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Tholen MG, Martin A, Stemeseder T, Vikoler T, Wageneder B, Aichhorn W, Kaiser AK. Evaluation of a flexible assertive community treatment (FACT) program for patients with severe mental illness: an observational study in Salzburg, Austria. Int J Ment Health Syst 2024; 18:6. [PMID: 38336693 PMCID: PMC10858489 DOI: 10.1186/s13033-024-00628-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Inpatient treatment of severe mentally ill patients binds substantial resources and creates the dilemma of "revolving-door hospitalizations". Evidence suggests that these patients benefit more from an assertive outreach community psychiatric treatment. This descriptive study evaluates the implementation of a new treatment program for severe mentally ill patients provided by a flexible assertive community treatment (FACT) team. METHODS An uncontrolled design with routine data was used to measure the total length of stays, readmission rates and number of contacts one year prior to the implementation of the FACT program and the following first three years of treatment. RESULTS A continuous decrease of hospitalization among patients with severe mental illness was observed with the implementation of the FACT program with declines in total length of stays and readmission rates and accompanied with a decreasing number of contacts per year. CONCLUSION Our findings indicate that this program may create effects in stabilizing patients with severe mental illness and may be highly relevant also for other patient groups.
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Affiliation(s)
- Matthias Gerhard Tholen
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria.
| | - Anna Martin
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
| | - Theresa Stemeseder
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Vikoler
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Barbara Wageneder
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
| | - Wolfgang Aichhorn
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Kurt Kaiser
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
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Hindenoch M, Kostova M, Urdapilleta I, Del Goleto S, Passerieux C. Health and Social Case Management for the Inclusion of People Living with a Schizophrenic Disorder: The PASSVers Experience. Community Ment Health J 2023; 59:1375-1387. [PMID: 37071385 PMCID: PMC10111323 DOI: 10.1007/s10597-023-01125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/30/2023] [Indexed: 04/19/2023]
Abstract
The way the social protection system in France is organized frequently leads to coordination difficulties between the social and healthcare sectors. A health and social program has been implemented in a French medical-psychological center to optimize the coherence of the pathway for people living with schizophrenia. This study evaluated the way users and professionals perceive this program so as to assess the relevance of double case management. Semi-structured interviews were conducted with users (N = 21) and professionals (N = 11) of this program and then analyzed with Alceste software. The results highlight the overall satisfaction of the participants with the program, and the double case management was shown to be beneficial in supporting people living with schizophrenia in their life project. These results indicate that this program enabled the emergence of a collective empowerment, which could assist with the recovery process of schizophrenia.
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Affiliation(s)
- Marie Hindenoch
- Laboratoire Paragraphe (UR 349), Université Paris 8 Vincennes-Saint-Denis, Saint-Denis, France.
- Laboratoire Cognition Humaine et Artificielle - CHArt (UR 4004), Université Paris 8 Vincennes-Saint-Denis, Saint-Denis, France.
- Université Versailles Saint-Quentin-en-Yvelines Paris Saclay, Inserm UMR 1018, CESP, "DevPsy", Villejuif, France.
| | - Milena Kostova
- Laboratoire Paragraphe (UR 349), Université Paris 8 Vincennes-Saint-Denis, Saint-Denis, France
| | - Isabel Urdapilleta
- Laboratoire Cognition Humaine et Artificielle - CHArt (UR 4004), Université Paris 8 Vincennes-Saint-Denis, Saint-Denis, France
| | - Sarah Del Goleto
- Centre Expert Schizophrénie, Hôpital Albert Chenevier, Créteil, France
| | - Christine Passerieux
- Université Versailles Saint-Quentin-en-Yvelines Paris Saclay, Inserm UMR 1018, CESP, "DevPsy", Villejuif, France
- Service de psychiatrie et d'addictologie, Centre Hospitalier de Versailles, Le Chesnay, France
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3
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van Genk C, Roeg D, van Vugt M, van Weeghel J, Van Regenmortel T. Current insights of community mental healthcare for people with severe mental illness: A scoping review. Front Psychiatry 2023; 14:1156235. [PMID: 37143787 PMCID: PMC10151504 DOI: 10.3389/fpsyt.2023.1156235] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/23/2023] [Indexed: 05/06/2023] Open
Abstract
Background For the last four decades, there has been a shift in mental healthcare toward more rehabilitation and following a more humanistic and comprehensive vision on recovery for persons with severe mental illness (SMI). Consequently, many community-based mental healthcare programs and services have been developed internationally. Currently, community mental healthcare is still under development, with a focus on further inclusion of persons with enduring mental health problems. In this review, we aim to provide a comprehensive overview of existing and upcoming community mental healthcare approaches to discover the current vision on the ingredients of community mental healthcare. Methods We conducted a scoping review by systematically searching four databases, supplemented with the results of Research Rabbit, a hand-search in reference lists and 10 volumes of two leading journals. We included studies on adults with SMI focusing on stimulating independent living, integrated care, recovery, and social inclusion published in English between January 2011 and December 2022 in peer-reviewed journals. Results The search resulted in 56 papers that met the inclusion criteria. Thematic analysis revealed ingredients in 12 areas: multidisciplinary teams; collaboration within and outside the organization; attention to several aspects of health; supporting full citizenship; attention to the recovery of daily life; collaboration with the social network; tailored support; well-trained staff; using digital technologies; housing and living environment; sustainable policies and funding; and reciprocity in relationships. Conclusion We found 12 areas of ingredients, including some innovative topics about reciprocity and sustainable policies and funding. There is much attention to individual ingredients for good community-based mental healthcare, but very little is known about their integration and implementation in contemporary, fragmented mental healthcare services. For future studies, we recommend more empirical research on community mental healthcare, as well as further investigation(s) from the social service perspective, and solid research on general terminology about SMI and outpatient support.
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Affiliation(s)
- Caroline van Genk
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- *Correspondence: Caroline van Genk,
| | - Diana Roeg
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- Kwintes Housing and Rehabilitation Services, Zeist, Netherlands
| | - Maaike van Vugt
- Trimbos Institute, Dutch Institute of Mental Health and Addiction, Utrecht, Netherlands
- HVO-Querido, Amsterdam, Netherlands
| | - Jaap van Weeghel
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | - Tine Van Regenmortel
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- Faculty of Social Sciences – HIVA, University of Leuven, Leuven, Belgium
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Gremyr A, Holmberg C, Thor J, Malm U, Gäre BA, Andersson AC. How a point-of-care dashboard facilitates co-production of health care and health for and with individuals with psychotic disorders: a mixed-methods case study. BMC Health Serv Res 2022; 22:1599. [PMID: 36585696 PMCID: PMC9803257 DOI: 10.1186/s12913-022-08992-2] [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: 04/19/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Individuals with psychotic disorders experience widespread treatment failures and risk early death. Sweden's largest department specializing in psychotic disorders sought to improve patients' health by developing a point-of-care dashboard to support joint planning and co-production of care. The dashboard was tested for 18 months and included more than 400 patients at two outpatient clinics. METHODS This study evaluates the dashboard by addressing two questions: 1) Can differences in health-related outcome measures be attributed to the use of the dashboard? 2) How did the case managers experience the accessibility, use, and usefulness of the dashboard for co-producing care with individuals with psychotic disorders? This mixed-method case study used both Patient-Reported Outcome Measures (PROM) and data from a focus group interview with case managers. Data collection and analysis were framed by the Clinical Adoption Meta Model (CAMM) phases: i) accessibility, ii) system use, iii) behavior, and iv) clinical outcomes. The PROM used was the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0), which assesses functional impairment and disability. Patients at clinics using the dashboard were matched with patients at clinics not using the dashboard. PROM data were compared using non-parametric statistics due to skewness in distribution. The focus group included five case managers who had experience using the dashboard with patients. RESULTS Compared to patients from clinics that did not use the dashboard, patients from clinics that did use the dashboard improved significantly overall (p = 0.045) and in the domain self-care (p = 0.041). Focus group participants reported that the dashboard supported data feedback-informed care and a proactive stance related to changes in patients' health. The dashboard helped users identify critical changes and enabled joint planning and evaluation. CONCLUSION Dashboard use was related to better patient health (WHODAS scores) when compared with matched patients from clinics that did not use the dashboard. In addition, case managers had a positive experience using the dashboard. Dashboard use might have lowered the risk for missing critical changes in patients' health while increasing the ability to proactively address needs. Future studies should investigate how to enhance patient co-production through use of supportive technologies.
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Affiliation(s)
- Andreas Gremyr
- grid.1649.a000000009445082XDepartment of Psychotic Disorders, Sahlgrenska University, Hospital, Sahlgrenska Universitetssjukhuset Psykiatri Psykos, Göteborgsvägen 31, 431 80, Mölndal, Sweden ,grid.118888.00000 0004 0414 7587Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, 55111 Jönköping, Sweden
| | - Christopher Holmberg
- grid.1649.a000000009445082XDepartment of Psychotic Disorders, Sahlgrenska University, Hospital, Sahlgrenska Universitetssjukhuset Psykiatri Psykos, Göteborgsvägen 31, 431 80, Mölndal, Sweden ,grid.8761.80000 0000 9919 9582Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30 Göteborg, Sweden
| | - Johan Thor
- grid.118888.00000 0004 0414 7587Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, 55111 Jönköping, Sweden
| | - Ulf Malm
- grid.8761.80000 0000 9919 9582Sahlgrenska Academy at Gothenburg University, Institute of Neuroscience and Physiology, Box 400, 40530 Göteborg, Sweden
| | - Boel Andersson Gäre
- grid.118888.00000 0004 0414 7587Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, 55111 Jönköping, Sweden ,Futurum Academy for Health and Care, Region Jönköping County, Jönköping, Sweden
| | - Ann-Christine Andersson
- grid.118888.00000 0004 0414 7587Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, 55111 Jönköping, Sweden ,grid.32995.340000 0000 9961 9487Department of Care Science, Malmö University, Nordenskiöldsgatan 1, 21119 Malmö, Sweden
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Stevović LI, Repišti S, Radojičić T, Sartorius N, Tomori S, Kulenović AD, Popova A, Kuzman MR, Vlachos II, Statovci S, Bandati A, Novotni A, Bajraktarov S, Panfil AL, Maric N, Delić M, Jovanović N. Non-pharmacological interventions for schizophrenia—analysis of treatment guidelines and implementation in 12 Southeast European countries. SCHIZOPHRENIA 2022; 8:10. [PMID: 35232972 PMCID: PMC8888596 DOI: 10.1038/s41537-022-00226-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/17/2021] [Indexed: 11/09/2022]
Abstract
AbstractThis study aimed to analyze treatment guidelines of 12 SEE countries to identify non-pharmacological interventions recommended for schizophrenia, explore the evidence base supporting recommendations, and assess the implementation of recommended interventions. Desk and content analysis were employed to analyze the guidelines. Experts were surveyed across the 12 countries to assess availability of non-pharmacological treatments in leading mental health institutions, staff training, and inclusion in the official service price list. Most SEE countries have published treatment guidelines for schizophrenia focused on pharmacotherapy. Nine countries—Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Moldova, Montenegro, North Macedonia, and Serbia—included non-pharmacological interventions. The remaining three countries—Kosovo (UN Resolution), Romania, and Slovenia—have not published such treatment guidelines, however they are on offer in leading institutions. The median number of recommended interventions was seven (range 5–11). Family therapy and psychoeducation were recommended in most treatment guidelines. The majority of recommended interventions have a negative or mixed randomized controlled trial evidence base. A small proportion of leading mental health institutions includes these interventions in their official service price list. The interventions recommended in the treatment guidelines seem to be rarely implemented within mental health services in the SEE countries.
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Psychische Erkrankungen in der Adoleszenz – Behandlungsansätze und klinische Erfahrungen. Prax Kinderpsychol Kinderpsychiatr 2022; 71:658-676. [DOI: 10.13109/prkk.2022.71.7.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Inpatient equivalent home-treatment (IEHT) was implemented in Germany in 2018. Persons with a mental disorder can be admitted to acute multiprofessional IEHT to avoid or shorten inpatient hospital treatment. Exclusion criteria are amongst others lack of consent of cohabitants or endangerment of self and others. Advantages of IEHT include normalization and reduction of stigma. Nevertheless, administrative requirements are high. While there is international evidence for home treatment and crisis resolution teams, there is still a lack of evidence for the concept of IEHT, although specific studies are currently being carried out (e.g. AktiV study financed by the Innovation Fund). Overall, IEHT is important for mental health services and should be further developed.
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Karow A, Luedecke D, Schöttle D, Rohenkohl A, Schimmelmann B, Gallinat J, Lambert M. [Characteristics of psychoses in adolescence-Longitudinal data of integrated care]. DER NERVENARZT 2022; 93:331-340. [PMID: 35277731 DOI: 10.1007/s00115-022-01276-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Integrated care according to the Hamburg model combines therapeutic assertive community treatment (TACT) with initiatives for early detection and early treatment of schizophrenia and affective psychoses. The aim of this study was to identify the clinical characteristics of adolescents in comparison to adult patients and to derive knowledge for transition-specific treatment approaches. METHODOLOGY Sociodemographic and clinical variables as well as treatment performance and clinical outcome were investigated over a period of 12 months in 167 patients with psychoses (16-25 years, n = 88; and >25 years, n = 79). RESULTS Patients with psychosis in adolescence had significantly more outpatient treatment contacts (3.5/week vs. 1.6/week; p < 0.001), while adults were hospitalized for twice as long (10 days vs. 21 days; p = 0.003). The duration of untreated psychoses was significantly shorter in the adolescent group than in adults (122 weeks vs. 208 weeks; p = 0.002). The proportion of comorbid mental disorders was significantly higher in the adolescent group (87% vs. 63%; p < 0.001). In addition, the adolescence patients already showed greater impairment of daily functions and a higher severity of illness at the start of treatment. DISCUSSION The treatment of psychoses in adolescence was characterized by a particularly high need for flexibility across all sectors and support systems, taking comorbid problem areas into account. Care models for adolescents and young adults with psychoses should therefore combine treatment approaches for severely ill patients with transition psychiatric interventions to avoid breaks in care and to meet the complex requirements of young patients with severe mental illnesses.
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Affiliation(s)
- Anne Karow
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Daniel Luedecke
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Daniel Schöttle
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Anja Rohenkohl
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Benno Schimmelmann
- Universitätsklinik für Kinder- und Jugendpsychiatrie, Universität Bern, Bern, Schweiz
| | - Jürgen Gallinat
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Martin Lambert
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
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Hindenoch M, Kostova M, Passerieux C, Urdapilleta I. L’analyse lexicale au service de l’évaluation d’un dispositif d’accompagnement socio-sanitaire à destination de personnes vivant avec une schizophrénie. EVOLUTION PSYCHIATRIQUE 2022. [DOI: 10.1016/j.evopsy.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Risk Factors for Relapse in People with Severe Mental Disorders during the COVID-19 Pandemic: A Multicenter Retrospective Study. Healthcare (Basel) 2021; 10:healthcare10010064. [PMID: 35052228 PMCID: PMC8775518 DOI: 10.3390/healthcare10010064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Evidence suggests that different variables associated with the COVID-19 pandemic may increase the risk of relapse in people with Severe Mental Disorders (SMDs). However, no studies have yet looked closely at the different risk factors involved to determine their influence on the worsening of these patients’ illnesses. Objective: To analyze which variables related to the COVID-19 pandemic have increased the risk of relapse in patients with SMDs. Method: A multicenter retrospective cohort study in which data were collected from 270 patients with mental disorders who had been under follow-up in day hospitals during the year 2020. Results: The proportion of full mental health inpatient admissions was significantly higher in those who lost their employment (40.7% vs. 18.1%; p = 0.01), in those who were not receiving psychotherapy interventions (33.9% vs. 16.6%; p = 0.006), and in those who were not receiving occupational therapy (25.7% vs. 13.6%: p = 0.013). Significant associations were detected between urgent mental health consultations, the number of COVID-19 symptoms (B = 0.274; p = 0.02), and the low-income group (1.2424 vs. 0.4583; p = 0.018). Conclusions: COVID-19 symptoms and certain consequences of the pandemic, such as loss of employment, economic hardship, and loss of interventions, have brought about clinical worsening in people with SMDs. Knowledge of these factors is important for health-related decision-making in future outbreaks or pandemics.
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The Greek Hybrid Version of the Assertive Community Treatment Model: A Perspective View between Challenges and Limitations. PSYCH 2021. [DOI: 10.3390/psych3040050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Assertive Community Treatment (ACT) model of care has been long considered to be effective in the management of patients with severe mental illness (SMI) in most Western countries. The implementation of the original ACT model may be particularly challenging in rural and remote communities with small and dispersed populations and lack of adequate mental health services. Rural programs may have to adapt the model and modify the ACT fidelity standards to accommodate these limitations, and this is the rationale for the introduction of more flexible, hybrid ACT models. In rural Greece, the so called Mobile Mental Health Units (MMHUs) are well-established community mental health services. For patients with SMI that have difficulties engaging with treatment services, the new hybrid ACT model has been recently launched. The objective of this manuscript is to present the recently launched hybrid ACT model in rural areas in Greece and to explore the challenges and limitations in its implementation from the experience of a team of mental health professionals with ACT experience. Referral criteria have not been strictly set, but the number of previous relapses and hospitalizations is taken under consideration, as well as the history of poor treatment adherence and disengagement from mental health services. The main limitation in the implementation of the hybrid ACT service is that it has been introduced in several areas in the absence of a pre-existing community mental health service. This may impact referrals and limit focus on the difficult cases of patients with SMI, thus making the evaluation of the model inapplicable.
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Tjaden C, Mulder CL, den Hollander W, Castelein S, Delespaul P, Keet R, van Weeghel J, Kroon H. Effectiveness of Resource Groups for Improving Empowerment, Quality of Life, and Functioning of People With Severe Mental Illness: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:1309-1318. [PMID: 34643679 PMCID: PMC8515257 DOI: 10.1001/jamapsychiatry.2021.2880] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/17/2021] [Indexed: 12/16/2022]
Abstract
Importance Although the importance of recovery-oriented care for people with severe mental illness (SMI) is widely acknowledged, essential elements such as personalization and involvement of significant others are not adequately implemented in practice. Objective To determine whether using resource groups (RGs) within flexible assertive community treatment (FACT) has favorable effects on empowerment and recovery-related outcomes in people with SMI. Design, Setting, and Participants This assessor-blind, multisite randomized clinical trial was conducted from September 1, 2017, to September 30, 2020, with follow-up at 9 and 18 months. A total of 158 participants aged 18 to 65 years meeting the criteria for SMI were randomly allocated to FACT plus RG vs FACT as usual (1:1) in 20 FACT teams throughout the Netherlands. Data were analyzed from September 1, 2020, to January 31, 2021. The study was prespecified in the trial protocol and data from the intent-to-treat population were analyzed. Interventions In the FACT plus RG condition, patients chose members from their informal and formal networks to form an RG that meets quarterly to discuss self-formulated recovery goals. The RG was integrated into the multidisciplinary support provided by the FACT team. In the FACT as-usual condition, empowerment (defined as overcoming powerlessness and gaining control of one's life) and involvement of significant others was also part of the provided care, but without the structure of the RG. Main Outcomes and Measures The primary outcome was self-reported empowerment, measured with the Netherlands Empowerment List. Results A total of 158 participants with SMI (median age, 38 [median absolute deviation, 13] years; 93 men [58.9%]) were randomized to FACT plus RG (n = 80) or FACT as usual (n = 78) care. Intention-to-treat analyses showed that randomization to the RG condition was associated with a clinically significant increase in empowerment (Cohen d, 0.54; 95% CI, 0.21-0.86) and improved outcomes with small to medium effect sizes in terms of quality of life (Cohen d, 0.25; 95% CI, -0.07 to 0.56), personal recovery (Cohen d, 0.38; 95% CI, 0.06-0.69), quality of social contact (Cohen d, 0.24; 95% CI, -0.07 to 0.56), disability (Cohen d, 0.29; 95% CI, -0.03 to 0.60), general functioning (Cohen d, 0.30; 95% CI, -0.01 to 0.62), and social functioning (Cohen d, 0.28; 95% CI, -0.04 to 0.59). No differences between conditions were found regarding psychopathological symptoms, attachment, frequency of social contact, and employment. Compared with FACT as usual, participants who stayed with the assigned treatment in the RG condition were more satisfied with treatment at 9 (Cohen d = 0.45; t135 = -2.62; P = .009) and 18 (Cohen d = 0.41; t116 = -2.22; P = .02) months. Conclusions and Relevance These findings show that working with RGs improves empowerment and other mental health outcomes in people with SMI who receive community-based mental health services. This method of network-oriented care empowers people with SMI within their own environment. Trial Registration Netherlands Trial Register Identifier: NL6548.
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Affiliation(s)
- Cathelijn Tjaden
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, the Netherlands
- Tranzo Scientific Center for Care and Welfare, Department of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Cornelis L. Mulder
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
- Parnassia Psychiatric Institute, Rotterdam, the Netherlands
| | - Wouter den Hollander
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, the Netherlands
| | - Stynke Castelein
- Lentis Research, Lentis Psychiatric Institute, Groningen, the Netherlands
- Faculty of Behavioural and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Philippe Delespaul
- School of Mental Health and NeuroSciences, Maastricht University, Maastricht, the Netherlands
- Mondriaan Mental Health Trust, Maastricht/Heerlen, the Netherlands
| | - Rene Keet
- Department of Community Mental Health, GGZ Noord-Holland-Noord, Heiloo, the Netherlands
| | - Jaap van Weeghel
- Tranzo Scientific Center for Care and Welfare, Department of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
- Phrenos Centre of Expertise, Utrecht, the Netherlands
| | - Hans Kroon
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, the Netherlands
- Tranzo Scientific Center for Care and Welfare, Department of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
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Sjöström N, Waern M, Johansson A, Weimand B, Johansson O, Ewertzon M. Relatives' Experiences of Mental Health Care, Family Burden and Family Stigma: Does Participation in Patient-Appointed Resource Group Assertive Community Treatment (RACT) Make a Difference? Issues Ment Health Nurs 2021; 42:1010-1019. [PMID: 34060978 DOI: 10.1080/01612840.2021.1924322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this exploratory cross-sectional study was to investigate the experiences of relatives of individuals with severe mental illness with and without participation in patient-appointed Resource Group Assertive Community Treatment (RACT). A total of 139 relatives (79 with and 60 without RACT) completed the Family Involvement and Alienation Questionnaire, the Burden Inventory for Relatives of Persons with Psychotic Disturbances, and the family version of the Inventory of Stigmatizing Experiences. We found that relatives participating in RACT experienced a more positive approach from the healthcare professionals, as well as a lower degree of alienation from the provision of care. Relatives who did not participate in RACT were more afraid that their ill next of kin would hurt someone. No other differences in family burden were found. Experiences of family stigmatization were similar in both groups. In conclusion, participating in patient-appointed RACT may contribute to a higher level of satisfaction for relatives in their encounter with healthcare professionals and a more positive alliance. Implementation of RACT in new settings would require adaptation to local conditions to facilitate cooperation between healthcare staff and other relevant services. Staff training focuses on the case manager function and needs assessment, as well as how to create an alliance with the patient and his/her relatives.
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Affiliation(s)
- Nils Sjöström
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Margda Waern
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
| | - Anita Johansson
- Research and Development Centre, Skaraborgs Hospital, Skövde, Sweden
| | - Bente Weimand
- Faculty of Health and Social Sciences, Department of Health, Social & Welfare Studies, University of South-Eastern Norway, Drammen, Norway.,Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Ola Johansson
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mats Ewertzon
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Swedish Family Care Competence Centre, Kalmar, Sweden
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14
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Bechdolf A, Bühling-Schindowski F, Nikolaidis K, Kleinschmidt M, Weinmann S, Baumgardt J. [Evidence on the effects of crisis resolution teams, home treatment and assertive outreach for people with mental disorders in Germany, Austria and Switzerland - a systematic review]. DER NERVENARZT 2021; 93:488-498. [PMID: 34114073 DOI: 10.1007/s00115-021-01143-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Based on international randomized controlled trials (RCT) the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) recommends acute treatment in the domestic environment (AHU) and intensive outreach treatment (IAB) with the highest level of evidence; however, due to large differences in national healthcare systems the transference of results from international studies to the healthcare systems in Germany, Austria and Switzerland could be limited. OBJECTIVE Evaluation of studies on outreach psychiatric treatment forms in Germany, Austria and Switzerland and discussion of the results in the light of international evidence. MATERIAL AND METHODS A systematic literature search for clinical trials on outreach community treatment from Germany, Austria and Switzerland was conducted in the PubMed database. RESULTS A total of 19 publications were identified which could be assigned to 5 publications on 4 studies with 2857 patients on AHU and 14 publications on 10 studies with 3207 patients on IAB. The studies on AHU showed this treatment form to be superior regarding the duration of inpatient stay and healthcare costs. The studies on IAB showed more positive outcomes in comparison to controls regarding symptoms, severity of illness, substance abuse, functioning level, remission, satisfaction with treatment, quality of life, healthcare costs, work and housing situations. CONCLUSION The studies from Germany, Austria, and Switzerland suggest that outreach community treatment is superior regarding several outcome parameters. Thus, there are no indications suggesting that international evidence could not be valid for these countries. Additionally, with one RCT for AHU and one for IAB the requirements for an evidence level of 1b for outreach community treatment in the healthcare systems in question are fulfilled.
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Affiliation(s)
- Andreas Bechdolf
- Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain - Akademische Lehrkrankenhäuser Charité-Universitätsmedizin Berlin, Dieffenbachstr. 1, 10967, Berlin, Deutschland. .,Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Köln, Köln, Deutschland. .,ORYGEN, National Center of Excellence of Youth Mental, Health, University of Melbourne, Melbourne, Australien.
| | - Felix Bühling-Schindowski
- Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain - Akademische Lehrkrankenhäuser Charité-Universitätsmedizin Berlin, Dieffenbachstr. 1, 10967, Berlin, Deutschland
| | - Konstantinos Nikolaidis
- Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain - Akademische Lehrkrankenhäuser Charité-Universitätsmedizin Berlin, Dieffenbachstr. 1, 10967, Berlin, Deutschland
| | - Martin Kleinschmidt
- Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain - Akademische Lehrkrankenhäuser Charité-Universitätsmedizin Berlin, Dieffenbachstr. 1, 10967, Berlin, Deutschland
| | - Stefan Weinmann
- Klinik für Psychiatrie und Psychotherapie, Rudolf-Sophien-Stift, Stuttgart, Deutschland.,Universitätsspital Basel, Basel, Schweiz
| | - Johanna Baumgardt
- Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain - Akademische Lehrkrankenhäuser Charité-Universitätsmedizin Berlin, Dieffenbachstr. 1, 10967, Berlin, Deutschland
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15
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Tjaden CD, Boumans J, Mulder CL, Kroon H. Interpersonal Relations Within the Context of Resource Groups for People With Severe Mental Illness: A Narrative Approach. Front Psychiatry 2021; 12:632437. [PMID: 33643099 PMCID: PMC7907181 DOI: 10.3389/fpsyt.2021.632437] [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: 11/23/2020] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The resource group method intends to promote patients' agency and self-management and to organize meaningful partnerships between patients and their informal and formal support systems. The aim of this study was to enhance the understanding of interpersonal dynamics that arise within resource groups for people with severe mental illness. Insight into these unfolding processes would enable improved implementation of the resource group method so that it contributes to establishing a positive social environment, which can lead to more enduring recovery. Methodology: We performed a narrative analysis of transcripts and field notes obtained in a longitudinal, qualitative study on the resource group method. The stories of four different resource groups were reconstructed and analyzed in depth. Data included a total of 36 interviews (with patients, significant others, and mental health professionals) and 18 observations of resource group meetings. Results: The degree to which the resource group method actually contributes to recovery was based on the extent to which the existing roles of and patterns between the patient and his/her resource group members were altered. Breaking through old patterns of inequality and the joint search for a new balance in relationships proved to be crucial processes for establishing an empowering resource group. The four cases showed that it takes time, patience, and small steps back and forth to overcome the struggles and fears related to finding new ways of relating to each other. An honest and reflective atmosphere in which all participants are encouraged to participate and be curious about themselves and each other is essential for changes in interpersonal dynamics to emerge. Such changes pave the way for individuals with SMI to find their own voices and pursue their unique recovery journeys. Conclusions: The functioning of the resource group and the ability of the involved members to respond in new ways are important when working toward the patient's recovery goals. The resource group method should therefore not be considered an intervention to organize informal support for the patient, but a platform to expose and adjust the functioning of the patient's social network as a whole.
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Affiliation(s)
- Cathelijn D. Tjaden
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, Netherlands
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands
| | - Jenny Boumans
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, Netherlands
| | - Cornelis L. Mulder
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
- Research Department ESPRi, Parnassia Psychiatric Institute, Rotterdam, Netherlands
| | - Hans Kroon
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, Netherlands
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands
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16
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Peritogiannis V, Gioti P, Gogou A, Samakouri M. Decrease of hospitalizations and length of hospital stay in patients with schizophrenia spectrum disorders treated in a community mental health service in rural Greece. Int J Soc Psychiatry 2020; 66:693-699. [PMID: 32552161 DOI: 10.1177/0020764020924462] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The treatment of severe and chronic mental disorders, such as schizophrenia and related syndromes, is largely based on community mental health services. AIMS The objective of the present study was to assess hospital admissions and length of hospital stay in patients with schizophrenia and related disorders, who are engaged to treatment with a Mobile Mental Health Unit (MMHU I-T) in a defined rural catchment area in Greece. METHOD Data were retrieved retrospectively for 76 patients with schizophrenia and related disorders. For each patient, comparison was made for the same interval prior and after engagement to treatment with the MMHU I-T. RESULTS The average age of patients was 56 years and the mean illness duration was 28 years. The mean follow-up duration was 5.3 years. There was a statistically significant decrease in the annual average of the number of voluntary and involuntary hospitalizations and on days of hospital stay after treatment engagement with the MMHU I-T. CONCLUSIONS Treatment of schizophrenia spectrum disorders in rural residents by the MMHUs may contribute to the reduction of patients' admissions and length of hospital stay. Future research should address the cost-effectiveness of such interventions.
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Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Panagiota Gioti
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Afroditi Gogou
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Maria Samakouri
- Department of Psychiatry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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17
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Peritogiannis V, Nikolaou P. Functioning in community-dwelling patients with schizophrenia spectrum disorders in rural Greece. Int J Soc Psychiatry 2020; 66:111-117. [PMID: 31692402 DOI: 10.1177/0020764019882709] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a dearth of studies on functioning in patients with psychotic disorders in rural areas. AIM The objective of this study was to assess functioning in a population-based sample of patients with psychotic disorders who live in rural, remote and deprived areas in Greece, and to explore the differences in functioning across ages. METHODS The sample consisted of 61 patients with psychotic disorders that were engaged to treatment with a community mental health service. The mean age of patients was 54.2 years, and the mean illness duration was 26.5 years. RESULTS A total of 23 patients (37.7%) had score in the Global Assessment of Functioning scale >60, and were rated as adequately functioning, and 18 patients (29.5%) had score in Clinical Global Impression scale-Schizophrenia ⩽3 and could be rated as mildly or minimally ill. Functioning was found to be inversely related to the patients' symptomatology. No correlation with age was found. CONCLUSION This study suggests that a large proportion of patients with psychotic disorders in rural Greece may achieve a satisfactory level of functioning in the long-term, across the whole age range despite the not completely remitted symptomatology. More research is needed to clarify the factors associated with rural residency that may account for patients' functioning.
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Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
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18
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Tjaden CD, Boumans J, Mulder CL, Kroon H. Embracing the Social Nature of Recovery: A Qualitative Study on the Resource Group Method for People With Severe Mental Illness. Front Psychiatry 2020; 11:574256. [PMID: 33329113 PMCID: PMC7732607 DOI: 10.3389/fpsyt.2020.574256] [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: 07/15/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022] Open
Abstract
Objective: The resource group method for people with severe mental illness might provide a useful framework to facilitate patient's empowerment and systematically engage significant others. However, no research has explored the perspectives and experiences of patients and their significant others. This is crucial for better adjustment to the needs of the people using the method. The aim of this study was to develop a useful framework for a deeper understanding of the resource group method and its outcomes. Method: The study used a longitudinal, qualitative multiple case-study design based on grounded theory methodology. During a period of 2 years, the developments and processes in eight resource groups were explored by conducting a total of 74 interviews (e.g., with patients, significant others, and mental health professionals) and 26 observations of resource group meetings. Results: Analysis showed that a well-functioning resource group set the stage for five processes to unfold: (i) experience of support; (ii) acknowledgment of significant others; (iii) activation; (iv) openness; and (v) integration. These processes facilitated recovery both in terms of an arousing curiosity within the patient as well as increasing reciprocity and equality in their social relations. In addition, the method emphasized the uniqueness of each recovery journey, thereby providing a framework to shape recovery-oriented care. The analysis also revealed three hindering factors: (i) embedding and implementation issues; (ii) predominant network; and (iii) tensions inherent in the resource group setting. Conclusion: Working according to the resource group method involves that the person's recovery work becomes a social process that takes place in relation to the social environment and everyday life in which it is important to acknowledge and integrate the needs of significant others in treatment and care. This study provides a first step toward a multidimensional comprehension of the resource group method, the working mechanisms and its influence on recovery for people with severe mental illness.
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Affiliation(s)
- Cathelijn D Tjaden
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, Netherlands.,Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands
| | - Jenny Boumans
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, Netherlands
| | - Cornelis L Mulder
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands.,Antes, Parnassia Psychiatric Institute, Rotterdam, Netherlands
| | - Hans Kroon
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, Netherlands.,Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands
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19
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Stiekema APM, van Heugten CM, de Vugt ME. Joining forces to improve psychosocial care for people with cognitive deficits across diagnoses: social health as a common framework. Aging Ment Health 2019; 23:1275-1281. [PMID: 30450949 DOI: 10.1080/13607863.2018.1498446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cognitive deficits such as memory problems have a major impact on independence in daily life and participation in society in several populations, such as people with dementia, brain injury (i.e. stroke) or a severe mental illness such as schizophrenia. Similarities in the impact on participation and well-being have resulted in the development of comparable psychosocial interventions across populations, aiming to support people to adapt to cognitive deficits or by adapting the environment. These interventions are developed separately, without using the expertise in other fields. We argue that each of the fields and the field of psychosocial care in general would benefit from closer collaboration on development and evaluation of innovative psychosocial interventions. Collaboration has been complicated by the use of different care models and theoretical frameworks, each with their own terminology. The concept of social health - the ability to participate in work or other meaningful activities and to feel healthy despite a condition - translates to the leading care models within the fields of dementia, brain injury and severe mental illness. The concept of social health provides a common language and framework. In this paper, we elaborate on strategies for collaboration using examples of interventions to improve social health.
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Affiliation(s)
- Annemarie P M Stiekema
- a 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
| | - Caroline M van Heugten
- a 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.,b School for Mental Health and Neuroscience, Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University , Maastricht , The Netherlands
| | - Marjolein E de Vugt
- a 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
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20
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Keet R, de Vetten-Mc Mahon M, Shields-Zeeman L, Ruud T, van Weeghel J, Bahler M, Mulder CL, van Zelst C, Murphy B, Westen K, Nas C, Petrea I, Pieters G. Recovery for all in the community; position paper on principles and key elements of community-based mental health care. BMC Psychiatry 2019; 19:174. [PMID: 31182058 PMCID: PMC6558752 DOI: 10.1186/s12888-019-2162-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 05/23/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Service providers throughout Europe have identified the need to define how high-quality community-based mental health care looks to organize their own services and to inform governments, commissioners and funders. In 2016, representatives of mental health care service providers, networks, umbrella organizations and knowledge institutes in Europe came together to establish the European Community Mental Health Services Provider (EUCOMS) Network. This network developed a shared vision on the principles and key elements of community mental health care in different contexts. The result is a comprehensive consensus paper, of which this position paper is an outline. With this paper the network wants to contribute to the discussion on how to improve structures in mental healthcare, and to narrow the gap between evidence, policy and practice in Europe. MAIN TEXT The development of the consensus paper started with an expert workshop in April 2016. An assigned writing group representing the workshop participants built upon the outcomes of this meeting and developed the consensus paper with the input from 100 European counterparts through two additional work groups, and two structured feedback rounds via email. High quality community-based mental health care: 1) protects human rights; 2) has a public health focus; 3) supports service users in their recovery journey; 4) makes use of effective interventions based on evidence and client goals; 5) promotes a wide network of support in the community and; 6) makes use of peer expertise in service design and delivery. Each principle is illustrated with good practices from European service providers that are members of the EUCOMS Network. CONCLUSIONS Discussion among EUCOMS network members resulted in a blueprint for a regional model of integrated mental health care based upon six principles.
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Affiliation(s)
- René Keet
- GGZ NHN, Stationsplein 138, Heerhugowaard, The Netherlands
| | | | - Laura Shields-Zeeman
- Department Trimbos International, Trimbos Institute, Da Costakade 45, Utrecht, The Netherlands
| | - Torleif Ruud
- Clinical of Health Services Research and Psychiatry, Institute of Clinical Medicine, Medical Faculty, University of Oslo, Blindern, 0318 Oslo, Norway
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Jaap van Weeghel
- Kenniscentrum Phrenos, Da Costakade 45, Utrecht, The Netherlands
- Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
| | - Michiel Bahler
- GGZ NHN, Stationsplein 138, Heerhugowaard, The Netherlands
| | - Cornelis L. Mulder
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, The Netherlands
| | - Catherine van Zelst
- Department of Psychiatry and Neuropsychology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Billy Murphy
- Inspire Mental Health, 10-20 Lombard Street, Belfast, Northern Ireland
| | - Koen Westen
- Nursing Department, Avans Hogeschool, Onderwijsboulevard 215, ‘s-Hertogenbosch, The Netherlands
| | - Chris Nas
- Zilveren Kruis Achmea, Dellaertweg 1, 2316 WZ Leiden, The Netherlands
| | - Ionela Petrea
- Department Trimbos International, Trimbos Institute, Da Costakade 45, Utrecht, The Netherlands
| | - Guido Pieters
- Department of Psychiatry, KU Leuven, UZ Herestraat 49, Leuven, Belgium
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21
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Tjaden CD, Mulder CL, van Weeghel J, Delespaul P, Keet R, Castelein S, Boumans J, Leeman E, Malm U, Kroon H. The resource group method in severe mental illness: study protocol for a randomized controlled trial and a qualitative multiple case study. Int J Ment Health Syst 2019; 13:15. [PMID: 30949233 PMCID: PMC6429834 DOI: 10.1186/s13033-019-0270-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The resource group method provides a structure to facilitate patients' empowerment and recovery processes, and to systematically engage significant others in treatment and care. A patient chooses members of a resource group (RG) that will work together on fulfilling patients' recovery plan. By adopting shared decision-making processes and stimulating collaboration of different support systems, a broad and continuous support of patients' chosen goals and wishes is preserved and problem solving and communication skills of the RG members are addressed. OBJECTIVE The objectives of this study are (1) to establish the effectiveness of the RG method in increasing empowerment in patients with severe mental illnesses (SMI) in the Netherlands; (2) to investigate the cost-effectiveness and cost utility of the RG method; and (3) to qualitatively explore its dynamics and processes. METHODS/DESIGN This multisite randomized controlled trial will compare the effects of the RG-method integrated in Flexible Assertive Community Treatment (FACT) (90 patients) with those of standard FACT (90 patients). Baseline assessments and 9-month and 18-month follow-up assessments will be conducted in face-to-face home visits. The primary outcome measure, empowerment, will be assessed using the Netherlands Empowerment List (NEL). The secondary outcomes will be quality of life (MANSA); personal, community and clinical recovery (I.ROC); general, social and community functioning (WHODAS 2.0); general psychopathological signs and symptoms (BSI-18); and societal costs (TiC-P). An economic evaluation of the cost-effectiveness and cost utility of the RG method will also be conducted. A qualitative multiple case-study will be added to collect patients', RG members' and professionals' perspectives by in-depth interviews, observations and focus groups. DISCUSSION This trial will be the first to study the effects of the RG method on empowerment in patients with SMI. By combining clinical-effectiveness data with an economic evaluation and in-depth qualitative information from primary stakeholders, it will provide a detailed overview of the RG method as a mean of improving care for patients with SMI.Trial registration The study has been registered in the Dutch Trial Register, identifier: NTR6737, September 2017.
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Affiliation(s)
- Cathelijn D. Tjaden
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, The Netherlands
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
| | - Cornelis L. Mulder
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
- Antes, Parnassia Psychiatric Institute, Rotterdam, The Netherlands
| | - Jaap van Weeghel
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
- Phrenos Centre of Expertise, Utrecht, The Netherlands
| | - Philippe Delespaul
- School of Mental Health and NeuroSciences, Maastricht University, Maastricht, The Netherlands
- Mondriaan Mental Health Trust, Maastricht/Heerlen, The Netherlands
| | - Rene Keet
- Department of Community Mental Health, GGZ Noord-Holland-Noord, Heiloo, The Netherlands
| | - Stynke Castelein
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jenny Boumans
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, The Netherlands
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
| | - Eva Leeman
- Antes, Parnassia Psychiatric Institute, Rotterdam, The Netherlands
| | - Ulf Malm
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Kroon
- Department of Reintegration and Community Care, Trimbos Institute, Utrecht, The Netherlands
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
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22
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Innovative Versorgungsmodelle für Menschen mit schizophrenen Erkrankungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:163-172. [DOI: 10.1007/s00103-018-2868-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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23
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Schout G, de Jong G. Nursing and the Emergence of Egoless Care: A Discussion on Social Engineering in Mental Health. Issues Ment Health Nurs 2018; 39:159-165. [PMID: 29193999 DOI: 10.1080/01612840.2017.1387626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The narrowing of the diverse fields of psychiatry to just the single dimension of the biomedical model has resulted in a situation where professions with a focus on curing (psychiatrists and psychologists) are favoured over those with a focus on caring and encouraging near communities to care for each other (nurses). The social engineering of mental problems leads to a state of helplessness. This paper contributes to an understanding of the barriers to utilise the social resources of people with mental health problems and argues for forms of "indirect social engineering" and "egoless care," and, ultimately, a rediscovery of nursing, using the mental health care in the Netherlands as a case study.
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Affiliation(s)
- Gert Schout
- a Senior Researcher, Department of Medical Humanities , EMGO+, VU University Medical Centre , Amsterdam , the Netherlands
| | - Gideon de Jong
- b Senior Researcher and Lecturer, School of Nursing and Midwifery, Edith Cowan University , Joondalup , WA , Australia
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Lambert M, Schöttle D, Sengutta M, Ruppelt F, Rohenkohl A, Luedecke D, Nawara LA, Galling B, Falk AL, Wittmann L, Niehaus V, Sarikaya G, Handwerk U, Rothländer W, Rietschel L, Gagern C, Lange B, Meigel-Schleiff C, Naber D, Schulte-Markwort M, Krüger H, Unger HP, Sippel S, Ott S, Romer G, Daubmann A, Wegscheider K, Correll CU, Schimmelmann BG, Bock T, Gallinat J, Karow A. Early detection and integrated care for adolescents and young adults with severe psychotic disorders: rationales and design of the Integrated Care in Early Psychosis Study (ACCESS III). Early Interv Psychiatry 2018; 12:96-106. [PMID: 27618789 DOI: 10.1111/eip.12361] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/25/2016] [Accepted: 06/28/2016] [Indexed: 12/18/2022]
Abstract
AIM The Integrated Care in Early Psychosis (ACCESS III) Study examined the efficacy and cost-effectiveness of a combined intervention consisting of strategies to improve early detection and quality of care (integrated care including therapeutic assertive community treatment) in adolescents and young adults in the early phase of a severe psychotic disorder from 2011 to 2014. METHODS This is a prospective, single-centre, 1-year cohort study comparing an intervention condition (early detection plus integrated care, n = 120) to the historical control condition (standard care, SC, n = 105) for adolescents and young adults aged 12-29 years suffering from a severe, early-phase psychotic disorder (i.e. within 2 years of treatment). RESULTS Primary outcome is the rate of combined symptomatic (i.e. Positive and Negative Syndrome Scale (PANSS) criteria) and functional (i.e. Global Assessment of Functioning scale (GAF) ≥ 60 points criterion) remission over at least 6 months at study endpoint. Secondary outcome comprises the comparison of the reduction in the duration of untreated psychosis within the 4-year study duration between integrated care and SC, course of psychopathology, functioning, quality of life, satisfaction with care, cost and quality-adjusted life years (QALYs) in comparison to a historical control group. CONCLUSION To the authors' knowledge, this is the first study assessing the efficacy and cost-effectiveness of a combined intervention consisting of early detection strategies and strategies to improve quality of care in both adolescents and young adults with early-phase psychosis. The results will be published in 2016.
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Affiliation(s)
- Martin Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Daniel Schöttle
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Mary Sengutta
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Friederike Ruppelt
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anja Rohenkohl
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Daniel Luedecke
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Luise Antonia Nawara
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Britta Galling
- Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, New York, USA
| | - Anne-Lena Falk
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Linus Wittmann
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Vivien Niehaus
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Gizem Sarikaya
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ute Handwerk
- Community Psychiatric Center Eimsbüttel (GPZE), Hamburg, Germany
| | | | - Liz Rietschel
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Charlotte Gagern
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Benjamin Lange
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christina Meigel-Schleiff
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Dieter Naber
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Helmut Krüger
- Community Psychiatric Center Eimsbüttel (GPZE), Hamburg, Germany
| | - Hans-Peter Unger
- Center for Mental Health, Department of Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Sven Sippel
- Center for Mental Health, Department of Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Sabine Ott
- Center for Mental Health, Department of Child and Adolescent Psychiatry Psychotherapy and Psychosomatics, Asklepios Hospital Harburg, Hamburg, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Muenster, Münster, Germany
| | - Anne Daubmann
- Institute for Biostatistics and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Karl Wegscheider
- Institute for Biostatistics and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Benno G Schimmelmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Thomas Bock
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jürgen Gallinat
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anne Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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de Jong G, Meijer E, Schout G. Family Group Conferencing as a Catalyst for Recovery and Ownership in Mental Health. Psychiatry 2018; 81:101-115. [PMID: 30199332 DOI: 10.1080/00332747.2018.1492850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Recovery is a journey not only of personal change but also of social reengagement. It underlines the essence of social environments that are supportive to the recovery of people with ongoing mental health issues. The process of recovery also affects other actors, and likewise these actors exert their influence on the recovery of their family member or friend. OBJECTIVE Since 2009, we have been studying whether the decision-making model called family group conferencing (FGC) helps mental health clients increase their self-reliance. The essence of FGC is that individuals who experience problems have the opportunity to develop a plan together with people from their social network. Clients in mental health have to deal with different forms of disempowerment, especially when they are threatened with compulsory measures. It is an aim to help them regain ownership over their problems as well as over the potential solutions. METHOD From 2011 to 2013, we evaluated 41 family group conferences that were organized for clients in a public mental health care setting in the north of the Netherlands. Each conference was analyzed in a qualitative case study framework. RESULTS This article highlights two case portraits. It gives insight into how ownership was restored and what this meant regarding clients' recovery process. CONCLUSION FGC seems a promising tool to shift the attention from disorders and inabilities to capacities and the rediscovery of social resources.
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Mueller-Stierlin AS, Helmbrecht MJ, Herder K, Prinz S, Rosenfeld N, Walendzik J, Holzmann M, Dinc U, Schützwohl M, Becker T, Kilian R. Does one size really fit all? The effectiveness of a non-diagnosis-specific integrated mental health care program in Germany in a prospective, parallel-group controlled multi-centre trial. BMC Psychiatry 2017; 17:283. [PMID: 28764729 PMCID: PMC5539984 DOI: 10.1186/s12888-017-1441-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/24/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The Network for Mental Health (NWpG-IC) is an integrated mental health care program implemented in 2009 by cooperation between health insurance companies and community mental health providers in Germany. Meanwhile about 10,000 patients have been enrolled. This is the first study evaluating the effectiveness of the program in comparison to standard mental health care in Germany. METHODS In a parallel-group controlled trial over 18 months conducted in five regions across Germany, a total of 260 patients enrolled in NWpG-IC and 251 patients in standard mental health care (TAU) were recruited between August 2013 and November 2014. The NWpG-IC patients had access to special services such as community-based multi-professional teams, case management, crisis intervention and family-oriented psychoeducation in addition to standard mental health care. The primary outcome empowerment (EPAS) and the secondary outcomes quality of life (WHO-QoL-BREF), satisfaction with psychiatric treatment (CSQ-8), psychosocial and clinical impairment (HoNOS) and information about mental health service needs (CAN) were measured four times at 6-month intervals. Linear mixed-effect regression models were used to estimate the main effects and interaction effects of treatment, time and primary diagnosis. Due to the non-randomised group assignment, propensity score adjustment was used to control the selection bias. RESULTS NWpG-IC and TAU groups did not differ with respect to most primary and secondary outcomes in our participating patients who showed a broad spectrum of psychiatric diagnoses and illness severities. However, a significant improvement in terms of patients' satisfaction with psychiatric care and their perception of treatment participation in favour of the NWpG-IC group was found. CONCLUSIONS Providing integrated mental health care for unspecific mentally ill target groups increases treatment participation and service satisfaction but seems not suitable to enhance the overall outcomes of mental health care in Germany. The implementation of strategies for ameliorating the needs orientation of the NWpG-IC should be considered. TRIAL REGISTRATION German Clinical Trial Register DRKS00005111 , registered 26 July 2013.
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Affiliation(s)
- Annabel Sandra Mueller-Stierlin
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ulm, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Katrin Herder
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ulm, Germany
| | - Stefanie Prinz
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ulm, Germany
| | - Nadine Rosenfeld
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ulm, Germany
| | - Julia Walendzik
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Marco Holzmann
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Uemmueguelsuem Dinc
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ulm, Germany
| | - Matthias Schützwohl
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Thomas Becker
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ulm, Germany
| | - Reinhold Kilian
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Ulm, Germany
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Schout G, Meijer E, de Jong G. Family Group Conferencing-Its Added Value in Mental Health Care. Issues Ment Health Nurs 2017; 38:480-485. [PMID: 28510481 DOI: 10.1080/01612840.2017.1282996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Worldwide, there is a growing emphasis on reducing coercion and involving social networks in the care of mental health clients. Nurses should encourage their clients to regain control over their lives, preferably with less coercion and with help from their social network. During four years, a Dutch evaluation study was deployed to determine the applicability of mobilising help from social networks of people with psychiatric problems. Specifically the potential of Family Group Conferencing was examined. In this discursive article the question, 'what Family Group Conferencing adds to the existing methods that aim to reduce coercion in mental health care and promote inclusion' is addressed.
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Affiliation(s)
- Gert Schout
- a Department of Medical Humanities , EMGO+, VU University Medical Centre , Amsterdam , The Netherlands
| | - Ellen Meijer
- a Department of Medical Humanities , EMGO+, VU University Medical Centre , Amsterdam , The Netherlands
| | - Gideon de Jong
- b School of Nursing and Midwifery, Edith Cowan University , Perth , Australia
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Schneeberger AR, Huber CG, Lang UE, Muenzenmaier KH, Castille D, Jaeger M, Seixas A, Sowislo J, Link BG. Effects of assisted outpatient treatment and health care services on psychotic symptoms. Soc Sci Med 2017; 175:152-160. [PMID: 28092756 DOI: 10.1016/j.socscimed.2017.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 12/14/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
Abstract
RATIONALE An ongoing debate concerns acceptability, benefits, and shortcomings of coercive treatment such as assisted outpatient treatment (AOT). The hypothesis that involuntary commitment to outpatient treatment may lead to a better clinical outcome for a subgroup of persons with severe mental illness (SMI) is controversial. Nonetheless, positive effects of AOT may be mediated by an increased availability of healthcare resources or increased service use. OBJECTIVE The purpose of the present study is to evaluate the course of delusions, hallucinations, and negative symptoms among patients with SMI receiving AOT compared to patients receiving non-compulsory treatment (NCT). Moreover, we assessed if the effects of AOT on psychotic symptoms were mediated by increased healthcare service use. METHODS This study used a quasi-experimental design to examine the effect of AOT and the use of healthcare services on psychotic symptoms. In total, 76 (41.3%) participants with SMI received AOT, and 108 (58.7%) received NCT. The participants were interviewed at baseline every 3 months up to 1 year. Propensity score matching was used to control for group differences. RESULTS In the basic model, AOT was associated with lower severity of psychotic symptoms over all follow-up points. In the model including healthcare service use, the frequency of case manager visits predicted a reduction in severity of all psychotic symptoms. The frequency of visits to the outpatient clinics, frequency of emergency room, and psychiatrist visits were independently associated with lower levels of delusional symptoms. Psychiatrist visits were related to a decrease in negative symptoms. CONCLUSION Results indicate that the treatment benefits of AOT are enhanced with the increased use of mental healthcare services, suggesting that the positive effect of AOT on psychotic symptoms is related to the availability of mental healthcare service use. Coercive outpatient treatment might be more effective through greater use of intensive services.
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Affiliation(s)
- Andres R Schneeberger
- Psychiatrische Dienste Graubuenden, Plazza Paracelsus 2, 7500 St. Moritz, Switzerland; Universitaere Psychiatrische Kliniken, Universitaet Basel, Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, 1300 Morris Park Avenue, Belfer Building, Room 402, 10461 Bronx, NY, USA.
| | - Christian G Huber
- Universitaere Psychiatrische Kliniken, Universitaet Basel, Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland
| | - Undine E Lang
- Universitaere Psychiatrische Kliniken, Universitaet Basel, Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland
| | - Kristina H Muenzenmaier
- Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, 1300 Morris Park Avenue, Belfer Building, Room 402, 10461 Bronx, NY, USA
| | | | - Matthias Jaeger
- Psychiatrische Universitaetsklinik, Zuerich, Lenggstrasse 31, 8032 Zuerich, Switzerland
| | - Azizi Seixas
- Center for Healthful Behavior Change, New York University School of Medicine, 227 East 30th Street, 10016 New York, NY, USA
| | - Julia Sowislo
- Universitaere Psychiatrische Kliniken, Universitaet Basel, Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland
| | - Bruce G Link
- Mailman School of Public Health, Columbia University, 722 W 168th St, 10032 New York, NY, USA
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van der Lee A, de Haan L, Beekman A. Schizophrenia in the Netherlands: Continuity of Care with Better Quality of Care for Less Medical Costs. PLoS One 2016; 11:e0157150. [PMID: 27275609 PMCID: PMC4898758 DOI: 10.1371/journal.pone.0157150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/25/2016] [Indexed: 01/31/2023] Open
Abstract
Background Patients with schizophrenia need continuous elective medical care which includes psychiatric treatment, antipsychotic medication and somatic health care. The objective of this study is to assess whether continuous elective psychiatric is associated with less health care costs due to less inpatient treatment. Methods Data concerning antipsychotic medication and psychiatric and somatic health care of patients with schizophrenia in the claims data of Agis Health Insurance were collected over 2008–2011 in the Netherlands. Included were 7,392 patients under 70 years of age with schizophrenia in 2008, insured during the whole period. We assessed the relationship between continuous elective psychiatric care and the outcome measures: acute treatment events, psychiatric hospitalization, somatic care and health care costs. Results Continuous elective psychiatric care was accessed by 73% of the patients during the entire three year follow-up period. These patients received mostly outpatient care and accessed more somatic care, at a total cost of €36,485 in three years, than those without continuous care. In the groups accessing fewer or no years of elective care 34%-68% had inpatient care and acute treatment events, while accessing less somatic care at average total costs of medical care from €33,284 to €64,509. Conclusions Continuous elective mental and somatic care for 73% of the patients with schizophrenia showed better quality of care at lower costs. Providing continuous elective care to the remaining patients may improve health while reducing acute illness episodes.
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Affiliation(s)
- Arnold van der Lee
- Kenniscentrum, Zilveren Kruis Achmea, Leusden, The Netherlands
- Department of Psychiatry, VUmc University Medical Center and GGZIngeest, Amsterdam, The Netherlands
- * E-mail:
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Centre, UvA, Amsterdam, The Netherlands
| | - Aartjan Beekman
- Department of Psychiatry, VUmc University Medical Center and GGZIngeest, Amsterdam, The Netherlands
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Lambert M, Schöttle D, Ruppelt F, Lüdecke D, Sarikaya G, Schulte-Markwort M, Gallinat J, Karow A. [Integrated care for patients with first and multiple episodes of severe psychotic illnesses: 3-year results of the Hamburg model]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 58:408-19. [PMID: 25676450 DOI: 10.1007/s00103-015-2123-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The so-called "Hamburg model" is a designated integrated care model according to § 140 of the Social Code Book (SGB) V for psychosis patients fulfilling the definition of severe mental illness (SMI). OBJECTIVES Description of the model and evaluation of efficacy of all patients being treated for ≥ 3 years. MATERIALS AND METHODS Service entry illness status, course of illness, and interventions were assessed within a continuous quality assurance study. One hundred and fifty-eight patients who fulfilled the criterion of being treated for ≥ 3 years were analyzed. RESULTS At service entry, SMI were among others mirrored by a high level of psychopathology (Brief Psychiatric Rating Scale [BPRS]: 80.3) and severity of illness (Clinical Global Impression Severity [CGI-S]/Clinical Global Impression Bipolar scales [CGI-BP]: 5.8), low functioning level (Global Assessment of Functioning scale [GAF]: 35.9), and high rates of comorbid psychiatric (94.3 %) and somatic (81.6 %) disorders. Only 8 patients (5.1 %) disengaged from the service within the 3-year treatment period. The course of the illness over 3 years showed significant and stable improvements in psychopathology (BPRS: p < 0.001), the severity of illness (CGI-S/CGI-BP: p < 0.001), functioning (GAF: p < 0.001), quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire [Q-LES-Q-18]: p < 0.001), and satisfaction with care (Client Satisfaction Questionnaire [CSQ-8]: 2.0 to 3.3; p = 0.164; nonsignificant because of early improvements). Further, compulsory admissions were reduced and medication adherence in addition to working ability improved (all p < 0.001). Data on interventions showed a continuously high frequency of outpatient interventions over time (on average 112.0 per year), a high percentage of patients in psychotherapy (67 %), and a nearly 90 % reduction in inpatient treatment days from year 1 to year 3. CONCLUSION Integrated care in severely ill patients with psychotic disorders leads to multidimensional illness improvement and stabilization by offering intensive outpatient care.
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Affiliation(s)
- Martin Lambert
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland,
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Malm U, Lundin L, Rydell P, Nordén T, Norlander T. Resource Group ACT (RACT) – A Review of an Integrative Approach to Psychoeducation of Individual Families Involving the Patient. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2015. [DOI: 10.1080/00207411.2015.1076290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Norlander T, Nordén T. The Hourglass Model: Are There Structural Problems with the Scarcity of Positive Results for Flexible ACT? Clin Pract Epidemiol Ment Health 2015; 11:155-7. [PMID: 26464577 PMCID: PMC4598425 DOI: 10.2174/1745017901511010155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 11/22/2022]
Abstract
The aim of the present article was to discuss the commentary by van Veldhuizen, Delespaul and Mulder (2015) regarding the review by Nordén and Norlander (2014) based on five empirical articles about Flexible Assertive Community Treatment (FACT). Veldhuizen et al. agree on that there is insufficient evidence for the effectiveness of FACT. However, van Veldhuizen et al. avoid a discussion of the lack of positive results despite extensive research during several years and therefore an analysis of why FACT did not fare better is missing. According to FACT it is an advantage that one single team spans the entire chain of care and rehabilitation, but no evidence is given for such an opinion. Instead there may be difficulties for the staff to shift between psychiatric care and psychiatric rehabilitation and the clients perhaps don’t want to encounter the same professional team during all phases of care and rehabilitation.
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Affiliation(s)
- Torsten Norlander
- Center for Research and Development, Evidens University College, Göteborg, Sweden ; Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Tommy Nordén
- Center for Research and Development, Evidens University College, Göteborg, Sweden
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Affiliation(s)
- Gary R Bond
- Dartmouth Psychiatric Research Center and Department of Psychiatry, Geisel Medical School at DartmouthHanover, NH, USA
| | - Robert E Drake
- Dartmouth Psychiatric Research Center and Department of Psychiatry, Geisel Medical School at DartmouthHanover, NH, USA
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Janlöv AC, Granskär M, Berg A. Challenges Highlighted During Peer Supervision by Mental Health Nurses and Social Workers Recently Trained as Case Managers in Sweden. Issues Ment Health Nurs 2015; 36:809-16. [PMID: 26514259 DOI: 10.3109/01612840.2015.1047073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study looked at 13 mental health nurses and social workers who were recently trained as case managers (CMs) and the work-related challenges they faced in community mental health services. Data were collected during ten peer supervisions sessions. Participants expressed pride and enthusiasm about their new function as CMs, but they also acknowledged that their new position meant they had to confront existing systems and posed several challenges, including organizational hindrances, economic prerequisites, nominated administrators, role function, and model fidelity. We conclude that the existing organizations seemed to be unprepared to hold and facilitate more person-centered approaches, such as designating CMs. The model fidelity is important, but has to be flexible according to clients' daily state.
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Affiliation(s)
- Ann-Christin Janlöv
- a Kristianstad University, Health and Social Sciences , Kristianstad , Sweden
| | - Monica Granskär
- a Kristianstad University, Health and Social Sciences , Kristianstad , Sweden
| | - Agneta Berg
- b Kristianstad University, Health and Social Sciences, Kristianstad, Sweden, and University West Trollhättan , Trollhättan , Sweden
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Nishio M, Sono T, Ishiguro T, Horiuchi K, Ambo H. How many Assertive Community Treatment Teams are Needed in Japan? Estimate from Need Survey in Sendai City. Clin Pract Epidemiol Ment Health 2014; 10:184-90. [PMID: 25614756 PMCID: PMC4296475 DOI: 10.2174/1745017901410010184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 09/29/2014] [Accepted: 10/02/2014] [Indexed: 12/04/2022]
Abstract
Despite the increasing ACT teams in Japan, no research exists on the need of ACT within the Japanese mental health system. The aim of this study was to describe the needs and feasibility of ACT teams. Furthermore, we estimated the number of po-tential ACT users and ACT teams needed in Japan. This study consists of two cross-sectional surveys in Sendai city. The primary survey was a self-completed questionnaire on the need and feasibility of ACT. In the secondary survey, the number of patients eligible for ACT was estimated based on primary physicians’ evaluations. In the primary survey, 17 of the 57 in-stitutions responded (response rate 29.8%). All respondents answered that ACT teams are needed in the city of Sendai and “Crisis response” was as the most needed role of ACT. Based on the results of the secondary survey, approximately 900 to 3,600 patients in Sendai are estimated to be eligible for ACT. This finding indicates that the estimated number of ACT teams needed for 100,000 populations is from 0.9 to 3.5 in Japan, a result that is in general agreement with data from other coun-tries.
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Affiliation(s)
- Masaaki Nishio
- Faculty of Comprehensive Welfare, Tohoku Fukushi University, 1-8-1 Kunimi, Aoba-ku, Sendai, Miyagi, 981-8522, Japan
| | - Tamaki Sono
- Psilocybe, Inc., 237 Sano, Higashi-Ohmi, Shiga, 521-1222, Japan
| | - Toru Ishiguro
- Faculty of Comprehensive Welfare, Tohoku Fukushi University, 1-8-1 Kunimi, Aoba-ku, Sendai, Miyagi, 981-8522, Japan
| | - Kentaro Horiuchi
- Lechwe Short Care Clinic, 1-15-10 Higashi-Kanda, Chiyoda, Tokyo, 101-0031, Japan
| | - Hiroaki Ambo
- Mirainokaze Seiwa Hospital, 9-70-1 Teshiromori, Morioka, Iwate, 020-0401, Japan
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Nordén T, Norlander T. Absence of Positive Results for Flexible Assertive Community Treatment. What is the next Approach? Clin Pract Epidemiol Ment Health 2014; 10:87-91. [PMID: 25320634 PMCID: PMC4197527 DOI: 10.2174/1745017901410010087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 06/03/2014] [Accepted: 07/13/2014] [Indexed: 11/22/2022]
Abstract
Aims were to review results of the five psychiatric studies on Flexible Assertive Community Treatment (FACT) published during 2007-2013, and to compare FACT with Resource-group Assertive Community Treatment (RACT) which specifically focuses on empowerment and rehabilitation of clients in the stable phase. During 2007 articles appeared in scientific journals arguing in favor of the need for the development of the treatment method Assertive Community Treatment (ACT). A particularly notable article was one that featured a Dutch version of ACT, namely FACT. The initiative received great sympathy given that clinical practice and research showed that both American and British versions of ACT were in need of new impulses to be able to maintain an optimal level of care. Seven years have passed since the Dutch model was international presented and five empirical studies about FACT have been published and therefore a first critical examination of FACT was conducted. The review indicated that the five empirical studies failed to show that FACT involves improvement of the clients in terms of symptoms, functioning, or well-being. The conclusions were that at present there is no evidence for FACT and that RACT with its small, flexible ACT teams, where the client him/herself is included and decides on the treatment goals, might be able to provide new impulses and a new vitality to the treatment mode of an assertive community treatment.
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Affiliation(s)
- Tommy Nordén
- Center for Research and Development, Evidens University College, Göteborg, Sweden
| | - Torsten Norlander
- Center for Research and Development, Evidens University College, Göteborg, Sweden ; Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
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Roeg DPK, van de Goor IAM, Voogt MCM, van Assen MALM, Garretsen HFL. Effects of interferential care: a community-based care program for persons with severe problems on several life areas. Int J Soc Psychiatry 2014; 60:584-94. [PMID: 24221098 PMCID: PMC4230954 DOI: 10.1177/0020764013507247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND AIMS Interferential care differs from the current community-based care programs in that it targets a larger, heterogeneous group and combines brokerage and full service elements in a multi-organizational care team. The team provides all the services itself, but with the aim to prepare clients within a few months for referral to regular (ambulant) healthcare services. The aim of this study was to assess the effectiveness of interferential care. METHODS In a multisite, pretest-posttest design, 523 patients of three interferential care teams were followed. Quality of life, problem severity, problems with referral and engagement were assessed at baseline, at referral and again after 6 months. Analyses were performed using linear mixed modeling. RESULTS Interferential care showed moderate to strong effects on quality of life and problem severity. These effects persisted (quality of life) or further improved (problem severity) until follow-up 6 months after referral to regular services. There were also small effects on both engagement and problems with referral. CONCLUSION Interferential care offers significant improvements in quality of life and problem severity in persons who have severe problems on several life areas and who are currently not reached by healthcare services. It is a promising community-based care program for healthcare systems in which regular care already contains many elements of home-based practice.
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Affiliation(s)
- Diana P K Roeg
- Tranzo Department, Tilburg University, Tilburg, The Netherlands Mental Health Care Institute GGz Eindhoven and the Kempen, Eindhoven, The Netherlands
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Carta MG, Maggiani F, Pilutzu L, Moro MF, Mura G, Cadoni F, Sancassiani F, Vellante M, Machado S, Preti A. Sailing for rehabilitation of patients with severe mental disorders: results of a cross over randomized controlled trial. Clin Pract Epidemiol Ment Health 2014; 10:73-9. [PMID: 25191520 PMCID: PMC4150377 DOI: 10.2174/1745017901410010073] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/12/2014] [Accepted: 05/12/2014] [Indexed: 11/22/2022]
Abstract
This study set out to evaluate the effectiveness of a sailing and learning-to-sail rehabilitation protocol in a sample of patients diagnosed with severe mental disorders. The study was a randomized, crossover, waiting-list controlled trial, following recruitment in the Departments of Mental Health of South Sardinia. Participants were outpatients diagnosed with severe mental disorders, recruited through announcements to the directors of the Departments of Mental Health of South Sardinia. Out of the 40 patients enrolled in the study, those exposed to rehabilitation with sailing during a series of guided and supervised sea expeditions near the beach of Cagliari (Sardinia), where the aim to explore the marine environment while sailing was emphasized, showed a statistically significant improvement of their clinical status (measured by BPRS) and, as well, of their general functioning (measured by HoNOS Scale) against the control group. The improvement was maintained at follow-up for some months only: after 12 months, the patients returned to their baseline values on the measures of psychopathology and showed a worsening trend of their quality of life. Sailing can represent a substitute of important experiences that the patients with severe mental disorders miss because of their illness.
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Affiliation(s)
- Mauro G Carta
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Federica Maggiani
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Laura Pilutzu
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Maria F Moro
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Gioia Mura
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Federica Cadoni
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Federica Sancassiani
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Marcello Vellante
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
| | - Sergio Machado
- Institute de Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ)
| | - Antonio Preti
- Department of Public Health and Clinical and Molecular Medicine University of Cagliari and Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari, Cagliari, Italy
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Carta MG, Maggiani F, Pilutzu L, Moro MF, Mura G, Sancassiani F, Vellante V, Migliaccio GM, Machado S, Nardi AE, Preti A. Sailing can improve quality of life of people with severe mental disorders: results of a cross over randomized controlled trial. Clin Pract Epidemiol Ment Health 2014; 10:80-6. [PMID: 25191521 PMCID: PMC4150378 DOI: 10.2174/1745017901410010080] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/12/2014] [Accepted: 06/12/2014] [Indexed: 12/28/2022]
Abstract
The aim of this study was to evaluate the impact of a sailing rehabilitation program on the quality of life (QoL) in a sample of patients with severe mental disorders. The study adopted a randomized, crossover, waiting-list controlled design. The participants enrolled in the study were outpatients diagnosed with severe chronic mental disorders. The participants (N=40) exposed to rehabilitation with sailing took part in a series of supervised cruises near the gulf of Cagliari, South Sardinia, and showed a statistically significant improvement of their quality of life compared to the control group. This improvement was comparable to the improvement in psychopathologic status and social functioning as shown in a previous report of the same research project. The improvement was maintained at follow-up only during the trial and for a few months later: after 12 months, patients returned to their baseline values and their quality of life showed a worsening trend. This is the first study to show that rehabilitation with sailing may improve the quality of life of people with severe chronic mental disorders. In all likelihood, a program grounded on learning how to manage a sailing vessel - during which patients perform cruises that emphasize the exploration of the marine environment by sailing - might be interesting enough and capture the attention of the patients so as to favour greater effectiveness of standard rehabilitation protocols, but this should be specifically tested.
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Affiliation(s)
- Mauro Giovanni Carta
- Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari and University of Cagliari, #CONI, Italian Olympic Committee - Sardinia
| | - Federica Maggiani
- Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari and University of Cagliari, #CONI, Italian Olympic Committee - Sardinia
| | - Laura Pilutzu
- Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari and University of Cagliari, #CONI, Italian Olympic Committee - Sardinia
| | - Maria Francesca Moro
- Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari and University of Cagliari, #CONI, Italian Olympic Committee - Sardinia
| | - Gioia Mura
- Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari and University of Cagliari, #CONI, Italian Olympic Committee - Sardinia
| | - Federica Sancassiani
- Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari and University of Cagliari, #CONI, Italian Olympic Committee - Sardinia
| | - Vellante Vellante
- Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari and University of Cagliari, #CONI, Italian Olympic Committee - Sardinia
| | - Gian Mario Migliaccio
- Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari and University of Cagliari, #CONI, Italian Olympic Committee - Sardinia
| | - Sergio Machado
- Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ)
| | | | - Antonio Preti
- Centro di Psichiatria di Consulenza e Psicosomatica AUOC Cagliari and University of Cagliari, #CONI, Italian Olympic Committee - Sardinia
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Carta MG, Sancassiani F, Lecca ME, Pintus E, Pintus M, Pisano E, Congiu S, Moro MF, Angermeyer CM. Coping with the crisis: people with severe mental disorders acting for social change through sustainable energy. Clin Pract Epidemiol Ment Health 2013; 9:214-20. [PMID: 24363774 PMCID: PMC3866694 DOI: 10.2174/1745017901309010214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 10/23/2013] [Accepted: 10/23/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of the study was to examine the efficacy of a vocational training program on renewable energy sources in reducing disabilities of people with chronic psychosis (CP). The innovative element was that the project could produce major advantages regarding the economic needs of the whole area involved. METHODS Experimental Cohort, 26 subjects with CP (EC); Control Cohort1, 130 subjects with CP following pharmacotherapy plus other rehabilitation activities (CIC); Control Cohort2, 101 subjects with CP following the usual treatment (pharmacotherapy) (CUC). Study tool: Health of the Nation Outcome Scales (HoNOS). Assessment made at the start of the study (T0) and after three months (T1). Statistical analysis made by MANOVA. RESULTS Improvement in HoNOS total score in both groups (F=7.574, p=0.000) with non-significant differences between groups over time (F=1.336, p=0.252) was found comparing EC vs. CIC. Greater improvement in EC vs. CIC was shown in the HoNOS "impairment" scale (F=4.910, p=0.028). EC vs. CUC: both groups improved in HoNOS total score (F=9.440, p=0.000) but the improvement was greater in EC (F = 2.273, P=0.048). CONCLUSIONS Work inclusion, as well as other rehabilitation treatments, reduces the social needs of people with chronic psychosis. Work inclusion in a project with real relevance for the area where these people live, produces more improvement of cognitive, physical and somatic disabilities, probably related to a better outcome in self-efficacy.
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Affiliation(s)
- MG Carta
- Department of Public Health, Clinical and Molecular Medicine – University of Cagliari (Italy)
| | - F Sancassiani
- Department of Public Health, Clinical and Molecular Medicine – University of Cagliari (Italy)
| | - ME Lecca
- Department of Public Health, Clinical and Molecular Medicine – University of Cagliari (Italy)
| | - E Pintus
- Department of Public Health, Clinical and Molecular Medicine – University of Cagliari (Italy)
| | - M Pintus
- Department of Public Health, Clinical and Molecular Medicine – University of Cagliari (Italy)
| | - E Pisano
- Department of Public Health, Clinical and Molecular Medicine – University of Cagliari (Italy)
| | - S Congiu
- Department of Public Health, Clinical and Molecular Medicine – University of Cagliari (Italy)
| | - MF Moro
- Department of Public Health, Clinical and Molecular Medicine – University of Cagliari (Italy)
| | - CM Angermeyer
- Center for Public Mental Health, Gosing and Wagram, Vienna, Austria
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Drukker M, Visser E, Sytema S, van Os J. Flexible Assertive Community Treatment, Severity of Symptoms and Psychiatric Health Service Use, a Real life Observational Study. Clin Pract Epidemiol Ment Health 2013; 9:202-9. [PMID: 24358050 PMCID: PMC3866708 DOI: 10.2174/1745017901309010202] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 09/12/2013] [Accepted: 09/16/2013] [Indexed: 11/22/2022]
Abstract
Background: Introduction of Flexible Assertive Community Treatment (FACT) may be associated with increased remission rates and changes in patterns of care. The present paper reports on differences in psychosocial functioning and health care use between patients in FACT and two groups of patients not currently provided with a specific model of community service.
Methods: The ongoing "Pharmacotherapy Monitoring and Outcome Survey" provided routine outcome measures of patients using antipsychotics in the north of the Netherlands. Level of psychosocial functioning was assessed using the Health of the Nations Outcome Scales (HoNOS) and matched with psychiatric health care consumption obtained from the Psychiatric Case Register. Patients who never received FACT, patients ever in FACT but not at assessment date, and patients in FACT were identified. Data were subjected to multilevel linear regression analysis.
Results: Data showed that most patients in FACT also had non-FACT episodes after the start of FACT. Furthermore, patients in FACT displayed higher levels of psychosocial functioning and used more outpatient care than the other two groups.
Conclusions: Patients in FACT receive more outpatient care and have better psychosocial functioning. However, causal inferences cannot be derived from these data. In addition, membership of a FACT-team in this setting did not last indefinitely.
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Affiliation(s)
- Marjan Drukker
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience MHeNS, Maastricht University, p.o. box 616, Location Vijverdal, 6200 MD, Maastricht, the Netherlands
| | - Ellen Visser
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Rob Giel Centre, p.o. box 30.001, 9700 RB Groningen, the Netherlands
| | - Sjoerd Sytema
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Rob Giel Centre, p.o. box 30.001, 9700 RB Groningen, the Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience MHeNS, Maastricht University, p.o. box 616, Location Vijverdal, 6200 MD, Maastricht, the Netherlands ; King's College London, King's Health Partners Department of Psychosis Studies; Institute of Psychiatry, London, UK
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Affiliation(s)
- Dieter Naber
- Department of Psychiatry and Psychotherapy; Centre of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf; Martinistrasse 52; 20246; Hamburg; Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy; Centre of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf; Martinistrasse 52; 20246; Hamburg; Germany
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