The silent world of young next of kin in mental healthcare

BACKGROUND:

Young next of kin to patients with mental health problems are faced with many challenges. It is important to focus on the special needs of children and adolescents as next of kin to ensure their welfare and prevent harm.

RESEARCH QUESTIONS:

We aimed to investigate young next of kin's need for information and involvement, to examine the ways they cope with situations involving coercion related to the treatment of their relative, and to identify ethical challenges.

RESEARCH DESIGN:

We conducted a qualitative study based on semi-structured, individual interviews.

PARTICIPANTS AND RESEARCH CONTEXT:

Seven young next of kin aged 14-22 years participated in the study. The informants were recruited from a regional hospital trust in Norway.

ETHICAL CONSIDERATIONS:

The study was approved by the National Data Protection Official for Research and based upon informed consent and confidentiality.

FINDINGS:

The adolescents wanted more information and described a need for increased interaction with their sick relative at the hospital. They struggled to keep their relationship with their relative intact, and they described communication problems in the family. Coercive treatment was perceived in a negative way.

DISCUSSION:

The study finds that there are ethical challenges at stake for young next of kin and their families other than those that are often emphasized by traditional healthcare, which often focuses on the individual patient's rights. These challenges are related to the young next of kin's needs for interconnectedness and for the preservation of relationships as well as challenges related to family communication and the need for information.

CONCLUSION:

The study finds a need for more family-oriented perspectives in both mental healthcare practices and healthcare ethics.

Cost-effectiveness of preventive case management for parents with a mental illness: a randomized controlled trial from three economic perspectives

Background

The children of parents with a mental illness (COPMI) are at increased risk for developing costly psychiatric disorders because of multiple risk factors which threaten parenting quality and thereby child development. Preventive basic care management (PBCM) is an intervention aimed at reducing risk factors and addressing the needs of COPMI-families in different domains. The intervention may lead to financial consequences in the healthcare sector and in other sectors, also known as inter-sectoral costs and benefits (ICBs). The objective of this study was to assess the cost-effectiveness of PBCM from three perspectives: a narrow healthcare perspective, a social care perspective (including childcare costs) and a broad societal perspective (including all ICBs).

Methods

Effects on parenting quality (as measured by the HOME) and costs during an 18-month period were studied in in a randomized controlled trial. Families received PBCM (n = 49) or care as usual (CAU) (n = 50). For all three perspectives, incremental cost-effectiveness ratios (ICERs) were calculated. Stochastic uncertainty in the data was dealt with using non-parametric bootstraps. Sensitivity analyses included calculating ICERs excluding cost outliers, and making an adjustment for baseline cost differences.

Results

Parenting quality improved in the PBCM group and declined in the CAU group, and PBCM was shown to be more costly than CAU. ICERs differ from 461 Euros (healthcare perspective) to 215 Euros (social care perspective) to 175 Euros (societal perspective) per one point improvement on the HOME T-score. The results of the sensitivity analyses, based on complete cases and excluding cost outliers, support the finding that the ICER is lower when adopting a broader perspective. The subgroup analysis and the analysis with baseline adjustments resulted in higher ICERs.

Conclusions

This study is the first economic evaluation of family-focused preventive basic care management for COPMI in psychiatric and family services. The effects of the chosen perspective on determining the cost-effectiveness of PBCM underscore the importance of economic studies of interdepartmental policies. Future studies focusing on the cost-effectiveness of programs like PBCM in other sites and studies with more power are encouraged as this may improve the quality of information used in supporting decision making.

Trial registration

NTR2569, date of registration 2010-10-12.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1498-z) contains supplementary material, which is available to authorized users.