Identifying Local and Centralized Mental Health Services-The Development of a New Categorizing Variable

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.

Regional Correlates of Psychiatric Inpatient Treatment

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.

How size matters: exploring the association between quality of mental health services and catchment area size

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.

Infancy-onset dietary counseling of low-saturated-fat diet improves insulin sensitivity in healthy adolescents 15-20 years of age: the Special Turku Coronary Risk Factor Intervention Project (STRIP) study

OBJECTIVE

We reported previously that low-saturated-fat dietary counseling started in infancy improves insulin sensitivity in healthy children 9 years of age. The aim of this study was to evaluate the effect of lifelong dietary counseling on insulin sensitivity in healthy adolescents between 15 and 20 years of age. In addition, we examined dietary fiber intake and the polyunsaturated fatty acid (PUFA)+monounsaturated (MUFA)-to-saturated fatty acid (SFA) ratio in the intervention and control adolescents and the association of these dietary factors with homeostasis model of insulin resistance (HOMA-IR).

RESEARCH DESIGN AND METHODS

The study comprised adolescents participating in the randomized, controlled Special Turku Coronary Risk Factor Intervention Project (STRIP) study, which aims to guide the study participants toward a diet beneficial for cardiovascular health. HOMA-IR was assessed annually between 15 and 20 years of age (n=518; intervention, n=245; control, n=273), along with diet, BMI, pubertal status, serum cotinine concentrations, and physical activity. Dietary counseling was given biannually during the follow-up.

RESULTS

HOMA-IR was lower (7.5% on average) in the intervention group than in the control group between 15 and 20 years of age (P=0.0051). The intervention effect was similar in girls and boys. The PUFA+MUFA-to-SFA ratio was higher (P<0.0001) and the dietary fiber (g/MJ) intake was higher (P=0.0058) in the intervention group compared with the control group. There was no association between the PUFA+MUFA-to-/SFA ratio and HOMA-IR, whereas dietary fiber intake (g/MJ) was associated with HOMA-IR in girls (P<0.0001).

CONCLUSIONS

Dietary counseling initiated in infancy and maintained until 20 years of age was associated with improved insulin sensitivity in adolescents.

Depression-focused interpersonal counseling and the use of healthcare services after myocardial infarction

PURPOSE

The purpose for this study was to evaluate the association between depression-focused interpersonal counseling (IPC) and the use of healthcare services in Finland after myocardial infarction (MI).

DESIGN AND METHODS

The measures were done at 6 and 18 months after MI in the randomized intervention (n= 51) and the control group (n= 52).

FINDINGS

There was less use of somatic specialized healthcare services in the intervention group from 6 to 18 months after hospital discharge, and with intervention patients who had no other long-term disease during 6 months.

PRACTICE IMPLICATIONS

Confirmation of possible benefits of IPC for practice calls for more specific studies.

The effects of interpersonal counselling on health-related quality of life after myocardial infarction

AIM

To evaluate the effects of interpersonal counselling on health-related quality of life after myocardial infarction.

BACKGROUND

Depression is a risk factor for poor health-related quality of life after myocardial infarction. Interpersonal counselling seems to reduce depressive symptoms and distress after myocardial infarction.

METHODS

Myocardial infarction patients (n=103) were randomised into an intervention group (n=51) with 1-6 (mean 4·6) interpersonal counselling-sessions focusing on managing depressive symptoms and a control group (n=52). Health-related quality of life after myocardial infarction was measured with EuroQol-5D (EQ-5D) in hospital, at six and 18 months after discharge.

RESULTS

No differences in the changes of health-related quality of life were found between the groups during follow-up. However, health-related quality of life improved significantly in the intervention group. In the group of patients under 60 years, the effect of interpersonal counselling was significant in the intervention group compared with the control group.

CONCLUSIONS

Interpersonal counselling does not seem to improve health-related quality of life better than standard care after myocardial infarction in general, but it does seem to be beneficial with younger myocardial infarction patients.

RELEVANCE TO CLINICAL PRACTICE

There is a need to study the effects of interpersonal counselling further with younger myocardial infarction patients and to develop the intervention further, before using it systematically as part of nursing practice.

The outcomes of interpersonal counselling on depressive symptoms and distress after myocardial infarction

AIMS

Depression is not treated adequately after myocardial infarction (MI). This study evaluates the interpersonal counselling (IPC) implemented by a registered nurse on outcomes for depressive symptoms and distress in MI patients.

METHODS

We studied MI patients (n = 103) randomized into intervention group (n = 51) and control group (n = 52) in hospital and at 6 and 18 months after discharge using validated questionnaires, Beck's Depression Inventory (BDI) and the Symptom Checklist-25 (SCL-25).

RESULTS

During the 18-month follow-up, depressive symptoms decreased statistically significantly (P = 0.009) in the intervention group compared with the control group. In the IPC intervention group, depressive symptoms decreased from 37.3% to 20.4% at 6 months (P = 0.014), and to 16.7% at 18 months (P = 0.001), while distress decreased from 37.3% to 26.5% (P = 0.132) during the 6-month follow-up, and to 20.8% (P = 0.015). In the control group with normal care, the number of patients with depressive symptoms and distress varied slightly at the three measurements, from 30.2 to 39.6%.

CONCLUSIONS

The number of patients with depressive symptoms and distress decreased in the intervention group and remained high in the control group. The progress of severity level of depressive symptoms was toward milder symptoms in the intervention group during the 18-month follow-up. This brief intervention that can rapidly be adopted may result in enduring benefits of clinical value.

Barriers to and facilitators of research utilization among Finnish registered nurses

1. The aim of nursing research is to produce a sound foundation for evidence-based nursing; the job of nurses is to make the best possible use of that foundation and apply the knowledge produced to the practice of nursing. 2. The purpose of this study was to identify and describe barriers to and facilitators of research utilization from the point of view of Finnish Registered Nurses. 3. The BARRIERS Scale was administered to 316 nurses in two major hospitals; 253 nurses returned the questionnaire, giving a response rate of 80%. The structured data were processed with SPSS 9.0, and the unstructured data were interpreted using the method of content analysis. 4. The main barriers to research utilization identified by the respondents were: the fact that most research is published in a foreign language; that physicians will not co-operate with implementation; and that statistical analyses are difficult to understand. The facilitators mentioned most often were nurses' positive attitudes and abilities. Other important facilitators included the support and activity of a ward sister as well as encouragement, a favourable attitude and collaboration on the part of all staff members. 5. The findings are discussed in relation to the Finnish healthcare context and nurse education, and evidence-based nursing practice.