Prevalence of psychiatric disorder in a methadone maintenance population

OBJECTIVE

The objective of this study was to examine the prevalence of psychiatric disorders in a group of patients who had recently entered a methadone maintenance programme.

METHOD

A total of 62 patients were interviewed using the Composite International Diagnostic Interview (CIDI) within 6 months of commencing methadone maintenance. The CIDI was used to establish symptoms of psychiatric illness at interview and in the 12 months prior.

RESULTS

In the 12 months prior to interview, 76% of the sample fulfilled ICD-10 criteria for a psychiatric disorder other than substance-use disorder. Over half of the group interviewed fulfilled ICD-10 criteria for an affective disorder, two-thirds fulfilled criteria for an anxiety disorder and just under half fulfilled diagnostic criteria for both an affective disorder and an anxiety disorder in the 12 months prior to interview. At the time of interview, 19% fulfilled ICD-10 diagnostic criteria for a moderate or severe affective disorder. Seventy per cent of males and 89% of females interviewed had a comorbid psychiatric illness. In 71% of the group who had a comorbid psychiatric illness, the onset of psychiatric symptomatology was reported to predate the use of heroin.

CONCLUSION

The prevalence of psychiatric disorder is up to 10 times higher in the population on methadone maintenance than in the general population and is two to three times higher than that found in community surveys of those with a substance-use disorder. These results are consistent with earlier findings and have implications for service planning.

Introducing the routine use of outcomes measurement to mental health services

Significant progress has been made in preparing for the introduction of the routine use of outcome measurement instruments to mental health services. However, limited attention has been paid to the linked issues of the practical challenge of their implementation and their possible uses in clinical practice. This paper reports on a qualitative study examining the views of clinicians, service managers, consumers and carers on how to effectively introduce a suite of measures to a public mental health service and use ratings generated by them in clinical practice. These findings are combined with practical experience gained in introducing a suite of outcome measures in order to suggest future strategies for implementation.

The measurement of improvement during hospitalisation for acute psychiatric illness

OBJECTIVE

The aim of this paper is to compare clinical changes and lengths of stay of patients with schizophrenic and affective disorders in public and private hospital settings.

METHOD

Recently published Australian work using the Health of the Nation Outcome Scales (HoNOS) was compared with new data collected in a public setting. Changes in HoNOS scores between admission and discharge were analysed against length of stay. Individual HoNOS items were also examined.

RESULTS

Public facilities tended to show greater improvements, owing to higher admission severities, and their lengths of stay tended to be shorter. Certain HoNOS items, notably the self-harm item, were significantly more severe in both diagnostic groups on admission in the public facilities.

CONCLUSIONS

The findings are discussed in terms of the fact that self-harm is a criterion for involuntary hospitalisation, and private facilities do not treat involuntary patients. Certain problems assessed by the HoNOS are more amenable to rapid reduction than others, and this may contribute to differences in length of stay. Implications for outcome measurement are discussed.

Health of the Nation Outcome Scales. Results of the Victorian field trial

BACKGROUND

In Victoria, Australia, systematic assessment of outcomes in mental health services are being instituted.

AIMS

To carry out a large-scale field trial of the Health of the Nation Outcome Scales (HoNOS).

METHOD

2137 clients were rated by mental health workers on the HoNOS, and about half were rated again within a few months.

RESULTS

While interrater reliability of the total score was satisfactory, that of some individual items was unacceptable. Significant associations with age and gender were found, and clients with non-psychotic disorders obtained higher (i.e. worse) ratings than those with psychotic disorders. There were relationships between service use and HoNOS total score. For the group as a whole, total scores had not changed at the second rating, but admissions and discharges were associated with increases and decreases in total score. Among clients in the community, there was no relationship between change in HoNOS total score and frequency of contacts.

CONCLUSIONS

Certain items, notably 11 and 12, were unreliable. The absence of evidence of sensitivity to change may be due to the short re-rating interval, little real change in the clients, or the characteristics of the scale itself.

The development of a mental health service patient information management system

In this paper we describe the development of the Mental Health-Patient Information Management System (MH-PIMS), which is an information management system designed for use in a modern, primarily community-based, mental health service. MH-PIMS is a computerised database which was designed by clinicians and is supported by a case management system and complementary patient record set-together called the Assessment and Care Evaluation (ACE) system. The paper also describes the ACE system. MH-PIMS can generate patient reports of use to case managers and teams in managing their caseloads and is of use to senior clinicians and service managers for audit and strategic planning purposes.