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Kellett R, Findlay L, Lubbe S, Wand AP. The Pathways to Community Living Initiative (PCLI) for older adults: implementation and outcomes. Australas Psychiatry 2024; 32:423-430. [PMID: 39054268 DOI: 10.1177/10398562241268139] [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] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To describe implementation of the Pathways to Community Living Initiative (PCLI) within an Older People's Mental Health (OPMH) service. METHOD A retrospective observational study was conducted. Implementation comprised partnership with a specialist Residential Aged Care Facility (RACF). Data were obtained from Clinical Advisory Committee (CAC) discussion and minutes, the PCLI database, and consumer medical records. RESULTS Eighteen consumers were accepted onto the program between April 2019 and March 2023. Their PCLI and rating scale outcomes alongside interventions facilitating placements are described. Interventions included OPMH case management, wide-reaching liaison, and inservices. Challenges included communication, confusion regarding roles, and differing views on capacity to accommodate complex consumers. Solutions included streamlining communication, including clinical updates in the CAC, facility appointment of a lead PCLI-nurse, and targeted RACF education. CONCLUSIONS Considered interventions strengthened the OPMH and specialist RACF partnership over time. Clarification of professional roles and intersection with other services was crucial. Successful placement for PCLI consumers required consideration of personalised needs and existing resident mix, liaison with stakeholders, and targeted staff training. These strategies may apply to other health services implementing similar initiatives supporting community placements for OPMH consumers with complex needs.
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Affiliation(s)
- Rowena Kellett
- Older People's Mental Health, Sydney Local Health District, c/o Camperdown Community Health Centre, Camperdown, NSW, Australia
| | - Lillian Findlay
- Older People's Mental Health, Sydney Local Health District, c/o Camperdown Community Health Centre, Camperdown, NSW, Australia
| | - Sean Lubbe
- Older People's Mental Health, Sydney Local Health District, c/o Camperdown Community Health Centre, Camperdown, NSW, Australia
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Anne Pf Wand
- Older People's Mental Health, Sydney Local Health District, c/o Camperdown Community Health Centre, Camperdown, NSW, Australia
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Randwick, NSW, Australia
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Sambrook L, Balmer A, Roks H, Tait J, Ashley-Mudie P, McIntyre JC, Shetty A, Bu C, Nathan R, Saini P. The journey of service users with complex mental health needs: a qualitative study. Health Psychol Behav Med 2024; 12:2365226. [PMID: 38887740 PMCID: PMC11182059 DOI: 10.1080/21642850.2024.2365226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/29/2024] [Indexed: 06/20/2024] Open
Abstract
Background: This study aimed to provide a robust picture of the journey of service users with complex mental health needs by evaluating the perspectives of service users and carers with lived experience of services and gaining clinician views about decision making in relation to this cohort. Methods: A qualitative design was used. Service users (n = 11), carers (n = 10) and clinicians (n = 18) took part in semi-structured interviews, which were transcribed verbatim and analysed using thematic analysis. Results: The following themes were identified by participants: 'relationships with staff,' 'treatment options, pathways and availability,' 'the role of autonomy in recovery,' 'impact of out-of-area placements,' and 'specialist training for staff.' The findings demonstrated that the journey of serviceusers can be impacted by a wide range of factors, including relationships with staff, the nature of support offered, community response, financial constraints, and organisational goals around bed pressures. Conclusions: Recommendations include the need for staff to work in partnership with service users and carers, foster autonomy, access specialised suicide prevention training, and agree discharge and contingency plans with service users. Further work is needed to deliver the best possible experience for individuals with complex mental health needs and those who care for them.
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Affiliation(s)
- Laura Sambrook
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Anna Balmer
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Hana Roks
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Jackie Tait
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | | | | | - Amrith Shetty
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Christopher Bu
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Rajan Nathan
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Pooja Saini
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
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3
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Martinelli A, Bonetto C, Pozzan T, Procura E, Cristofalo D, Ruggeri M, Killaspy H. Exploring gender impact on collaborative care planning: insights from a community mental health service study in Italy. BMC Psychiatry 2023; 23:834. [PMID: 37957583 PMCID: PMC10644654 DOI: 10.1186/s12888-023-05307-5] [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: 03/28/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Personal recovery is associated with socio-demographic and clinical factors, and gender seems to influence the recovery process. This study aimed to investigate: i) differences in the recovery goals of men and women users of a community mental health service in Italy; ii) any differences by gender in recovery over six months using the Mental Health Recovery Star (MHRS). METHODS Service users and staff completed the MHRS together at recruitment and six months later to agree the recovery goals they wished to focus on. Socio-demographic and clinical characteristics and ratings of symptoms (BPRS), needs (CAN), functioning (FPS), and functional autonomy (MPR) were collected at recruitment and six months follow-up. Comparisons between men and women were made using t-tests. RESULTS Ten women and 15 men completed the MHRS with 19 mental health professionals. Other than gender, men and women had similar socio-demographic, and clinical characteristics at recruitment. Women tended to choose recovery goals that focused on relationships whereas men tended to focus on work related goals. At follow-up, both men and women showed improvement in their recovery (MHRS) and women were less likely to focus on relationship related goals, perhaps because some had found romantic partners. There were also gains for both men and women in engagement with work related activities. Ratings of functional autonomy (MPR) improved for both men and women, and men also showed improvement in symptoms (BPRS) and functioning (FPS). CONCLUSIONS Our findings suggest that collaborative care planning tools such as the MHRS can assist in identifying individualized recovery goals for men and women with severe mental health problems as part of their rehabilitation.
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Affiliation(s)
| | - Chiara Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Tecla Pozzan
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Elena Procura
- Mental Health Center, Isola Della Scala, Ospedale Di Bussolengo, Verona, Italy
| | - Doriana Cristofalo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mirella Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, UK
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Edwards T, Meaden A, Commander M. A 10-year follow-up service evaluation of the treatment pathway outcomes for patients in nine in-patient psychiatric rehabilitation services. BJPsych Bull 2023; 47:23-27. [PMID: 35012699 PMCID: PMC10028550 DOI: 10.1192/bjb.2021.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIMS AND METHOD This study examines the treatment pathway outcomes over a 10-year period for patients in nine rehabilitation wards at the beginning of this time period. RESULTS Data were obtained on 85 patients, of whom 59 were discharged during the 10-year period; 29 were readmitted, of whom 15 had further in-patient rehabilitation admissions. Nineteen patients remained in hospital throughout the period. Only nine patients were living independently at the time of follow-up or death, and 34 were in longer-term in-patient settings. Eighteen patients had died during the 10-year period. CLINICAL IMPLICATIONS New planning of rehabilitation services needs to ensure an integrated whole-systems approach, across in-patient and community settings, with specialist mental health rehabilitation teams to support people moving from hospital to the community, and for the small number remaining in hospital for very long periods, development of sufficient high-quality, local in-patient provision.
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Affiliation(s)
- Tom Edwards
- Gloucestershire Health and Care NHS Foundation Trust, UK
| | - Alan Meaden
- Birmingham and Solihull Foundation Trust, UK
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Ciobanu AM, Ciobanu AC, Catrinescu LM, Niculae CP, Geza L, Ioniță I. Community-Based Psychiatric Treatment in Romania: Past, Present, Future. CONSORTIUM PSYCHIATRICUM 2022; 3:129-136. [PMID: 39045120 PMCID: PMC11262102 DOI: 10.17816/cp180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/09/2022] [Indexed: 11/08/2022] Open
Abstract
Community psychiatry has its origins in the West, in the 1950s, when many institutions for the mentally ill were closed down in an effort to shift the focus from hospital-based care to community-based. The aim of the current paper is to review the available literature on the community-based psychiatric treatment in Romania. The Romanian Ministry of Health is dedicated to promoting mental health education and to creating a mental health system that ensures that every patient has access to care and treatments designed for their own particular needs. Today, in Romania, as across the entirety of Central and Eastern Europe, mental health systems are transitioning from hospital-based care to community-based services. The RECOVER-E project, the SEE Mental Health Project, the "Horizons" project, among others, showcase Romania's mental healthcare system in terms of improving the chances of mental health patients' recovery. Community Psychiatry in Romania is a budding field that can greatly aid in the management and treatment of patients with mental disorders from both urban and rural areas. By applying the principles of deinstitutionalization and community health care at a systemic level, resources may be invested in the creation of a strong network of specialists that treat patients in their own living spaces.
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Saini P, Martin A, McIntyre J, Balmer A, Burton S, Roks H, Sambrook L, Shetty A, Nathan R. COMplex mental health PAThways (COMPAT) Study: A mixed methods study to inform an evidence-based service delivery model for people with complex needs: Study protocol. PLoS One 2022; 17:e0264173. [PMID: 35259173 PMCID: PMC8903266 DOI: 10.1371/journal.pone.0264173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 02/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Mental health services for adults, as they are currently configured, have been designed to provide predominantly community-based interventions. It has long been recognised that some patients have such significant clinical and/or risk needs that those needs cannot be adequately met within standard service delivery models, resulting in a pressing need to consider the best models for this group of people. This paper shares a protocol for a mixed methods study that aims to understand: the profile and history of service users described as having complex needs; the decision-making processes by clinicians that lead to complex needs categorisation; service users and carers experience of service use; and, associated economic impact. This protocol describes a comprehensive evaluation that aims to inform an evidence-based service delivery model for people with complex needs.
Methods
We will use a mixed methods design, combining quantitative and qualitative methods using in-depth descriptive and inferential analysis of patient records, written medical notes and in-depth interviews with service users, carers, and clinicians. The study will include five components: (1) a quantitative description and analysis of the demographic clinical characteristics of the patient group; (2) an economic evaluation of alternative patient pathways; (3) semi-structured interviews about service user and carer experiences; (4) using data from components 1–3 to co-produce vignettes jointly with relevant stakeholders involved in the care of service users with complex mental health needs; and, (5) semi-structured interviews about clinical decision-making by clinicians in relation to this patient group, using the vignettes as example case studies.
Discussion
The study’s key outcomes will be to: examine the resource use and cost-impact associated with alternative care pathways to the NHS and other sectors of the economy (including social care); explore patient health and non-health outcomes associated with alternative care pathways; and, gain an understanding of a complex service user group and how treatment decisions are made to inform consistent and person-centred future service delivery.
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Affiliation(s)
- Pooja Saini
- Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
- * E-mail:
| | | | - Jason McIntyre
- Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Anna Balmer
- Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Sam Burton
- Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Hana Roks
- Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Laura Sambrook
- Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Amrith Shetty
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, United Kingdom
| | - Rajan Nathan
- Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, United Kingdom
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Lindström M. Development of the Everyday Life Rehabilitation model for persons with long-term and complex mental health needs: Preliminary process findings on usefulness and implementation aspects in sheltered and supported housing facilities. Front Psychiatry 2022; 13:954068. [PMID: 36051549 PMCID: PMC9424656 DOI: 10.3389/fpsyt.2022.954068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED This paper describes the initial phases of the design and development of the Everyday Life Rehabilitation (ELR) intervention, and it presents preliminary findings on usefulness and implementation aspects derived from an ongoing larger trial exploring the effect, cost-effectiveness, and usefulness of ELR. ELR is a model designed to meet the absence of meaningful activities and challenges with integrated, activity- and recovery-oriented rehabilitation in sheltered and supported housing facilities for persons with extensive psychiatric disabilities. The aim of the present study was to examine early experiences of implementing the ELR model from the perspectives of managers, housing staff, and occupational therapists. The paper will sum up preliminary findings based on process data included in an internal pilot prior to a full-scale pragmatic clustered RCT. Four Swedish municipalities with 19 housing facility units were involved and provided process data for the study. Thematic analysis were applied. The informants perceived the methodology to be well suited to the target group and context and to contribute to positive changes in participants' lives. The web-based training was also experienced as relevant and easily accessible to staff, as well as elements of collegial learning and feedback. However, they reported that their municipalities lacked basic conditions for making the whole concept work in such a short time. The ELR is overall perceived as useful, but experiences also make complex difficulties visible regarding integrated, coordinated rehabilitation and organizational readiness. Based on findings, a recommendation on basic prerequisites will be added to the ELR guidance for leadership and management. CLINICAL TRIAL REGISTRATION [ClinicalTrials.gov, 24 September 2021], identifier [NCT05056415].
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Affiliation(s)
- Maria Lindström
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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8
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Roth C, Wensing M, Koetsenruijter J, Istvanovic A, Novotni A, Tomcuk A, Dedovic J, Djurisic T, Milutinovic M, Kuzman MR, Nica R, Bjedov S, Medved S, Rotaru T, Hipple Walters B, Petrea I, Shields-Zeeman L. Perceived Support for Recovery and Level of Functioning Among People With Severe Mental Illness in Central and Eastern Europe: An Observational Study. Front Psychiatry 2021; 12:732111. [PMID: 34621196 PMCID: PMC8490702 DOI: 10.3389/fpsyt.2021.732111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/23/2021] [Indexed: 11/14/2022] Open
Abstract
Background: Many people with severe mental illness experience limitations in personal and social functioning. Care delivered in a person's community that addresses needs and preferences and focuses on clinical and personal recovery can contribute to addressing the adverse impacts of severe mental illness. In Central and Eastern Europe, mental health care systems are transitioning from institutional-based care toward community-based care. The aim of this study is to document the level of functioning and perceived support for recovery in a large population of service users with severe mental illness in Central and Eastern Europe, and to explore associations between perceived support for recovery and the degree of functional limitations. Methods: The implementation of community mental health teams was conducted in five mental health centers in five countries in Central and Eastern Europe. The present study is based on trial data at baseline among service users across the five centers. Baseline data included sociodemographic, the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for functional limitations, and the Recovery Support (INSPIRE) tool for perceived staff support toward recovery. We hypothesized that service users reporting higher levels of perceived support for their recovery would indicate lower levels of functional limitation. Results: Across all centers, the greatest functional limitations were related to participation in society (43.8%), followed by daily life activities (33.3%), and in education or work (35.6%). Service users (N = 931) indicated that they were satisfied overall with the support received from their mental health care provider for their social recovery (72.5%) and that they valued their relationship with their providers (80.3%). Service users who perceived the support they received from their provider as valuable (b = -0.10, p = 0.001) and who reported to have a meaningful relationship with them (b = -0.13, p = 0.003) had a lower degree of functional limitation. Conclusion: As hypothesized, the higher the degree of perceived mental health support from providers, the lower the score in functional limitations. The introduction of the community-based care services that increase contact with service users and consider needs and which incorporate recovery-oriented principles, may improve clinical recovery and functional outcomes of service users with severe mental illness.
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Affiliation(s)
- Catharina Roth
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, Heidelberg, Germany
| | - Jan Koetsenruijter
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, Heidelberg, Germany
| | - Ana Istvanovic
- Croatian Institute of Public Health, Rockefellerova, Zagreb, Croatia
| | - Antoni Novotni
- University St. Cyril and Methodius, University Clinic of Psychiatry, Skopje, North Macedonia
| | - Aleksandr Tomcuk
- Health Institution Special Psychiatric Hospital Dobrota Kotor, Mental Health Promotion and International Cooperation Department and Department of Forensic Psychiatry, Kotor, Montenegro
| | - Jovo Dedovic
- Health Institution Special Psychiatric Hospital Dobrota Kotor, Mental Health Promotion and International Cooperation Department and Department of Forensic Psychiatry, Kotor, Montenegro
| | | | - Milos Milutinovic
- University St. Cyril and Methodius, University Clinic of Psychiatry, Skopje, North Macedonia
| | - Martina Rojnic Kuzman
- Zagreb University Hospital Centre and the Zagreb School of Medicine, Zagreb, Croatia
| | - Raluca Nica
- Institute Liga Romana Pentru Sanatate Mintala, Bucuresti-Sector, Romania
| | - Sarah Bjedov
- Zagreb University Hospital Centre, Clinic for Psychiatry and Psychological Medicine, Zagreb, Croatia
| | - Sara Medved
- Zagreb University Hospital Centre, Clinic for Psychiatry and Psychological Medicine, Zagreb, Croatia
| | - Tiberiu Rotaru
- Siret Psychiatric Hospital, Psychotherapy Unit, Siret, Romania
| | - Bethany Hipple Walters
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Department of Mental Health Prevention and Expertise Centre for Tobacco Control, Utrecht, Netherlands
| | - Ionela Petrea
- INSIGHT International Institute for Mental Health and Integrated Health Systems, Amsterdam, Netherlands
| | - Laura Shields-Zeeman
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Department of Mental Health Prevention and Expertise Centre for Tobacco Control, Utrecht, Netherlands
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van der Meer L, Jonker T, Wadman H, Wunderink C, van Weeghel J, Pijnenborg GHM, van Setten ERH. Targeting Personal Recovery of People With Complex Mental Health Needs: The Development of a Psychosocial Intervention Through User-Centered Design. Front Psychiatry 2021; 12:635514. [PMID: 33897494 PMCID: PMC8060492 DOI: 10.3389/fpsyt.2021.635514] [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: 11/30/2020] [Accepted: 01/25/2021] [Indexed: 12/21/2022] Open
Abstract
Long-term admissions in psychiatric facilities often result in a gradual erosion of the identity of people diagnosed with severe mental illnesses (SMIs) into merely "patient." Moreover, experiences of loss often reduced people's sense of purpose. Although regaining a multidimensional identity and a sense of purpose are essential for personal recovery, few interventions specifically address this, while at the same time take people's often considerable cognitive and communicative disabilities into consideration. This study describes the development process of a new intervention through user-centered design (UCD). UCD is an iterative process in which a product (in this case, an intervention) is developed in close cooperation with future users, such that the final product matches their needs. The design process included three phases: an analysis, design, and evaluation phase. In the analysis phase, the "problem" was defined, users' needs were identified, and design criteria were established. In the design phase, the collected information served as input to create a testable prototype using a process of design and redesign, in close collaboration with service users and other stakeholders. This resulted in an intervention entitled "This is Me" (TiM) in which service users, together with a self-chosen teammate, actively engage in new experiences on which they are prompted to reflect. Finally, in the evaluation phase, TiM was implemented and evaluated in a real-life setting. In a small feasibility pilot, we found indications that some people indeed demonstrated increased reflection on their identity during the intervention. Furthermore, TiM seemed to benefit the relationship between the service users and the mental health professionals with whom they underwent the experiences. The pilot also revealed some aspects of the (implementation of) TiM that can be improved. Overall, we conclude that UCD is a useful method for the development of a new psychosocial intervention. The method additionally increased our knowledge about necessary factors in targeting personal recovery for people with complex mental health needs. Moreover, we conclude that TiM is a promising tool for supporting people with SMI in redeveloping a multidimensional identity and a renewed sense of purpose.
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Affiliation(s)
- Lisette van der Meer
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
| | - Tessa Jonker
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands
| | - Heleen Wadman
- BuurtzorgT Mental Health Institution, Groningen, Netherlands
| | - Charlotte Wunderink
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands.,Research and Innovation Center for Rehabilitation, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Jaap van Weeghel
- Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Parnassia Group, Parnassia Noord Holland, Castricum, Netherlands.,Phrenos Center of Expertise on Severe Mental Illness, Utrecht, Netherlands
| | - Gerdina Hendrika Maria Pijnenborg
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands.,Department of Psychotic Disorders, GGZ-Drenthe, Assen, Netherlands
| | - Ellie R H van Setten
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands.,Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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10
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Stiekema APM, van Dam MT, Bruggeman R, Redmeijer JE, Swart M, Dethmers M, Rietberg K, Wekking EM, Velligan DI, Timmerman ME, Aleman A, Castelein S, van Weeghel J, Pijnenborg GMH, van der Meer L. Facilitating Recovery of Daily Functioning in People With a Severe Mental Illness Who Need Longer-Term Intensive Psychiatric Services: Results From a Cluster Randomized Controlled Trial on Cognitive Adaptation Training Delivered by Nurses. Schizophr Bull 2020; 46:1259-1268. [PMID: 32144418 PMCID: PMC7505172 DOI: 10.1093/schbul/sbz135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Feasible and effective interventions to improve daily functioning in people with a severe mental illness (SMI), such as schizophrenia, in need of longer-term rehabilitation are scarce. AIMS We assessed the effectiveness of Cognitive Adaptation Training (CAT), a compensatory intervention to improve daily functioning, modified into a nursing intervention. METHOD In this cluster randomized controlled trial, 12 nursing teams were randomized to CAT in addition to treatment as usual (CAT; n = 42) or TAU (n = 47). Daily functioning (primary outcome) was assessed every 3 months for 1 year. Additional follow-up assessments were performed for the CAT group in the second year. Secondary outcomes were assessed every 6 months. Data were analyzed using multilevel modeling. RESULTS CAT participants improved significantly on daily functioning, executive functioning, and visual attention after 12 months compared to TAU. Improvements were maintained after 24 months. Improved executive functioning was related to improved daily functioning. Other secondary outcomes (quality of life, empowerment, negative symptoms) showed no significant effects. CONCLUSIONS As a nursing intervention, CAT leads to maintained improvements in daily functioning, and may improve executive functioning and visual attention in people with SMI in need of longer-term intensive psychiatric care. Given the paucity of evidence-based interventions in this population, CAT can become a valuable addition to recovery-oriented care.
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Affiliation(s)
- Annemarie P M Stiekema
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, the Netherlands
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Michelle T van Dam
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, the Netherlands
- Rob Giel Research Center University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Richard Bruggeman
- Rob Giel Research Center University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- University Medical Center Groningen, University Center of Psychiatry, University of Groningen, Groningen, the Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| | - Jeroen E Redmeijer
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, the Netherlands
| | - Marte Swart
- Functional Assertive Community Treatment, Lentis Psychiatric Institute, Groningen, the Netherlands
| | - Marian Dethmers
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, the Netherlands
| | - Kees Rietberg
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, the Netherlands
| | - Ellie M Wekking
- Parnassia Group, Parnassia Noord Holland, Castricum, the Netherlands
| | - Dawn I Velligan
- Division of Community Recovery, Research and Training, Department of Psychiatry, University of Texas, San Antonio, TX
| | - Marieke E Timmerman
- Heymans Institute for Psychological Research, Psychometrics and Statistics, University of Groningen, Groningen, the Netherlands
| | - André Aleman
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stynke Castelein
- Research Department, Lentis Psychiatric Institute, Groningen, the Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Jaap van Weeghel
- Parnassia Group, Parnassia Noord Holland, Castricum, the Netherlands
- Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, the Netherlands
| | - Gerdina M H Pijnenborg
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
- Department of Psychotic Disorders, GGZ Drenthe, Assen, the Netherlands
| | - Lisette van der Meer
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, the Netherlands
- Rob Giel Research Center University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
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11
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De Ruysscher C, Vandevelde S, Tomlinson P, Vanheule S. A qualitative exploration of service users' and staff members' perspectives on the roles of inpatient settings in mental health recovery. Int J Ment Health Syst 2020; 14:15. [PMID: 32165919 PMCID: PMC7060519 DOI: 10.1186/s13033-020-00347-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Today, international mental health care increasingly focuses on creating recovery-oriented systems of support. This study aims to unravel the daily practice of an inpatient psychiatric ward that engages with persons with complex mental health needs. Methods 17 in-depth interviews were conducted with patients and staff of the ward. Data was analyzed by means of thematic analysis. Results Three important functions of the ward were identified in the participants’ experiences. First, it functions as an asylum, a safe environment where patients can ‘simply be’. Second, the ward is experienced as a particularizing space, as support is organized in an individualized way and patients are encouraged to reconnect with their own identity. Third, the ward functions as a transitional space towards a valuable community life, in which finding adequate housing is of central importance. Conclusions The results show that inpatient forms of support tally with personal and social dimensions of recovery and fulfill important roles in recovery-oriented systems of support.
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Affiliation(s)
- Clara De Ruysscher
- 1Department of Special Needs Education, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Stijn Vandevelde
- 1Department of Special Needs Education, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | | | - Stijn Vanheule
- 3Department of Psychoanalysis and Clinical Consulting, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
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12
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Clausen H, Ruud T, Odden S, Benth JŠ, Heiervang KS, Stuen HK, Landheim A. Improved Rehabilitation Outcomes for Persons With and Without Problematic Substance Use After 2 Years With Assertive Community Treatment-A Prospective Study of Patients With Severe Mental Illness in 12 Norwegian ACT Teams. Front Psychiatry 2020; 11:607071. [PMID: 33424668 PMCID: PMC7785822 DOI: 10.3389/fpsyt.2020.607071] [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: 09/16/2020] [Accepted: 11/11/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Persons with severe mental illness often face difficulties in accessing and receiving adequate services enabling them to live independently. Many have co-occurring substance use problems that increase the risk of adverse outcomes. Community-based service models have been implemented around the world, including assertive community treatment (ACT), but the knowledge of rehabilitation outcomes in different subgroups is limited. We aimed to explore rehabilitation outcomes among patients suffering severe mental illness with and without substance use problems who had received ACT services for at least 2 years. Additionally, we compared differences in changes between the two groups. Methods: A total of 142 patients who received services for 2 years from the first 12 Norwegian ACT teams were included. Eighty-four (59%) had problematic substance use, while 58 (41%) did not. Data regarding housing, activity, symptoms, functioning, and subjective quality of life were collected upon enrollment into ACT and at 2 years of follow-up. Clinician-rated scales and self-report questionnaires were used. Changes within the two groups and differences in change between the groups were assessed using generalized linear mixed models. Results: Both groups were more likely to have good housing, higher level of functioning, and less anxiety and depressive symptoms after 2 years. The odds of good housing among participants with problematic substance use increased only after adjusting for age and gender. Participants with problematic substance use had less severe symptoms, particularly negative and manic symptoms, while participants without problematic substance use reported improved satisfaction with life in general. Neither group experienced a change in having a meaningful daily activity, positive symptoms, practical and social functioning, or subjective quality of life. The reduction of manic symptoms in the substance use group was the only difference between the groups. Conclusion: After 2 years, patients with and without problematic substance use experienced improvements in several important domains. Furthermore, the improvements were similar in both groups for most outcomes. This may suggest that ACT has a place in the continued effort toward integrated and comprehensive community services empowering patients with severe mental illness to achieve and sustain an independent life, including marginalized groups with severe substance use.
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Affiliation(s)
- Hanne Clausen
- Department of Research and Development, Division of Mental Health Services, Akerhus University Hospital, Lørenskog, Norway.,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Torleif Ruud
- Department of Research and Development, Division of Mental Health Services, Akerhus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sigrun Odden
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Kristin Sverdvik Heiervang
- Department of Research and Development, Division of Mental Health Services, Akerhus University Hospital, Lørenskog, Norway.,Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hanne Kilen Stuen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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13
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Zomer LJC, Voskes Y, van Weeghel J, Widdershoven GAM, van Mierlo TFMM, Berkvens BS, Stavenuiter B, van der Meer L. The Active Recovery Triad Model: A New Approach in Dutch Long-Term Mental Health Care. Front Psychiatry 2020; 11:592228. [PMID: 33250796 PMCID: PMC7674651 DOI: 10.3389/fpsyt.2020.592228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
Unlike developments in short-term clinical and community care, the recovery movement has not yet gained foothold in long-term mental health services. In the Netherlands, approximately 21,000 people are dependent on long-term mental health care and support. To date, these people have benefited little from recovery-oriented care, rather traditional problem-oriented care has remained the dominant approach. Based on the view that recovery is within reach, also for people with complex needs, a new care model for long-term mental health care was developed, the active recovery triad (ART) model. In a period of 2.5 years, several meetings with a large group of stakeholders in the field of Dutch long-term mental health care took place in order to develop the ART model. Stakeholders involved in the development process were mental health workers, policy advisors, managers, directors, researchers, peer workers, and family representatives. The ART model combines an active role for professionals, service users, and significant others, with focus on recovery and cooperation between service users, family, and professionals in the triad. The principles of ART are translated into seven crucial steps in care and a model fidelity scale in order to provide practical guidelines for teams implementing the ART model in practice. The ART model provides guidance for tailored recovery-oriented care and support to this "low-volume high-need" group of service users in long-term mental health care, aiming to alter their perspective and take steps in the recovery process. Further research should investigate the effects of the ART model on quality of care, recovery, and autonomy of service users and cooperation in the triad.
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Affiliation(s)
- Lieke J C Zomer
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, Netherlands
| | - Yolande Voskes
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, Netherlands.,Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Impact Care Group, GGz Breburg, Tilburg, Netherlands
| | - Jaap van Weeghel
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Phrenos Center of Expertise on Severe Mental Illness, Utrecht, Netherlands.,Parnassia Mental Health Center, The Hague, Netherlands
| | | | | | | | | | - Lisette van der Meer
- Department of Clinical & Developmental Neuropsychology, University of Groningen, Groningen, Netherlands.,Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, Netherlands
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14
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Lynch DA, Medalia A, Saperstein A. The Design, Implementation, and Acceptability of a Telehealth Comprehensive Recovery Service for People With Complex Psychosis Living in NYC During the COVID-19 Crisis. Front Psychiatry 2020; 11:581149. [PMID: 33101093 PMCID: PMC7506069 DOI: 10.3389/fpsyt.2020.581149] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/19/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The COVID-19 crisis and subsequent stay-at-home orders have produced unprecedented challenges to the dissemination of recovery oriented behavioral health services (RS) that support the treatment of those with complex psychosis (CP).This population has typically been managed with in-person pharmacotherapy and/or RS, with the goals of relieving symptoms, improving life satisfaction and increasing community engagement. COVID-19 related social distancing measures have required rapid shifts in care management, while easing of telehealth regulations has allowed for flexibility to approach RS differently. It is essential to learn from the RS telemedicine implementation experience, so that RSs can maintain care for this vulnerable and needy population. METHOD This paper describes the successful telehealth conversion of a NYC-based, university affiliated RS that serves adults with severe mental illnesses (SMI; n = 64). Results focus on the telehealth acceptance rates of the subset of participants with CP (n = 23). RESULTS The RS continued providing services including intake, care coordination, group psychotherapies, skills training groups, individual skills coaching, and vocational/educational supports. The telehealth conversion rates of the CP subsample indicated that 90% of CP patients accepted telehealth sessions and maintained their specific treatment plans in the virtual format. Mean comparisons between session attendance and cancellations/no-shows during the six-week period before and after telehealth conversion showed no significant differences in service utilization. DISCUSSION RSs play an essential role in the treatment of CP and telehealth may prove to be a viable format of care delivery even after the COVID-19 crisis subsides. The multiple factors in the inner and outer treatment setting that contributed to successful conversion to telehealth will be considered along with the challenges that clinicians and patients encountered.
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Affiliation(s)
- David A Lynch
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, United States
| | - Alice Medalia
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, NY, United States
| | - Alice Saperstein
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
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15
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Craig TJ. Social care: an essential aspect of mental health rehabilitation services. Epidemiol Psychiatr Sci 2019; 28:4-8. [PMID: 30012237 PMCID: PMC6998944 DOI: 10.1017/s204579601800029x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 11/07/2022] Open
Abstract
This study is aimed at the importance of social care in rehabilitation. A brief overview of the social care theme is used as the methodology. There is a tension in mental health care between biological and psychological treatments that focus on deficits at the individual level (symptoms, disabilities) and social interventions that try to address local inequalities and barriers in order to improve access for service users to ordinary housing, employment and leisure opportunities. The history of mental health care tells us that social care is often underfunded and too easily dismissed as not the business of health care. But too much emphasis on a health model of individual deficits is a slippery slope to institutionalisation by way of therapeutic nihilism. Rehabilitation services follow the biopsychosocial model but with a shift in emphasis, recognising the vital role played by social interventions in improving the functional outcomes that matter to service users including access to housing, occupation, leisure facilities and the support of family and friends. In conclusion, rehabilitation is framed within a model of personal recovery in which the target of intervention is to boost hope and help the individual find a meaning to life, living well regardless of enduring symptoms.
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Affiliation(s)
- T. J. Craig
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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16
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Bouras N, Ikkos G, Craig T. From Community to Meta-Community Mental Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E806. [PMID: 29677100 PMCID: PMC5923848 DOI: 10.3390/ijerph15040806] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 11/24/2022]
Abstract
Since the 1960s, we have witnessed the development and growth of community mental health care that continues to dominate mental health policy and practice. Several high-income countries have implemented community mental health care programmes but for many others, including mostly low- and middle-income countries, it remains an aspiration. Although community mental health care has been positive for many service users, it has also had severe shortcomings. Expectations that it would lead to fuller social integration have not been fulfilled and many service users remain secluded in sheltered or custodial environments with limited social contacts and no prospect of work. Others receive little or no service at all. In today’s complex landscape of increasingly specialised services for people with mental health problems, the number of possible interfaces between services is increasing. Together with existing uneven financing systems and a context of constant change, these interfaces are challenging us to develop effective care pathways adjusted to the needs of service users and their carers. This discussion paper reviews the developments in community mental health care over the recent years and puts forward the concept of “Meta-Community Mental Health Care”. “Meta-Community Mental Health Care” embraces pluralism in understanding and treating psychiatric disorders, acknowledges the complexities of community provision, and reflects the realities and needs of the current era of care.
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Affiliation(s)
- Nick Bouras
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, P.O. Box 27, London SE5 8AF, UK.
| | - George Ikkos
- Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA4 7LP, UK.
| | - Thomas Craig
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, P.O. Box 27, London SE5 8AF, UK.
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17
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Meehan T, Stedman T, Parker S, Curtis B, Jones D. Comparing clinical and demographic characteristics of people with mental illness in hospital- and community-based residential rehabilitation units in Queensland. AUST HEALTH REV 2017; 41:139-143. [PMID: 27119964 DOI: 10.1071/ah15207] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/14/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to examine care pathways and characteristics of mental health consumers participating in both hospital- and community-based residential rehabilitation programs. Methods An audit of consumers (n=240) in all publicly funded residential rehabilitation units in Queensland was performed on the same day in 2013. Data collection focused on demographic characteristics, clinical information and measures of consumer functioning. Results Significant differences emerged for consumers in community- and hospital-based services with regard to age, length of stay, functioning, Mental Health Act status, guardianship status, family contact and risk of violence. Consumers in hospital-based programs have more severe and complex problems. Conclusions Consumers in residential rehabilitation units have high levels of disability, poor physical health and high levels of vulnerability. Nonetheless, it is likely that a sizeable proportion of consumers occupying rehabilitation beds in Queensland could be discharged if more 'step-down' options to move patients on were available. What is known about the topic? A small subgroup of people with severe and complex mental health problems is likely to require time in a residential rehabilitation program. This group is characterised by failure to respond to treatment, severe negative symptoms and some degree of cognitive impairment. What does this paper add? Patients currently occupying residential rehabilitation beds in Queensland have high levels of disability, poor physical health and high levels of vulnerability. Patients in hospital-based programs are more severely disabled than those in community-based programs. What are the implications for practitioners? It is likely that a sizeable proportion of patients occupying rehabilitation beds in Queensland could be discharged if more 'step-down' options were available. Future planning initiatives need to focus on developing a greater array of community support options to facilitate the discharge of people from residential services.
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Affiliation(s)
- Tom Meehan
- Queensland Mental Health Benchmarking Unit, The Park, Centre for Mental Health, Locked Bag 500, Archerfield, Qld 4108, Australia.
| | - Terry Stedman
- Queensland Mental Health Benchmarking Unit, The Park, Centre for Mental Health, Locked Bag 500, Archerfield, Qld 4108, Australia.
| | - Stephen Parker
- Rehabilitation Clinical Academic Unit, Metro South Addiction and Mental Health Service, 519 Kessels Road, MacGregor, Qld 4109, Australia. Email
| | - Bretine Curtis
- Queensland Mental Health Benchmarking Unit, The Park, Centre for Mental Health, Locked Bag 500, Archerfield, Qld 4108, Australia.
| | - Donna Jones
- Queensland Mental Health Benchmarking Unit, The Park, Centre for Mental Health, Locked Bag 500, Archerfield, Qld 4108, Australia.
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18
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Bouras N, Ikkos G, Craig T. Meta-community mental health care: towards a new concept. Lancet Psychiatry 2017; 4:581-582. [PMID: 28748791 DOI: 10.1016/s2215-0366(17)30108-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 02/28/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Nick Bouras
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| | - George Ikkos
- Royal National Orthopaedic Hospital NHS Trust, Middlesex, UK
| | - Tom Craig
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
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19
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An assessment of need for mental health rehabilitation amongst in-patients in a Welsh region. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1285-91. [PMID: 27059660 DOI: 10.1007/s00127-016-1213-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Rehabilitation services have received little attention in the literature compared with other types of mental health service provision over the past 15 years. However, they are an important component of whole-system functioning in mental health services. Lack of provision has a particular impact on acute in-patient services. Poor pathway management can result in delayed discharges, placement of service users far from home, and resultant loss of resource for the local mental health economy. METHODS A cross-sectional study gathered demographic, clinical, service utilisation, and financial data on 100 participants from out of area, rehabilitation and acute mental health units. Financial data was provided by the Health Board. Other data were gathered by two clinicians from case records and staff interviews. FINDINGS 26.0 % of people were inappropriately placed, with frequent overprovision of support. It was calculated that within an annual budget of £12.7 M, £2.5 M (19.7 % of the total expenditure on this patient group) could be saved if all placements were appropriate. INTERPRETATION There were differences between the three cohorts. Those placed out of area had the most complex needs, although those in rehabilitation placements were similar. Most participants had been in contact with services for more than 5 years. A system better matched to their needs would benefit these patients and would also generate financial savings for reinvestment in the mental health economy.
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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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Edwards T, Macpherson R, Commander M, Meaden A, Kalidindi S. Services for people with complex psychosis: towards a new understanding. BJPsych Bull 2016; 40:156-61. [PMID: 27280038 PMCID: PMC4887735 DOI: 10.1192/pb.bp.114.050278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper describes the need for commissioners and service providers to consider the development of a whole-system approach to providing rehabilitation services for patients with complex psychosis, in the context of the current economic pressures and emergence of a competitive market in this area of mental health. The practical and organisational arrangements for the management of risk with such services are described, taking into account the varying provision of rehabilitation services across the UK and considering how these can be developed against the care clustering system and interfaces with other mental health services.
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Affiliation(s)
- Tom Edwards
- Dudley and Walsall Mental Health Partnership NHS Trust
| | | | | | - Alan Meaden
- Birmingham and Solihull Mental Health NHS Foundation Trust
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