with no dysfunction (p = 0.001, odds ratio = 0.384, confidence interval = [0.218, 0.677]), as was current smoking compared with none (p = 0.001, odds ratio = 0.606, confidence interval = [0.445, 0.824]). CONCLUSION Findings suggest services provided by non-governmental organisations are targeted to those with the greatest disability although targeting could be improved. A subgroup of people with psychosis and severe disability in community mental health services do not access non-governmental services. Their unmet needs for rehabilitation and recovery have important implications for future development of community mental health, including the non-governmental sector.
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Affiliation(s)
- Carol Harvey
- Psychosocial Research Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia NorthWestern Mental Health, Melbourne, VIC, Australia
| | - Lisa Brophy
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia Mind Australia, Melbourne, VIC, Australia
| | - Samuel Parsons
- Psychosocial Research Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Dan Siskind
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
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13
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Firn M, White SJ, Hubbeling D, Jones B. The replacement of assertive outreach services by reinforcing local community teams: a four-year observational study. J Ment Health 2016; 27:4-9. [PMID: 26850124 DOI: 10.3109/09638237.2016.1139073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mike Firn
- South West London & St. George’s Mental Health NHS Trust, London, UK, and
| | - Sarah Jane White
- Population Health Research Institute, St Georges University of London, London, UK
| | - Dieneke Hubbeling
- South West London & St. George’s Mental Health NHS Trust, London, UK, and
| | - Ben Jones
- South West London & St. George’s Mental Health NHS Trust, London, UK, and
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14
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Jethwa KD, Onalaja O. Advance care planning and palliative medicine in advanced dementia: a literature review. BJPsych Bull 2015; 39:74-8. [PMID: 26191437 PMCID: PMC4478901 DOI: 10.1192/pb.bp.114.046896] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 04/11/2014] [Accepted: 05/19/2014] [Indexed: 11/23/2022] Open
Abstract
Aims and method To assess the factors that affect the clinical use of advanced care planning and palliative care interventions in patients with dementia. A literature search of Medline, Embase and PsycINFO was performed to identify themes in advanced care planning and palliative care in dementia. Results In total, 64 articles were found, including 12 reviews, and three key areas emerged: barriers to advanced care planning, raising awareness and fostering communication between professionals and patients, and disease-specific interventions. Clinical implications Most of the studies analysed were carried out in the USA or Continental Europe. This narrative review aims to help guide future primary research, systematic reviews and service development in the UK.
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Affiliation(s)
- Ketan Dipak Jethwa
- University of Warwick and Coventry and Warwickshire Partnership NHS Trust
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15
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Sood L, Owen A. Assertive community treatment: keeping what works. PSYCHIATRIC BULLETIN 2014; 38:46. [PMID: 25237495 DOI: 10.1192/pb.38.1.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sood L, Owen A. A 10-year service evaluation of an assertive community treatment team: trends in hospital bed use. J Ment Health 2014; 23:323-7. [PMID: 25222169 DOI: 10.3109/09638237.2014.954694] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Studies of assertive community treatment (ACT) have shown various benefits, including reduced hospital bed use. In the UK, this finding was not replicated by randomised controlled trials (RCTs), which lacked fidelity to the model. Conversely, observational studies, while limited by their inherent weakness in implying causality, have shown lower bed use. Against this background many ACT teams are being disestablished in the UK. AIMS To observe the long-term effect of ACT on bed use, incorporating methods of analysis which mitigate against some weaknesses of observational design. METHODS Bed use was compared for equal periods of time either side of starting support from an ACT team. RESULTS Ninety-three people were followed for up to 10.5 years after starting ACT. Hospital bed use was compared for each person, showing a reduction from a mean of 72 d per year prior to ACT to 44 d per year during ACT (p = 0.0018). CONCLUSIONS The results demonstrate that ACT is associated with reduced bed use in the UK and that it is possible to use an observational design with enhanced analysis techniques to increase evidence for causality. These techniques may have value in other service evaluations.
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Affiliation(s)
- Loopinder Sood
- Coventry and Warwickshire NHS Partnership Trust, St Michaels Hospital , Warwick , UK
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Ogunremi SA. Looking at vanishing treatment effect in Europe. PSYCHIATRIC BULLETIN (2014) 2014; 38:46. [PMID: 25237493 PMCID: PMC4067838 DOI: 10.1192/pb.38.1.46a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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