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Diaz-Milanes D, Almeda N, Rodero-Cosano ML, Salinas-Perez JA, Garcia-Alonso CR. Assessment of care provision integration in a community-based mental health system: balanced care model implementation in Andalusia (Spain). BMC Public Health 2024; 24:2671. [PMID: 39350100 PMCID: PMC11440898 DOI: 10.1186/s12889-024-20169-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 09/24/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Andalusia is the second largest region in Spain, and it has developed a comprehensive mental health (MH) plan that encourages the consolidation of the balanced care model. However, its geographical and socioeconomic disparity is a great challenge for a community-based MH system. Both the assessment of the implementation of the MH plan and the development of new tools to support decision-making can be considered critical. OBJECTIVES The present study aims (i) to assess how the integration of different types of MH care may influence system performance and (ii) to check the performance evolution of the integration process geographically regarding the small MH areas of Andalusia. METHODS The performance of the Andalusian MH system was assessed by combining Monte Carlo simulation, fuzzy inference and data envelopment analysis. The relative technical efficiency was the main performance indicator. RESULTS A correct integration of appropriate types of MH care, according to population needs, increases the performance of the Andalusian MH system both from global and regional perspectives. The spatial representation (based on small MH areas) of the results highlights how the performance depends on specific geographical characteristics. By analyzing the identified spatial clusters, defined by different management patterns depending on user and socioeconomic characteristics, benchmark areas and areas for improvement can be studied to design evidence-informed policies and interventions. CONCLUSIONS A global analysis of MH system performance was carried out, including both the successive integration of different types of care and its spatial evolution. Although an appropriate integration of different types of MH care has a positive effect on the Andalusian MH system, this process has different profiles depending on specific geographically based user and socioeconomic characteristics. The balanced care model can be considered the paradigm for assessing the performance of a large and populated territory such as Andalusia, which has a community-based MH system. This methodological approach (performance assessment and spatial analysis) may be used as a guide for developing future evidence-informed policies and managerial interventions.
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Affiliation(s)
- Diego Diaz-Milanes
- Department of Quantitative Methods, Universidad Loyola Andalucia, Seville, Spain.
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.
| | - Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucia, Seville, Spain
| | | | - Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucia, Seville, Spain
- Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Carlos R Garcia-Alonso
- Department of Quantitative Methods, Universidad Loyola Andalucia, Seville, Spain
- Health Research Institute, University of Canberra, Canberra, ACT, Australia
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Calik A, Liu HM, Montgomery A, Honisett S, Van Munster KA, Morris T, Eapen V, Goldfeld S, Hiscock H, Eastwood J, Woolfenden S. Moving from idea to reality: The barriers and enablers to implementing Child and Family Hubs policy into practice in NSW, Australia. Health Res Policy Syst 2024; 22:83. [PMID: 39010121 PMCID: PMC11247851 DOI: 10.1186/s12961-024-01164-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/23/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Adverse childhood experiences can impact physical and mental health throughout the lifespan. To support families experiencing adversity and improve child health and developmental equity, an integrated, multi-sector response is required. Child and Family Hubs (Hubs) are a feasible and acceptable approach to providing such a response. In the Australian context, a number of federal and New South Wales (NSW) state policies support an integrated, multi-sector response using Hubs to support families experiencing adversity. This study examined NSW policy stakeholder and health service manager perspectives on the barriers and enablers to translating policy into practice in the implementation of Child and Family Hubs. METHODS Semi-structured interviews were conducted with 11 NSW government policy stakeholders and 13 community health service managers working in child and family policy and planning or child and family community-based services. Interviews were of 30-60 min duration and explored stakeholder knowledge, perspectives and experiences around childhood adversity, and barriers and enablers to operationalizing policies supporting Hubs. Analysis of barriers and facilitators to implementation of Hub models of care was undertaken using the Consolidated Framework for Implementation Research (CFIR). RESULTS Key barriers that emerged included short-term and inconsistent funding, lack of resourcing for a Hub co-ordinator, limited support for evaluation and insufficient time to plan for Hub implementation. Key enablers included flexibility and adaptability of Hub models to meet local needs, formal change management processes, strong governance structures and engagement among Hub practitioners. Key insights included the importance of targeted strategies to support sustained individual practice change and the need for organization-wide commitment to enable the successful adoption and maintenance of the Hub model of care. CONCLUSIONS This study provides valuable insights and contributes evidence around what is needed to strengthen and support the operationalization and scalability of the Hub model of care. Key recommendations for Hub practitioners include the importance of formal change management processes and establishment of strong governance structures, while key recommendations for policymakers include the need for sustainable Hub funding and a standardized, evidence-based framework to support Hub implementation and evaluation.
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Affiliation(s)
- Anna Calik
- Department of Community Paediatrics, Sydney Local Health District (SLHD), Sydney, NSW, Australia.
- Sydney Institute for Women, Children and Their Families, SLHD, Sydney, NSW, Australia.
| | - Huei Ming Liu
- Department of Community Paediatrics, Sydney Local Health District (SLHD), Sydney, NSW, Australia
- Sydney Institute for Women, Children and Their Families, SLHD, Sydney, NSW, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Alicia Montgomery
- Department of Community Paediatrics, Sydney Local Health District (SLHD), Sydney, NSW, Australia
- Sydney Institute for Women, Children and Their Families, SLHD, Sydney, NSW, Australia
| | - Suzy Honisett
- Centre of Research Excellence in Childhood Adversity and Mental Health, Centre for Community Child Health, Murdoch Children's Research Institute, Victoria, Australia
| | - Kerri-Anne Van Munster
- Department of Community Paediatrics, Sydney Local Health District (SLHD), Sydney, NSW, Australia
| | - Tamara Morris
- Department of Community Paediatrics, Sydney Local Health District (SLHD), Sydney, NSW, Australia
- Sydney Institute for Women, Children and Their Families, SLHD, Sydney, NSW, Australia
- Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health/Faculty of Medicine and Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Sharon Goldfeld
- Department of Paediatrics, University of Melbourne, Victoria, Australia
- The Royal Children's Hospital, Victoria, Australia
- Centre of Research Excellence in Childhood Adversity and Mental Health, Centre for Community Child Health, Murdoch Children's Research Institute, Victoria, Australia
| | - Harriet Hiscock
- Department of Paediatrics, University of Melbourne, Victoria, Australia
- The Royal Children's Hospital, Victoria, Australia
- Health Services and Economics, Centre for Community Child Health, Murdoch Children's Research Institute, Victoria, Australia
- Centre of Research Excellence in Childhood Adversity and Mental Health, Centre for Community Child Health, Murdoch Children's Research Institute, Victoria, Australia
| | - John Eastwood
- Department of Community Paediatrics, Sydney Local Health District (SLHD), Sydney, NSW, Australia
- Sydney Institute for Women, Children and Their Families, SLHD, Sydney, NSW, Australia
| | - Susan Woolfenden
- Department of Community Paediatrics, Sydney Local Health District (SLHD), Sydney, NSW, Australia.
- Sydney Institute for Women, Children and Their Families, SLHD, Sydney, NSW, Australia.
- Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
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Diaz-Milanes D, Almeda N, Gutierrez-Colosia MR, Garcia-Alonso CR, Sadeniemi M, Salvador-Carulla L. Impact of the workforce allocation on the technical performance of mental health services: the collective case of Helsinki-Uusimaa (Finland). Health Res Policy Syst 2023; 21:108. [PMID: 37872626 PMCID: PMC10594770 DOI: 10.1186/s12961-023-01061-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Long-term mental health (MH) policies in Finland aimed at investing in community care and promoting reforms have led to a reduction in the number of psychiatric hospital beds. However, most resources are still allocated to hospital and community residential services due to various social, economic and political factors. Despite previous research focussing on the number and cost of these services, no study has evaluated the emerging patterns of use, their technical performance and the relationship with the workforce structure. OBJECTIVE The purpose of this study was to observe the patterns of use and their technical performance (efficiency) of the main types of care of MH services in the Helsinki-Uusimaa region (Finland), and to analyse the potential relationship between technical performance and the corresponding workforce structure. METHODS The sample included acute hospital residential care, non-hospital residential care and outpatient care services. The analysis was conducted using regression analysis, Monte Carlo simulation, fuzzy inference and data envelopment analysis. RESULTS The analysis showed a statistically significant linear relationship between the number of service users and the length of stay, number of beds in non-hospital residential care and number of contacts in outpatient care services. The three service types displayed a similar pattern of technical performance, with high relative technical efficiency on average and a low probability of being efficient. The most efficient acute hospital and outpatient care services integrated multidisciplinary teams, while psychiatrists and nurses characterized non-hospital residential care. CONCLUSIONS The results indicated that the number of resources and utilization variables were linearly related to the number of users and that the relative technical efficiency of the services was similar across all types. This suggests homogenous MH management with small variations based on workforce allocation. Therefore, the distribution of workforce capacity should be considered in the development of effective policies and interventions in the southern Finnish MH system.
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Affiliation(s)
- Diego Diaz-Milanes
- Department of Quantitative Methods, Universidad Loyola Andalucía, Avenida de las Universidades, S/N, Dos Hermanas, Seville, 41704, Cordova, Spain.
- Institute of Health Research, University of Canberra, Canberra, Australia.
| | - Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
| | | | - Carlos R Garcia-Alonso
- Department of Quantitative Methods, Universidad Loyola Andalucía, Avenida de las Universidades, S/N, Dos Hermanas, Seville, 41704, Cordova, Spain
- Institute of Health Research, University of Canberra, Canberra, Australia
| | | | - Luis Salvador-Carulla
- Institute of Health Research, University of Canberra, Canberra, Australia
- Health Information Systems Group (SICA-CTS-553), University of Cadiz, Cadiz, Spain
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Salinas-Perez JA, Gutierrez-Colosia MR, Garcia-Alonso CR, Furst MA, Tabatabaei-Jafari H, Kalseth J, Perkins D, Rosen A, Rock D, Salvador-Carulla L. Patterns of mental healthcare provision in rural areas: A demonstration study in Australia and Europe. Front Psychiatry 2023; 14:993197. [PMID: 36815193 PMCID: PMC9939444 DOI: 10.3389/fpsyt.2023.993197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Mental healthcare systems are primarily designed to urban populations. However, the specific characteristics of rural areas require specific strategies, resource allocation, and indicators which fit their local conditions. This planning process requires comparison with other rural areas. This demonstration study aimed to describe and compare specialized rural adult mental health services in Australia, Norway, and Spain; and to demonstrate the readiness of the healthcare ecosystem approach and the DESDE-LTC mapping tool (Description and Evaluation of Services and Directories of Long Term Care) for comparing rural care between countries and across areas. METHODS The study described and classified the services using the DESDE-LTC. The analyses included context analysis, care availability, placement capacity, balance of care, and diversity of care. Additionally, readiness (Technology Readiness Levels - TRL) and impact analyses (Adoption Impact Ladder - AIL) were also assessed by two independent raters. RESULTS The findings demonstrated the usability of the healthcare ecosystem approach and the DESDE-LTC to map and identify differences and similarities in the pattern of care of highly divergent rural areas. Day care had a greater weight in the European pattern of care, while it was replaced by social outpatient care in Australian areas. In contrast, care coordination was more common in Australia, pointing to a more fragmented system that requires navigation services. The share between hospital and community residential care showed no differences between the two regions, but there were differences between catchment areas. The healthcare ecosystem approach showed a TRL 8 (the tool has been demonstrated in a real-world environment and it is ready for release and general use) and an AIL of 5 (the target public agencies provided resources for its completion). Two experts evaluated the readiness of the use of DESDE-LTC in their respective regional studies. All of them were classified using the TRL. DISCUSSION In conclusion, this study strongly supports gathering data on the provision of care in rural areas using standardized methods to inform rural service planning. It provides information on context and service availability, capacity and balance of care that may improve, directly or through subsequent analyses, the management and planning of services in rural areas.
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Affiliation(s)
- Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain.,Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | | | - Carlos R Garcia-Alonso
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain.,Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Mary Anne Furst
- Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | | | | | - David Perkins
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,Centre for Rural and Remote Mental Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alan Rosen
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Daniel Rock
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,WA Primary Health Alliance, Subiaco, WA, Australia.,Discipline of Psychiatry, The University of Western Australia, Perth, WA, Australia
| | - Luis Salvador-Carulla
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.,National Centre for Epidemiology and Population Health (NCEPH), Faculty of Health and Medicine, Australian National University, Canberra, Australia
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Pokhilenko I, Kast T, Janssen LMM, Evers SMAA, Paulus ATG, Simon J, Mayer S, Berger M, Konnopka A, Muntendorf L, Brodszky V, García-Pérez L, Park A, Salvador-Carulla L, Drost RMWA. International comparability of reference unit costs of education services: when harmonizing methodology is not enough (PECUNIA project). Expert Rev Pharmacoecon Outcomes Res 2023; 23:135-141. [PMID: 36472303 DOI: 10.1080/14737167.2023.2152331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Health problems can lead to costs in the education sector. However, these costs are rarely incorporated in health economic evaluations due to the lack of reference unit costs (RUCs), cost per unit of service, of education services and of validated methods to obtain them. In this study, a standardized unit cost calculation tool developed in the PECUNIA project, the PECUNIA RUC Template for services, was applied to calculate the RUCs of selected education services in five European countries. METHODS The RUCs of special education services and of educational therapy were calculated using the information collected via an exploratory gray literature search and contact with service providers. RESULTS The RUCs of special education services ranged from €55 to €189 per school day. The RUCs of educational therapy ranged from €6 to €25 per contact and from €5 to €35 per day. Variation was observed in the type of input data and measurement unit, among other. DISCUSSION The tool helped reduce variability in the RUCs related to costing methodology and gain insights into other aspects that contribute to the variability (e.g. data availability). Further research and efforts to generate high quality input data are required to reduce the variability of the RUCs.
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Affiliation(s)
- I Pokhilenko
- Centre for Economics of Obesity, Health Economics Unit, Institute of Applied Health Research, College of Dental and Medical Sciences, University of Birmingham, Birmingham, The United Kingdom
| | - T Kast
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - L M M Janssen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands.,Centre of Economic Evaluation & Machine Learning, Trimbos Institute, National Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - A T G Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands.,School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - J Simon
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria.,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - S Mayer
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - M Berger
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - A Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Muntendorf
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - L García-Pérez
- Servicio de Evaluación, Servicio Canario de la Salud (SESCS), Santa Cruz de Tenerife, Spain
| | - A Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - L Salvador-Carulla
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, Australia
| | - R M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
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Salvador-Carulla L, Furst MA, Tabatabaei-Jafari H, Mendoza J, Riordan D, Moore E, Rock D, Anthes L, Bagheri N, Salinas-Perez JA. Patterns of service provision in child and adolescent mental health care in Australia. J Child Health Care 2022:13674935221146381. [PMID: 36538047 DOI: 10.1177/13674935221146381] [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] [Indexed: 12/24/2022]
Abstract
Standard description of local care provision is essential for evidence-informed planning. This study aimed to map and compare the availability and diversity of current mental health service provision for children and adolescents in Australia. We used a standardised service classification instrument, the Description and Evaluation of Services and DirectoriEs (DESDE) tool, to describe service availability in eight urban and two rural health districts in Australia. The pattern of care was compared with that available for other age groups in Australia. Outpatient care was found to be the most common type of service provision, comprising 212 (81.2%) of all services identified. Hospital care (acute and non-acute) was more available in urban than in rural areas (20 services [9.7%] vs 1 [1.8%]). The level of diversity in the types of care available for children and adolescents was lower than that for the general adult population, but slightly higher than that for older people in the same areas. Standardised comparison of the pattern of care across regions reduces ambiguity in service description and classification, enables gap analysis and can inform policy and planning.
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Affiliation(s)
- Luis Salvador-Carulla
- Health Research Institute, Health College, University of Canberra, Australia
- Menzies Centre for Health. Faculty of Medicine and Health. 4334University of Sydney, Australia
| | - Mary Anne Furst
- Health Research Institute, Health College, University of Canberra, Australia
| | | | - John Mendoza
- Mental Health & Prison Health, Central Adelaide Local Health Network, SA, Australia ; Brain and Mind Centre, 4334University of Sydney, Australia
| | - Denise Riordan
- Canberra Health Services, Canberra Australia; 102944Centre for Mental health research, Canberra, Australia
| | - Elizabeth Moore
- 2212Office for Mental Health and Wellbeing Australian Capital Territory, Canberra, Australia
| | - Daniel Rock
- WA Primary Health Alliance, Perth, Western Australia & Discipline of Psychiatry, 2720University of Western Australia, Perth, Australia
| | - Lauren Anthes
- 103006Capital Health Network, Deakin West, ACT, Australia
| | - Nasser Bagheri
- Health Research Institute, Health College, University of Canberra, Australia
| | - Jose A Salinas-Perez
- Health Research Institute, Health College, University of Canberra, Australia
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain
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Magnitude of terminological bias in international health services research: a disambiguation analysis in mental health. Epidemiol Psychiatr Sci 2022; 31:e59. [PMID: 35993182 PMCID: PMC9428902 DOI: 10.1017/s2045796022000403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
AIMS Health services research (HSR) is affected by a widespread problem related to service terminology including non-commensurability (using different units of analysis for comparisons) and terminological unclarity due to ambiguity and vagueness of terms. The aim of this study was to identify the magnitude of the terminological bias in health and social services research and health economics by applying an international classification system. METHODS This study, that was part of the PECUNIA project, followed an ontoterminology approach (disambiguation of technical and scientific terms using a taxonomy and a glossary of terms). A listing of 56 types of health and social services relevant for mental health was compiled from a systematic review of the literature and feedback provided by 29 experts in six European countries. The disambiguation of terms was performed using an ontology-based classification of services (Description and Evaluation of Services and DirectoriEs - DESDE), and its glossary of terms. The analysis focused on the commensurability and the clarity of definitions according to the reference classification system. Interrater reliability was analysed using κ. RESULTS The disambiguation revealed that only 13 terms (23%) of the 56 services selected were accurate. Six terms (11%) were confusing as they did not correspond to services as defined in the reference classification system (non-commensurability bias), 27 (48%) did not include a clear definition of the target population for which the service was intended, and the definition of types of services was unclear in 59% of the terms: 15 were ambiguous and 11 vague. The κ analyses were significant for agreements in unit of analysis and assignment of DESDE codes and very high in definition of target population. CONCLUSIONS Service terminology is a source of systematic bias in health service research, and certainly in mental healthcare. The magnitude of the problem is substantial. This finding has major implications for the international comparability of resource use in health economics, quality and equality research. The approach presented in this paper contributes to minimise differentiation between services by taking into account key features such as target population, care setting, main activities and type and number of professionals among others. This approach also contributes to support financial incentives for effective health promotion and disease prevention. A detailed analysis of services in terms of cost measurement for economic evaluations reveals the necessity and usefulness of defining services using a coding system and taxonomical criteria rather than by 'text-based descriptions'.
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Almeda N, García-Alonso CR, Killaspy H, Gutiérrez-Colosía MR, Salvador-Carulla L. The critical factor: The role of quality in the performance of supported accommodation services for complex mental illness in England. PLoS One 2022; 17:e0265319. [PMID: 35298512 PMCID: PMC8929565 DOI: 10.1371/journal.pone.0265319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 02/24/2022] [Indexed: 12/02/2022] Open
Abstract
Rehabilitation services have a key role in ensuring integrated and comprehensive mental health (MH) care in the community for people suffering from long-term and severe mental disorders. MH-supported accommodation services aim to promote service users’ autonomy and independence. Given the complexity associated with MH-supported accommodation services in England, a comparative evaluation of critical performance indicators, including service provision and quality of care, seems to be necessary in designing evidence-informed policies. This study aims to explore the influence of service quality indicators on the performance of MH-supported accommodation services in England. The analysed sample includes supported accommodation services from 14 nationally representative local authorities in England from the QuEST study grouped by three main types of care: residential care homes (divided into two subgroups: move-on and non-move-on oriented), supported housing and floating outreach. EDeS-MH (efficient decision support-mental health) was used to assess the performance indicators for the selected services by combining a Monte Carlo simulation engine, data envelopment analysis and a fuzzy inference engine for integrating expert knowledge. Depending on the type of care, six/seven quality domains were sequentially included after a baseline scenario (only technical) was analysed. Relative technical efficiency scores for the baseline scenarios revealed high performance in all the selected supported accommodation services, but the statistical variability was high. Quality domains significantly improved performance in every type of care. The inclusion of quality indicators has a positive impact on the global performance of each type of care. Remaining at the corresponding services more than expected for two years has a negative impact on performance. These findings can be considered from a planning perspective to facilitate the design of pathways of care with more realistic expectations about gaining autonomy in two years.
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Affiliation(s)
- Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
- * E-mail:
| | | | - Helen Killaspy
- Faculty of Brain Sciences, Division of Psychiatry, University College London, London, United Kingdom
| | | | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
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Zhen-Duan J, Chary A, NeMoyer A, Fukuda M, Markle SL, Hoyos M, Zhang L, Fuentes L, Pérez G, Chambers V, Rosenthal J, Mention N, Alegría M. Key stakeholder perspectives on the use of research about supported employment for racially and ethnically diverse patients with mental illness in the United States. Health Serv Res 2022; 57 Suppl 1:95-104. [PMID: 35243630 DOI: 10.1111/1475-6773.13905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To explore how stakeholders responded to research evidence regarding supported employment (e.g., vocational rehabilitation), and ways evidence could be incorporated into policy and action. DATA SOURCES Qualitative data were collected from three stakeholder groups-people with lived experience of mental health challenges, community health advocates, and state health policy makers. STUDY DESIGN This study consisted of two sequential steps. First, three focus groups were conducted after presenting stakeholder groups (inclusive of 22 participants) with simulation data showing that improvement in employment status had a stronger impact on mental health than improvement in education or income for racially/ethnically diverse groups. Second, with guidance from focus group findings, researchers conducted additional in-depth interviews (n = 19) to gain a deeper understanding of the opportunities and challenges related to incorporating these findings into policy and practice. DATA COLLECTION/EXTRACTION METHODS Focus groups and in-depth interviews were conducted, audio recorded, transcribed, and analyzed using a thematic analysis approach. PRINCIPAL FINDINGS People with lived experience described the positive effect of employment in their own life while highlighting the need to increase workplace accommodations and social supports for those with mental health challenges. Across stakeholder groups, participants emphasized the need for linguistic and cultural competence to promote equity in delivery of supported employment programs. Stakeholders also underscored that centralizing existing resources and using evidence-based approaches are crucial for successful implementation. CONCLUSION Implementing effective supported employment programs should focus on meeting the specific needs of target individuals, as many of those needs are not considered in current employment-related programming. Collecting information from diverse users of research demonstrates what other aspects of supported employment are required for the likelihood of successful uptake. Implementation and dissemination efforts need to fortify collaborations and knowledge transfer between stakeholders to optimize supported employment and mental health resources.
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Affiliation(s)
- Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Anita Chary
- Department of Medicine, Section of Health Services Research, Center for Innovations in Quality, Effectiveness and Safety, Baylor College of Medicine, Houston, Texas, USA.,Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Amanda NeMoyer
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Marie Fukuda
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sheri Lapatin Markle
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mercedes Hoyos
- Department of Political Science, Boston College, Chestnut Hill, Massachusetts, USA
| | - Liao Zhang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Larimar Fuentes
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gilberto Pérez
- Bienvenido Community Solutions, LLC, Goshen, Indiana, USA
| | | | - Jill Rosenthal
- National Academy for State Health Policy, Portland, Maine, USA.,Center for American Progress, Washington, District of Columbia, USA
| | - Najeia Mention
- National Academy for State Health Policy, Portland, Maine, USA.,Counseling & Psychological Services (CAPS), University of Hartford, Hartford, Connecticut, USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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10
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Almeda N, Garcia-Alonso CR, Gutierrez-Colosia MR, Salinas-Perez JA, Iruin-Sanz A, Salvador-Carulla L. Modelling the balance of care: Impact of an evidence-informed policy on a mental health ecosystem. PLoS One 2022; 17:e0261621. [PMID: 35015762 PMCID: PMC8752022 DOI: 10.1371/journal.pone.0261621] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022] Open
Abstract
Major efforts worldwide have been made to provide balanced Mental Health (MH) care. Any integrated MH ecosystem includes hospital and community-based care, highlighting the role of outpatient care in reducing relapses and readmissions. This study aimed (i) to identify potential expert-based causal relationships between inpatient and outpatient care variables, (ii) to assess them by using statistical procedures, and finally (iii) to assess the potential impact of a specific policy enhancing the MH care balance on real ecosystem performance. Causal relationships (Bayesian network) between inpatient and outpatient care variables were defined by expert knowledge and confirmed by using multivariate linear regression (generalized least squares). Based on the Bayesian network and regression results, a decision support system that combines data envelopment analysis, Monte Carlo simulation and fuzzy inference was used to assess the potential impact of the designed policy. As expected, there were strong statistical relationships between outpatient and inpatient care variables, which preliminarily confirmed their potential and a priori causal nature. The global impact of the proposed policy on the ecosystem was positive in terms of efficiency assessment, stability and entropy. To the best of our knowledge, this is the first study that formalized expert-based causal relationships between inpatient and outpatient care variables. These relationships, structured by a Bayesian network, can be used for designing evidence-informed policies trying to balance MH care provision. By integrating causal models and statistical analysis, decision support systems are useful tools to support evidence-informed planning and decision making, as they allow us to predict the potential impact of specific policies on the ecosystem prior to its real application, reducing the risk and considering the population’s needs and scientific findings.
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Affiliation(s)
- Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
| | | | | | - Jose A. Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Seville, Spain
- * E-mail:
| | - Alvaro Iruin-Sanz
- Instituto Biodonostia, Red de Salud Mental Extrahospitalaria de Gipuzkoa, Donostia-San Sebastián, Spain
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
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11
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Castelpietra G, Simon J, Gutiérrez-Colosía MR, Rosenberg S, Salvador-Carulla L. Disambiguation of psychotherapy: a search for meaning. Br J Psychiatry 2021; 219:532-537. [PMID: 33143767 DOI: 10.1192/bjp.2020.196] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This analysis identifies the significant problem of ambiguity, variation and vagueness in relation to the intervention described as 'psychotherapy'. Its purpose is to raise international awareness of this problem and alternative solutions.
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Affiliation(s)
- Giulio Castelpietra
- In-patient and Out-patient Care Service, Central Health Directorate, Regione Autonoma Friuli Venezia Giulia, Trieste; and Department of Medicine (DAME), University of Udine, Italy
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Austria; and Department of Psychiatry, University of Oxford; and Oxford Health NHS Trust, Warneford Hospital, Oxford, UK
| | | | - Sebastian Rosenberg
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra; and Menzies Centre for Health Policy, Faculty of Medicine and Health, University of Sydney, Australia
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12
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Romero-Lopez-Alberca C, Alonso-Trujillo F, Almenara-Abellan JL, Salinas-Perez JA, Gutierrez-Colosia MR, Gonzalez-Caballero JL, Pinzon Pulido S, Salvador-Carulla L. A Semiautomated Classification System for Producing Service Directories in Social and Health Care (DESDE-AND): Maturity Assessment Study. J Med Internet Res 2021; 23:e24930. [PMID: 33720035 PMCID: PMC8074989 DOI: 10.2196/24930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/19/2020] [Accepted: 12/17/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND DESDE-LTC (Description and Evaluation of Services and DirectoriEs for Long-Term Care) is an international classification system that allows standardized coding and comparisons between different territories and care sectors, such as health and social care, in defined geographic areas. We adapted DESDE-LTC into a computer tool (DESDE-AND) for compiling a directory of care services in Andalucia, Spain. OBJECTIVE The aim of this study was to evaluate the maturity of DESDE-AND. A secondary objective of this study is to show the practicality of a new combined set of standard evaluation tools for measuring the maturity of health technology products. METHODS A system for semiautomated coding of service provision has been co-designed. A panel of 23 domain experts and a group of 68 end users participated in its maturity assessment that included its technology readiness level (TRL), usability, validity, adoption (Adoption Impact Ladder [AIL]), and overall degree of maturity [implementation maturity model [IMM]). We piloted the prototype in an urban environment (Seville, Spain). RESULTS The prototype was demonstrated in an operational environment (TRL 7). Sixty-eight different care services were coded, generating fact sheets for each service and its geolocation map. The observed agreement was 90%, with moderate reliability. The tool was partially adopted by the regional government of Andalucia (Spain), reaching a level 5 in adoption (AIL) and a level 4 in maturity (IMM) and is ready for full implementation. CONCLUSIONS DESDE-AND is a usable and manageable system for coding and compiling service directories and it can be used as a core module of decision support systems to guide planning in complex cross-sectoral areas such as combined social and health care.
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Affiliation(s)
- Cristina Romero-Lopez-Alberca
- Department of Psychology, Universidad de Cádiz, Cádiz, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Federico Alonso-Trujillo
- Agencia de Servicios Sociales y Dependencia de Andalucía, Junta de Andalucía, Sevilla, Spain
- Health Information Systems Group (SICA-CTS-553), Universidad de Cádiz, Cádiz, Spain
| | - Jose Luis Almenara-Abellan
- Health Information Systems Group (SICA-CTS-553), Universidad de Cádiz, Cádiz, Spain
- Hospital Universitario Reina Sofía, Servicio Andaluz de Salud, Córdoba, Spain
| | - Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | | | | | - Sandra Pinzon Pulido
- Escuela Andaluza de Salud Pública, Gobierno Regional de la Junta de Andalucía, Granada, Spain
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
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13
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Tabatabaei-Jafari H, Salinas-Perez JA, Furst MA, Bagheri N, Mendoza J, Burke D, McGeorge P, Salvador-Carulla L. Patterns of Service Provision in Older People's Mental Health Care in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8516. [PMID: 33212966 PMCID: PMC7698522 DOI: 10.3390/ijerph17228516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/26/2022]
Abstract
Australia has a population of around 4 million people aged 65 years and over, many of whom are at risk of developing cognitive decline, mental illness, and/or psychological problems associated with physical illnesses. The aim of this study was to describe the pattern of specialised mental healthcare provision (availability, placement capacity, balance of care and diversity) for this age group in urban and rural health districts in Australia. The Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) tool was used in nine urban and two rural health districts of the thirty-one Primary Health Networks across Australia. For the most part service provision was limited to hospital and outpatient care across all study areas. The latter was mainly restricted to health-related outpatient care, and there was a relative lack of social outpatient care. While both acute and non-acute hospital care were available in urban areas, in rural areas hospital care was limited to acute care. Limited access to comprehensive mental health care, and the uniformity in provision across areas in spite of differences in demographic, socioeconomic and health characteristics raises issues of equity in regard to psychogeriatric care in this country. Comparing patterns of mental health service provision across the age span using the same classification method allows for a better understanding of care provision and gap analysis for evidence-informed policy.
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Affiliation(s)
- Hossein Tabatabaei-Jafari
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
| | - Jose A. Salinas-Perez
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
- Department of Quantitative Methods, Universidad Loyola Andalucía, 41704 Dos Hermanas, Sevilla, Spain
| | - Mary Anne Furst
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
| | - Nasser Bagheri
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
| | - John Mendoza
- Mental Health & Prison Health, Central Adelaide Local Health Network, Adelaide, SA 5000, Australia;
- Brain and Mind Centre, University of Sydney, Sydney, NSW 2050, Australia
| | - David Burke
- Discipline of Psychiatry, University of Notre Dame, Sydney, NSW 2010, Australia; (D.B.); (P.M.)
| | - Peter McGeorge
- Discipline of Psychiatry, University of Notre Dame, Sydney, NSW 2010, Australia; (D.B.); (P.M.)
- School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia; (H.T.-J.); (M.A.F.); (N.B.); (L.S.-C.)
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW 2006, Australia
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14
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What Is Rural Adversity, How Does It Affect Wellbeing and What Are the Implications for Action? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020. [PMID: 33019735 DOI: 10.3390/ijerph17197205.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A growing body of literature recognises the profound impact of adversity on mental health outcomes for people living in rural and remote areas. With the cumulative effects of persistent drought, record-breaking bushfires, limited access to quality health services, the COVID-19 pandemic and ongoing economic and social challenges, there is much to understand about the impact of adversity on mental health and wellbeing in rural populations. In this conceptual paper, we aim to review and adapt our existing understanding of rural adversity. We undertook a wide-ranging review of the literature, sought insights from multiple disciplines and critically developed our findings with an expert disciplinary group from across Australia. We propose that rural adversity be understood using a rural ecosystem lens to develop greater clarity around the dimensions and experiences of adversity, and to help identify the opportunities for interventions. We put forward a dynamic conceptual model of the impact of rural adversity on mental health and wellbeing, and close with a discussion of the implications for policy and practice. Whilst this paper has been written from an Australian perspective, it has implications for rural communities internationally.
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15
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Lawrence-Bourne J, Dalton H, Perkins D, Farmer J, Luscombe G, Oelke N, Bagheri N. What Is Rural Adversity, How Does It Affect Wellbeing and What Are the Implications for Action? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7205. [PMID: 33019735 PMCID: PMC7578975 DOI: 10.3390/ijerph17197205] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 01/28/2023]
Abstract
A growing body of literature recognises the profound impact of adversity on mental health outcomes for people living in rural and remote areas. With the cumulative effects of persistent drought, record-breaking bushfires, limited access to quality health services, the COVID-19 pandemic and ongoing economic and social challenges, there is much to understand about the impact of adversity on mental health and wellbeing in rural populations. In this conceptual paper, we aim to review and adapt our existing understanding of rural adversity. We undertook a wide-ranging review of the literature, sought insights from multiple disciplines and critically developed our findings with an expert disciplinary group from across Australia. We propose that rural adversity be understood using a rural ecosystem lens to develop greater clarity around the dimensions and experiences of adversity, and to help identify the opportunities for interventions. We put forward a dynamic conceptual model of the impact of rural adversity on mental health and wellbeing, and close with a discussion of the implications for policy and practice. Whilst this paper has been written from an Australian perspective, it has implications for rural communities internationally.
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Affiliation(s)
- Joanne Lawrence-Bourne
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW 2800, Australia; (J.L.-B.); (H.D.)
| | - Hazel Dalton
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW 2800, Australia; (J.L.-B.); (H.D.)
| | - David Perkins
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW 2800, Australia; (J.L.-B.); (H.D.)
| | - Jane Farmer
- Social Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC 3122, Australia;
| | - Georgina Luscombe
- School of Rural Health, University of Sydney, Orange, NSW 2800, Australia;
| | - Nelly Oelke
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC V1V 1V7, Canada;
| | - Nasser Bagheri
- Centre for Mental Health Research, Australian National University, Acton, ACT 2601, Australia;
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16
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Salinas-Perez JA, Gutierrez-Colosia MR, Furst MA, Suontausta P, Bertrand J, Almeda N, Mendoza J, Rock D, Sadeniemi M, Cardoso G, Salvador-Carulla L. Patterns of Mental Health Care in Remote Areas: Kimberley (Australia), Nunavik (Canada), and Lapland (Finland): Modèles de soins de santé mentale dans les régions éloignées: Kimberley (Australie), Nunavik (Canada) et Laponie (Finlande). CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:721-730. [PMID: 32720514 PMCID: PMC7502882 DOI: 10.1177/0706743720944312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Mental health (MH) care in remote areas is frequently scarce and fragmented and difficult to compare objectively with other areas even in the same country. This study aimed to analyze the adult MH service provision in 3 remote areas of Organization for Economic Cooperation and Development countries in the world. METHODS We used an internationally agreed set of systems indicators, terminology, and classification of services (Description and Evaluation of Services and DirectoriEs for Long Term Care). This instrument provided a standard description of MH care provision in the Kimberley region (Australia), Nunavik (Canada), and Lapland (Finland), areas characterized by an extremely low population density and high relative rates of Indigenous peoples. RESULTS All areas showed high rates of deprivation within their national contexts. MH services were mostly provided by the public sector supplemented by nonprofit organizations. This study found a higher provision per inhabitant of community residential care in Nunavik in relation to the other areas; higher provision of community outreach services in the Kimberley; and a lack of day services except in Lapland. Specific cultural-based services for the Indigenous population were identified only in the Kimberley. MH care in Lapland was self-sufficient, and its care pattern was similar to other Finnish areas, while the Kimberley and Nunavik differed from the standard pattern of care in their respective countries and relied partly on services located outside their boundaries for treating severe cases. CONCLUSION We found common challenges in these remote areas but a huge diversity in the patterns of MH care. The implementation of care interventions should be locally tailored considering both the environmental characteristics and the existing pattern of service provision.
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Affiliation(s)
- Jose A. Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, Spain
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Mencia R. Gutierrez-Colosia
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, Spain
- Asociación Científica Psicost, Dos Hermanas, Sevilla, Spain
| | - Mary Anne Furst
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Petra Suontausta
- Faculty of Social Sciences, Tampere University, Pirkanmaa, Finland
| | | | - Nerea Almeda
- Department of Psychology, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, Spain
| | - John Mendoza
- ConNetica Consulting, Coolum, Queensland, Australia
| | - Daniel Rock
- WA Primary Health Alliance, Perth, Western Australia, Australia
- Discipline of Psychiatry, The University of Western Australia, Perth, Western Australia, Australia
| | - Minna Sadeniemi
- Unit for Mental Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health, Comprehensive Health Research Center (CHRC), Nova Medical School, Nova University of Lisbon, Portugal
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
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17
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Salinas-Pérez JA, Gutiérrez-Colosia MR, Romero López-Alberca C, Poole M, Rodero-Cosano ML, García-Alonso CR, Salvador-Carulla L. [Everything is on the map: Integrated Mental Health Atlases as support tools for service planning. SESPAS Report 2020]. GACETA SANITARIA 2020; 34 Suppl 1:11-19. [PMID: 32933792 DOI: 10.1016/j.gaceta.2020.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 06/04/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This article reviews the usability of the Integrated Atlases of Mental Health as a decision support tool for service planning following a health ecosystem research approach. METHOD This study describes the types of atlases and the procedure for their development. Atlases carried out in Spain are presented and their impact in mental health service planning is assessed. Atlases comprise information on the local characteristics of the health care system, geographical availability of resources collected with the DESDE-LTC instrument and their use. Atlases use geographic information systems and other visualisation tools. Atlases follow a bottom-up collaborative approach involving decision-makers from planning agencies for their development and external validation. RESULTS Since 2005, Integrated Atlases of Mental Health have been developed for nine regions in Spain comprising over 65% of the Spanish inhabitants. The impact on service planning has been unequal for the different regions. Catalonia, Biscay and Gipuzkoa, and Andalusia reach the highest impact. In these areas, health advisors have been actively involved in their co-design and implementation in service planning. CONCLUSIONS Atlases allow detecting care gaps and duplications in care provision; monitoring changes of the system over time, and carrying out national and international comparisons, efficiency modelling and benchmarking. The knowledge provided by atlases could be incorporated to decision support systems in order to support an efficient mental health service planning based on evidence-informed policy.
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Affiliation(s)
- José A Salinas-Pérez
- Asociación Científica Psicost, Sevilla, España; Departamento de Métodos Cuantitativos, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, España.
| | - Mencía R Gutiérrez-Colosia
- Asociación Científica Psicost, Sevilla, España; Departamento de Psicología, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, España
| | - Cristina Romero López-Alberca
- Asociación Científica Psicost, Sevilla, España; Departamento de Psicología, Universidad de Cádiz, San Fernando, Cádiz, España
| | - Miriam Poole
- Asociación Científica Psicost, Sevilla, España; Asociación Nuevo Futuro, Madrid, España
| | - María Luisa Rodero-Cosano
- Asociación Científica Psicost, Sevilla, España; Departamento de Métodos Cuantitativos, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, España
| | - Carlos R García-Alonso
- Asociación Científica Psicost, Sevilla, España; Departamento de Métodos Cuantitativos, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, España
| | - Luis Salvador-Carulla
- Asociación Científica Psicost, Sevilla, España; Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia; Menzies Centre for Health Policy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Abstract
PURPOSE OF REVIEW The aim of this article is to provide a framework and analysis of a series of critical components to inform the future design, development, sustaining, and monitoring of community mental health services. RECENT FINDINGS Many mental health services remain too hospital-centric, often without adequate outreach services. On the basis of outcome evidence, we need to shift the balance of mental health services from hospital-centered with community outreach when convenient for staff, to community-centered and mobile, with in-reach to hospital only when necessary. Too few training programs those with emphasize the macroskills of public advocacy, working with service users, families, social movements, and the media to improve mental health and wellbeing of regional and local communities. SUMMARY We should adopt a health ecosystems approach to mental healthcare and training, encompassing nano to macrolevels of service in every region. Catchment mental health services should be rebuilt as community-centric mental health services, integrating all community and inpatient components, but led and integrated from community sites. Community psychiatrists and mental health professionals of the future will need to be well trained in the nano to macroskills required to take responsibility for the mental health and wellbeing of their catchment communities and to provide leadership in service-planning, management, and continuing revision on the basis of rigorous evaluation. These approaches should be the core of all training in psychiatry and all mental health professions prior to any subspecialization.
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19
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Exploring the identification, validation, and categorization of costs and benefits of education in mental health: The PECUNIA project. Int J Technol Assess Health Care 2020. [DOI: 10.1017/s0266462320000203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BackgroundMental health problems can lead to costs and benefits in other sectors (e.g. in the education sector) in addition to the healthcare sector. These related costs and benefits are known as intersectoral costs and benefits (ICBs). Although some ICBs within the education sector have been identified previously, little is known about their extensiveness and transferability, which is crucial for their inclusion in health economics research.ObjectivesThe aim of this study was to identify ICBs in the education sector, to validate the list of ICBs in a broader European context, and to categorize the ICBs using mental health as a case study.MethodsPreviously identified ICBs in the education sector were used as a basis for this study. Additional ICBs were extracted from peer-reviewed literature in PubMed and grey literature from six European countries. A comprehensive list of unique items was developed based on the identified ICBs. The list was validated by surveying an international group of educational experts. The survey results were used to finalize the list, which was categorized according to the care atom.ResultsAdditional ICBs in the education sector were retrieved from ninety-six sources. Fourteen experts from six European countries assessed the list for completeness, clarity, and relevance. The final list contained twenty-four ICBs categorized into input, throughput, and output.ConclusionBy providing a comprehensive list of ICBs in the education sector, this study laid further foundations for the inclusion of important societal costs in health economics research in the broader European context.
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20
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van Spijker BA, Salinas-Perez JA, Mendoza J, Bell T, Bagheri N, Furst MA, Reynolds J, Rock D, Harvey A, Rosen A, Salvador-Carulla L. Service availability and capacity in rural mental health in Australia: Analysing gaps using an Integrated Mental Health Atlas. Aust N Z J Psychiatry 2019; 53:1000-1012. [PMID: 31250654 DOI: 10.1177/0004867419857809] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Access to services and workforce shortages are major challenges in rural areas worldwide. In order to improve access to mental health care, it is imperative to understand what services are available, what their capacity is and where existing funds might be spent to increase availability and accessibility. The aim of this study is to investigate mental health service provision in a selection of rural and remote areas across Australia by analysing service availability, placement capacity and diversity. METHOD This research studies the health regions of Western New South Wales and Country Western Australia and their nine health areas. Service provision was analysed using the DESDE-LTC system for long-term care service description and classification that allows international comparison. Rates per 100,000 inhabitants were calculated to compare the care availability and placement capacity for children and adolescents, adults and older adults. RESULTS The lowest diversity was found in northern Western Australia. Overall, Western New South Wales had a higher availability of non-acute outpatient services for adults, but hardly any acute outpatient services. In Country Western Australia, substantially fewer non-acute outpatient services were found, while acute services were much more common. Acute inpatient care services were more common in Western New South Wales, while sub-acute inpatient services and non-acute day care services were only found in Western New South Wales. CONCLUSION The number and span of services in the two regions showed discrepancies both within and between regions, raising issues on the equity of access to mental health care in Australia. The standard description of the local pattern of rural mental health care and its comparison across jurisdictions is critical for evidence-informed policy planning and resource allocation.
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Affiliation(s)
- Bregje A van Spijker
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Jose A Salinas-Perez
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia.,Department of Quantitative Methods, Universidad Loyola Andalucía, Sevilla, Spain
| | - John Mendoza
- ConNetica Consulting, Caloundra, QLD, Australia.,Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Tanya Bell
- ConNetica Consulting, Caloundra, QLD, Australia
| | - Nasser Bagheri
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Mary Anne Furst
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Julia Reynolds
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
| | - Daniel Rock
- Discipline of Psychiatry, University of Western Australia Medical School, Perth, WA, Australia.,Western Australian Primary Health Alliance, Perth, WA, Australia
| | - Andrew Harvey
- Western New South Wales Primary Health District, Dubbo, NSW, Australia
| | - Alan Rosen
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Illawarra Institute for Mental Health, University of Wollongong, Wollongong, NSW, Australia.,Far West LHD Mental Health Services, Broken Hill, NSW, Australia
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, ACT, Australia
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Mortimer D, Iezzi A, Dickins M, Johnstone G, Lowthian J, Enticott J, Ogrin R. Using co-creation and multi-criteria decision analysis to close service gaps for underserved populations. Health Expect 2019; 22:1058-1068. [PMID: 31187600 PMCID: PMC6803401 DOI: 10.1111/hex.12923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 04/29/2019] [Accepted: 05/14/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Navigating treatment pathways remains a challenge for populations with complex needs due to bottlenecks, service gaps and access barriers. The application of novel methods may be required to identify and remedy such problems. OBJECTIVE To demonstrate a novel approach to identifying persistent service gaps, generating potential solutions and prioritizing action. DESIGN Co-creation and multi-criteria decision analysis in the context of a larger, mixed methods study. SETTING AND PARTICIPANTS Community-dwelling sample of older women living alone (OWLA), residing in Melbourne, Australia (n = 13-37). Convenience sample of (n = 11) representatives from providers and patient organizations. INTERVENTIONS Novel interventions co-created to support health, well-being and independence for OWLA and bridge missing links in pathways to care. MAIN OUTCOME MEASURES Performance criteria, criterion weights , performance ratings, summary scores and ranks reflecting the relative value of interventions to OWLA. RESULTS The co-creation process generated a list of ten interventions. Both OWLA and stakeholders considered a broad range of criteria when evaluating the relative merits of these ten interventions and a "Do Nothing" alternative. Combining criterion weights with performance ratings yielded a consistent set of high priority interventions, with "Handy Help," "Volunteer Drivers" and "Exercise Buddies" most highly ranked by both OWLA and stakeholder samples. DISCUSSION AND CONCLUSIONS The present study described and demonstrated the use of multi-criteria decision analysis to prioritize a set of novel interventions generated via a co-creation process. Application of this approach can add community voice to the policy debate and begin to bridge the gap in service provision for underserved populations.
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Affiliation(s)
- Duncan Mortimer
- Centre for Health Economics, Monash Business SchoolMonash UniversityClaytonVictoriaAustralia
| | - Angelo Iezzi
- Centre for Health Economics, Monash Business SchoolMonash UniversityClaytonVictoriaAustralia
| | - Marissa Dickins
- Bolton Clarke Research InstituteBolton ClarkeBrisbaneQueenslandAustralia
- Southern Synergy, Department of Psychiatry at Monash Health, Southern Clinical SchoolMonash UniversityClaytonVictoriaAustralia
| | - Georgina Johnstone
- Bolton Clarke Research InstituteBolton ClarkeBrisbaneQueenslandAustralia
| | - Judy Lowthian
- Bolton Clarke Research InstituteBolton ClarkeBrisbaneQueenslandAustralia
- School of Public Health and Preventive MedicineMonash UniversityClaytonVictoriaAustralia
| | - Joanne Enticott
- Southern Synergy, Department of Psychiatry at Monash Health, Southern Clinical SchoolMonash UniversityClaytonVictoriaAustralia
- Department of General Practice, School of Primary and Allied Health CareMonash UniversityClaytonVictoriaAustralia
| | - Rajna Ogrin
- Bolton Clarke Research InstituteBolton ClarkeBrisbaneQueenslandAustralia
- Austin Health Clinical SchoolUniversity of MelbourneMelbourneVictoriaAustralia
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Abstract
AIMS There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care in Europe) project. METHODS A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (≥18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS. RESULTS The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona - Italy and Girona - Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sør-Trøndelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care. CONCLUSIONS There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.
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García-Alonso CR, Almeda N, Salinas-Pérez JA, Gutiérrez-Colosía MR, Uriarte-Uriarte JJ, Salvador-Carulla L. A decision support system for assessing management interventions in a mental health ecosystem: The case of Bizkaia (Basque Country, Spain). PLoS One 2019; 14:e0212179. [PMID: 30763361 PMCID: PMC6375615 DOI: 10.1371/journal.pone.0212179] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 01/30/2019] [Indexed: 01/30/2023] Open
Abstract
Evidence-informed strategic planning is a top priority in Mental Health (MH) due to the burden associated with this group of disorders and its societal costs. However, MH systems are highly complex, and decision support tools should follow a systems thinking approach that incorporates expert knowledge. The aim of this paper is to introduce a new Decision Support System (DSS) to improve knowledge on the health ecosystem, resource allocation and management in regional MH planning. The Efficient Decision Support-Mental Health (EDeS-MH) is a DSS that integrates an operational model to assess the Relative Technical Efficiency (RTE) of small health areas, a Monte-Carlo simulation engine (that carries out the Monte-Carlo simulation technique), a fuzzy inference engine prototype and basic statistics as well as system stability and entropy indicators. The stability indicator assesses the sensitivity of the model results due to data variations (derived from structural changes). The entropy indicator assesses the inner uncertainty of the results. RTE is multidimensional, that is, it was evaluated by using 15 variable combinations called scenarios. Each scenario, designed by experts in MH planning, has its own meaning based on different types of care. Three management interventions on the MH system in Bizkaia were analysed using key performance indicators of the service availability, placement capacity in day care, health care workforce capacity, and resource utilisation data of hospital and community care. The potential impact of these interventions has been assessed at both local and system levels. The system reacts positively to the proposals by a slight increase in its efficiency and stability (and its corresponding decrease in the entropy). However, depending on the analysed scenario, RTE, stability and entropy statistics can have a positive, neutral or negative behaviour. Using this information, decision makers can design new specific interventions/policies. EDeS-MH has been tested and face-validated in a real management situation in the Bizkaia MH system.
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Affiliation(s)
| | | | | | | | - José J Uriarte-Uriarte
- Bizkaia Mental Health Services, Osakidetza-Basque Health Service, Biocruces Health Research Institute, Bilbao, Spain
| | - Luis Salvador-Carulla
- ANU College of Health and Medicine, Australian National University, Canberra, Australia
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24
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Almeda N, García-Alonso CR, Salinas-Pérez JA, Gutiérrez-Colosía MR, Salvador-Carulla L. Causal Modelling for Supporting Planning and Management of Mental Health Services and Systems: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030332. [PMID: 30691052 PMCID: PMC6388254 DOI: 10.3390/ijerph16030332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/19/2019] [Accepted: 01/19/2019] [Indexed: 12/17/2022]
Abstract
Mental health services and systems (MHSS) are characterized by their complexity. Causal modelling is a tool for decision-making based on identifying critical variables and their causal relationships. In the last two decades, great efforts have been made to provide integrated and balanced mental health care, but there is no a clear systematization of causal links among MHSS variables. This study aims to review the empirical background of causal modelling applications (Bayesian networks and structural equation modelling) for MHSS management. The study followed the PRISMA guidelines (PROSPERO: CRD42018102518). The quality of the studies was assessed by using a new checklist based on MHSS structure, target population, resources, outcomes, and methodology. Seven out of 1847 studies fulfilled the inclusion criteria. After the review, the selected papers showed very different objectives and subjects of study. This finding seems to indicate that causal modelling has potential to be relevant for decision-making. The main findings provided information about the complexity of the analyzed systems, distinguishing whether they analyzed a single MHSS or a group of MHSSs. The discriminative power of the checklist for quality assessment was evaluated, with positive results. This review identified relevant strategies for policy-making. Causal modelling can be used for better understanding the MHSS behavior, identifying service performance factors, and improving evidence-informed policy-making.
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Affiliation(s)
- Nerea Almeda
- Universidad Loyola Andalucía, Department of Psychology, C/ Energía Solar 1, 41014 Seville, Spain.
| | - Carlos R García-Alonso
- Universidad Loyola Andalucía, Department of Quantitative Methods, C/ Energía Solar 1, 41014 Seville, Spain.
| | - José A Salinas-Pérez
- Universidad Loyola Andalucía, Department of Quantitative Methods, C/ Energía Solar 1, 41014 Seville, Spain.
| | | | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, Australian National University, 63 Eggleston Rd, Acton ACT 2601, Australia.
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Salinas-Perez JA, Salvador-Carulla L, Saldivia S, Grandon P, Minoletti A, Lopez-Alberca CR. Integrated mapping of local mental health systems in Central Chile. Rev Panam Salud Publica 2018; 42:e144. [PMID: 31093172 PMCID: PMC6385966 DOI: 10.26633/rpsp.2018.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/10/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the availability of local mental health (MH) services in small MH catchment areas in Central Chile, using a bottom-up approach. METHODS MH services of 19 small MH catchment areas in five health districts of Central Chile that provide health care to more than 4 million inhabitants were assessed using DESDE-LTC (Description and Evaluation of Services and Directories in Europe for Long-Term Care), a tool for standardized description and classification of LTC health services, in a study conducted in 2012 ("DESDE-Chile") designed to complement other studies conducted in 2004 and 2012 at the national and regional level using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS). Key informants from national, regional, and local health authorities were contacted to compile a comprehensive list of MH services or facilities (health, social services, education, employment, and housing). The analysis of local care provision covered three criteria-service availability, placement capacity, and workforce capacity. RESULTS The study detected disparities in all three criteria (availability and placement and workforce capacity) across the five health districts, between urban and rural areas, and between neighboring urban areas. Analysis of service availability revealed differences in the weight of residential services versus day and outpatient care. The Talcahuano area could be considered a benchmark of MH care in Central Chile, based on its service provision patterns, and the criteria of the community care model. The list of MH services identified in this study differed from the one generated in the 2012 WHO-AIMS study. CONCLUSIONS This survey of local MH service provision in small catchment areas using the DESDE-LTC tool provided MH service provision data that complemented information collected in other studies conducted at the national/regional level using the WHO-AIMS tool. The bottom-up approach applied in this study would also be useful for the assessment of equity and accessibility and local planning.
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Affiliation(s)
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia.
| | - Sandra Saldivia
- Department of Psychiatry and Mental Health, School of Medicine, Universidad de Concepción, Concepción, Chile.
| | - Pamela Grandon
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile.
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26
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Cetrano G, Salvador-Carulla L, Tedeschi F, Rabbi L, Gutiérrez-Colosía MR, Gonzalez-Caballero JL, Park AL, McDaid D, Sfetcu R, Kalseth J, Kalseth B, Hope Ø, Brunn M, Chevreul K, Straßmayr C, Hagmair G, Wahlbeck K, Amaddeo F. The balance of adult mental health care: provision of core health versus other types of care in eight European countries. Epidemiol Psychiatr Sci 2018; 29:e6. [PMID: 30328401 PMCID: PMC8061296 DOI: 10.1017/s2045796018000574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/17/2018] [Accepted: 09/10/2018] [Indexed: 12/02/2022] Open
Abstract
AIMS Although many mental health care systems provide care interventions that are not related to direct health care, little is known about the interfaces between the latter and core health care. 'Core health care' refers to services whose explicit aim is direct clinical treatment which is usually provided by health professionals, i.e., physicians, nurses, psychologists. 'Other care' is typically provided by other staff and includes accommodation, training, promotion of independence, employment support and social skills. In such a definition, 'other care' does not necessarily mean being funded or governed differently. The aims of the study were: (1) using a standard classification system (Description and Evaluation of Services and Directories in Europe for Long Term Care, DESDE-LTC) to identify 'core health' and 'other care' services provided to adults with mental health problems; and (2) to investigate the balance of care by analysing the types and characteristics of core health and other care services. METHODS The study was conducted in eight selected local areas in eight European countries with different mental health systems. All publicly funded mental health services, regardless of the funding agency, for people over 18 years old were identified and coded. The availability, capacity and the workforce of the local mental health services were described using their functional main activity or 'Main Types of Care' (MTC) as the standard for international comparison, following the DESDE-LTC system. RESULTS In these European study areas, 822 MTCs were identified as providing core health care and 448 provided other types of care. Even though one-third of mental health services in the selected study areas provided interventions that were coded as 'other care', significant variation was found in the typology and characteristics of these services across the eight study areas. CONCLUSIONS The functional distinction between core health and other care overcomes the traditional division between 'health' and 'social' sectors based on governance and funding. The overall balance between core health and other care services varied significantly across the European sites. Mental health systems cannot be understood or planned without taking into account the availability and capacity of all services specifically available for this target population, including those outside the health sector.
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Affiliation(s)
- G. Cetrano
- Social Care Workforce Research Unit, King's Policy Institute, King's College London, London, UK
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - L. Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
- PSICOST Research Association, Jerez de la Frontera, Spain
| | - F. Tedeschi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - L. Rabbi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - M. R. Gutiérrez-Colosía
- PSICOST Research Association, Jerez de la Frontera, Spain
- Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain
| | | | - A.-L. Park
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - D. McDaid
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - R. Sfetcu
- Institute for Economic Forecasting, Bucharest, Romania
- Faculty of Psychology and Educational Sciences, University Spiru Haret, Bucharest, Romania
| | - J. Kalseth
- Department of Health Research, SINTEF, Trondheim, Norway
| | - B. Kalseth
- Department of Health Research, SINTEF, Trondheim, Norway
| | - Ø. Hope
- Department of Health Research, SINTEF, Trondheim, Norway
| | - M. Brunn
- Université Paris Diderot, Sorbonne, Paris, France
- Inserm, ECEVE, U1123, F-75 010, Paris, France
- AP-HP, URC-Eco, Paris, France
| | - K. Chevreul
- Université Paris Diderot, Sorbonne, Paris, France
- Inserm, ECEVE, U1123, F-75 010, Paris, France
- AP-HP, URC-Eco, Paris, France
| | | | - G. Hagmair
- IMEHPS.research, Vienna, Austria
- Department for Cultural Analysis, Universitaet Klagenfurt, Klagenfurt, Austria
| | - K. Wahlbeck
- Department of Mental Health, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - F. Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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27
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Ala-Nikkola T, Pirkola S, Kaila M, Joffe G, Kontio R, Oranta O, Sadeniemi M, Wahlbeck K, Saarni SI. Identifying Local and Centralized Mental Health Services-The Development of a New Categorizing Variable. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061131. [PMID: 29857540 PMCID: PMC6025394 DOI: 10.3390/ijerph15061131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/17/2018] [Accepted: 05/28/2018] [Indexed: 12/02/2022]
Abstract
The challenges of mental health and substance abuse services (MHS) require shifting of the balance of resources from institutional care to community care. In order to track progress, an instrument that can describe these attributes of MHS is needed. We created a coding variable in the European Service Mapping Schedule-Revised (ESMS-R) mapping tool using a modified Delphi panel that classified MHS into centralized, local services with gatekeeping and local services without gatekeeping. For feasibility and validity, we tested the variable on a dataset comprising MHS in Southern Finland, covering a population of 2.3 million people. There were differences in the characteristics of services between our study regions. In our data, 41% were classified as centralized, 37% as local without gatekeeping and 22% as local services with gatekeeping. The proportion of resources allocated to local services varied from 20% to 43%. Reclassifying ESMS-R is an easy way to compare the important local vs. centralized balance of MHS systems globally, where such data exists. Further international studies comparing systems and validating this approach are needed.
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Affiliation(s)
- Taina Ala-Nikkola
- Clinic of Psychiatry and Clinic of Public Health Välskärinkatu 12 and Stenbäckinkatu 9, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.), Mannerheimintie 168, FI-00270 Helsinki, Finland.
- Public Health Medicine, University of Helsinki and Helsinki University Hospital, FI-000014 Helsinki, Finland.
| | - Sami Pirkola
- University of Tampere School of Health Sciences and Tampere University Hospital, Lääkärinkatu 1, FI-33014 Tampere, Finland.
| | - Minna Kaila
- Clinic of Psychiatry and Clinic of Public Health Välskärinkatu 12 and Stenbäckinkatu 9, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
- Public Health Medicine, University of Helsinki and Helsinki University Hospital, FI-000014 Helsinki, Finland.
| | - Grigori Joffe
- Clinic of Psychiatry and Clinic of Public Health Välskärinkatu 12 and Stenbäckinkatu 9, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
| | - Raija Kontio
- Clinic of Psychiatry and Clinic of Public Health Välskärinkatu 12 and Stenbäckinkatu 9, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
- University of Turku, FI-20014 Turku, Finland.
- Lohja Hospital Area, Sairaalakatu 8, 08200 Lohja, Finland.
| | - Olli Oranta
- Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, FI-20520 Turku, Finland.
| | - Minna Sadeniemi
- Clinic of Psychiatry and Clinic of Public Health Välskärinkatu 12 and Stenbäckinkatu 9, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland.
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.), Mannerheimintie 168, FI-00270 Helsinki, Finland.
- Department of Social Services and Health Care, City of Helsinki, FI-00099 Helsinki, Finland.
| | - Kristian Wahlbeck
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.), Mannerheimintie 168, FI-00270 Helsinki, Finland.
| | - Samuli I Saarni
- Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, FI-20520 Turku, Finland.
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Chung Y, Salvador-Carulla L, Salinas-Pérez JA, Uriarte-Uriarte JJ, Iruin-Sanz A, García-Alonso CR. Use of the self-organising map network (SOMNet) as a decision support system for regional mental health planning. Health Res Policy Syst 2018; 16:35. [PMID: 29695248 PMCID: PMC5922302 DOI: 10.1186/s12961-018-0308-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background Decision-making in mental health systems should be supported by the evidence-informed knowledge transfer of data. Since mental health systems are inherently complex, involving interactions between its structures, processes and outcomes, decision support systems (DSS) need to be developed using advanced computational methods and visual tools to allow full system analysis, whilst incorporating domain experts in the analysis process. In this study, we use a DSS model developed for interactive data mining and domain expert collaboration in the analysis of complex mental health systems to improve system knowledge and evidence-informed policy planning. Methods We combine an interactive visual data mining approach, the self-organising map network (SOMNet), with an operational expert knowledge approach, expert-based collaborative analysis (EbCA), to develop a DSS model. The SOMNet was applied to the analysis of healthcare patterns and indicators of three different regional mental health systems in Spain, comprising 106 small catchment areas and providing healthcare for over 9 million inhabitants. Based on the EbCA, the domain experts in the development team guided and evaluated the analytical processes and results. Another group of 13 domain experts in mental health systems planning and research evaluated the model based on the analytical information of the SOMNet approach for processing information and discovering knowledge in a real-world context. Through the evaluation, the domain experts assessed the feasibility and technology readiness level (TRL) of the DSS model. Results The SOMNet, combined with the EbCA, effectively processed evidence-based information when analysing system outliers, explaining global and local patterns, and refining key performance indicators with their analytical interpretations. The evaluation results showed that the DSS model was feasible by the domain experts and reached level 7 of the TRL (system prototype demonstration in operational environment). Conclusions This study supports the benefits of combining health systems engineering (SOMNet) and expert knowledge (EbCA) to analyse the complexity of health systems research. The use of the SOMNet approach contributes to the demonstration of DSS for mental health planning in practice. Electronic supplementary material The online version of this article (10.1186/s12961-018-0308-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Younjin Chung
- Faculty of Engineering & Information Technologies, The University of Sydney, 1 Cleveland Street, Darlington, NSW, 2008, Australia. .,ANU College of Health and Medicine, Australian National University, 63 Eggleston Road, Acton, ACT, 2601, Australia.
| | - Luis Salvador-Carulla
- Faculty of Health Sciences, The University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.,ANU College of Health and Medicine, Australian National University, 63 Eggleston Road, Acton, ACT, 2601, Australia
| | - José A Salinas-Pérez
- PSICOST Research Association, Universidad Loyola Andalucía, C/Energía Solar, 1 Edificio G, 41014, Sevilla, Spain
| | - Jose J Uriarte-Uriarte
- Bizkaia Mental Health Services, Osakidetza-Basque Health Service, Biocruces Health Research Institute, Calle Maria Diaz de Haro, 58, 48010, Bilbao, Spain
| | - Alvaro Iruin-Sanz
- Gipuzkoa Mental Health Services, Osakidetza - Basque Health Service, Biocruces Health Research Institute, Paseo Doctor Beguiristain, 115, 20014, San Sebastian, Spain
| | - Carlos R García-Alonso
- Department of Quantitative Methods, Universidad Loyola Andalucía, C/Escritor Castilla Aguayo, 4, 14004, Córdoba, Spain
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Ala-Nikkola T, Pirkola S, Kaila M, Saarni SI, Joffe G, Kontio R, Oranta O, Sadeniemi M, Wahlbeck K. Regional Correlates of Psychiatric Inpatient Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121204. [PMID: 27929403 PMCID: PMC5201345 DOI: 10.3390/ijerph13121204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/13/2016] [Accepted: 11/30/2016] [Indexed: 11/16/2022]
Abstract
Current reforms of mental health and substance abuse services (MHS) emphasize community-based care and the downsizing of psychiatric hospitals. Reductions in acute and semi-acute hospital beds are achieved through shortened stays or by avoiding hospitalization. Understanding the factors that drive the current inpatient treatment provision is essential. We investigated how the MHS service structure (diversity of services and balance of personnel resources) and indicators of service need (mental health index, education, single household, and alcohol sales) correlated with acute and semi-acute inpatient treatment provision. The European Service Mapping Schedule-Revised (ESMS-R) tool was used to classify the adult MHS structure in southern Finland (population 1.8 million, 18+ years). The diversity of MHS in terms of range of outpatient and day care services or the overall personnel resourcing in inpatient or outpatient services was not associated with the inpatient treatment provision. In the univariate analyses, sold alcohol was associated with the inpatient treatment provision, while in the multivariate modeling, only a general index for mental health needs was associated with greater hospitalization. In the dehospitalization process, direct resource re-allocation and substituting of inpatient treatment with outpatient care per se is likely insufficient, since inpatient treatment is linked to contextual factors in the population and the health care system. Mental health services reforms require both strategic planning of service system as a whole and detailed understanding of effects of societal components.
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Affiliation(s)
- Taina Ala-Nikkola
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.); Mannerheimintie 168, Helsinki FI-00270, Finland.
- Public Health Medicine, University of Helsinki and Helsinki University Hospital, Helsinki FI-000014, Finland.
| | - Sami Pirkola
- University of Tampere School of Health Sciences, and Tampere University Hospital, Lääkärinkatu 1, Tampere FI-33014, Finland.
| | - Minna Kaila
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
- Public Health Medicine, University of Helsinki and Helsinki University Hospital, Helsinki FI-000014, Finland.
| | - Samuli I Saarni
- Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, Turku FI-20520, Finland.
| | - Grigori Joffe
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
| | - Raija Kontio
- University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland.
- University of Turku, Turku FI-20014, Finland.
| | - Olli Oranta
- Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, Turku FI-20520, Finland.
| | - Minna Sadeniemi
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.); Mannerheimintie 168, Helsinki FI-00270, Finland.
- Department of Social Services and Health Care, City of Helsinki, Helsinki FI-00099, Finland.
| | - Kristian Wahlbeck
- Unit for Mental Health, National Institute for Health and Welfare (T.H.L.); Mannerheimintie 168, Helsinki FI-00270, Finland.
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Ala-Nikkola T, Sadeniemi M, Kaila M, Saarni S, Kontio R, Pirkola S, Joffe G, Oranta O, Wahlbeck K. How size matters: exploring the association between quality of mental health services and catchment area size. BMC Psychiatry 2016; 16:289. [PMID: 27520368 PMCID: PMC4983042 DOI: 10.1186/s12888-016-0992-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/03/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The diversity of mental health and substance abuse services (MHS) available to service users is seen as an indicator of the quality of the service system. In most countries MHS are provided by a mix of public, private and third sector providers. In Finland, officially, the municipalities are responsible for organizing the services needed, but the real extent and roles of private and third sector service providers are not known. Our previous study showed that the catchment area population size was strongly associated with diversity of mental health services. It is not known whether this was due to some types of services or some provider types being more sensitive to the size effect than others. The aim of this study was to investigate the association between area population size and diversity of mental health services, i.e. which types of services and which service providers' contributions are sensitive to population size. METHODS To map and classify services, we used the ESMS-R. The diversity of services was defined as the count of main types of care. Providers were classified as public, private or third sectors. RESULTS The diversity of outpatient, residential and voluntary services correlated positively with catchment area population size. The strongest positive correlation between the size of population and services available was found in third sector activities followed by public providers, but no correlation was found for diversity of private services. The third sector and public corporations each provided 44 % of the service units. Third sector providers produced all self-help services and most of the day care services. Third sector and private companies provided a significant part (59 %) of the residential care service units. CONCLUSIONS Significant positive correlations were found between size of catchment area population and diversity of residential, outpatient and voluntary services, indicating that these services concentrate on areas with larger population bases. The third sector seems to significantly complement the public sector in providing different services. Thus the third sector be needs to be functionally integrated with other MHS services to achieve a diversified and integrated service system.
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Affiliation(s)
- Taina Ala-Nikkola
- University of Helsinki and Helsinki University Hospital, Psychiatry, Välskärinkatu 12, FI-00029, Helsinki, Finland. .,Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270, Helsinki, Finland.
| | - Minna Sadeniemi
- Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270 Helsinki, Finland ,Department of Social Services and Health Care, City of Helsinki, FI-00099 Helsinki, Finland ,Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, FI-00029 Helsinki, Finland
| | - Minna Kaila
- Department of Public Health, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, FI-000014 Helsinki, Finland
| | - Samuli Saarni
- Turku University Central Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
| | - Raija Kontio
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, FI-00029 Helsinki, Finland
| | - Sami Pirkola
- University of Tampere and Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-33014 Tampere, Finland
| | - Grigori Joffe
- University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, FI-00029 Helsinki, Finland
| | - Olli Oranta
- Turku University Central Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
| | - Kristian Wahlbeck
- Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270 Helsinki, Finland
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