Needs assessed by psychiatric health care and social services in a defined cohort of clients with mental disabilities

A systematic review of clinician-rated instruments to assess adults' levels of functioning in specialised public sector mental health services

BACKGROUND

Functioning is one of the key domains emphasised in the routine assessment of outcomes that has been occurring in specialised public sector mental health services across Australia since 2002, via the National Outcomes and Casemix Collection. For adult consumers (aged 18-64), the 16-item Life Skills Profile (LSP-16) has been the instrument of choice to measure functioning. However, review of the National Outcomes and Casemix Collection protocol has highlighted some limitations to the current approach to measuring functioning. A systematic review was conducted to identify, against a set of pre-determined criteria, the most suitable existing clinician-rated instruments for the routine measurement of functioning for adult consumers.

METHOD

We used two existing reviews of functioning measures as our starting point and conducted a search of MEDLINE and PsycINFO to identify articles relating to additional clinician-rated instruments. We evaluated identified instruments using a hierarchical, criterion-based approach. The criteria were as follows: (1) is brief (<50 items) and simple to score, (2) is not made redundant by more recent instruments, (3) relevant version has been scientifically scrutinised, (4) considers functioning in a contemporary way and (5) demonstrates sound psychometric properties.

RESULTS

We identified 20 relevant instruments, 5 of which met our criteria: the LSP-16, the Health of the Nation Outcome Scales, the Illness Management and Recovery Scale-Clinician Version, the Multnomah Community Ability Scale and the Personal and Social Performance Scale.

CONCLUSION

Further work is required to determine which, if any, of these instruments satisfy further criteria relating to their appropriateness for assessing functioning within relevant service contexts, acceptability to clinicians and consumers, and feasibility in routine practice. This should involve seeking stakeholders' opinions (e.g. about the specific domains of functioning covered by each instrument and the language used in individual items) and testing completion rates in busy service settings.

Prevalence of psychoses in Stockholm County--a population-based study using comprehensive healthcare registers

BACKGROUND

Major variations in the prevalence of schizophrenia and other psychoses have been reported in different geographical areas, partly explained by the methodology used as well as characteristics of the area.

AIMS

The purpose of this study was to estimate the 1-year prevalence of schizophrenia (ICD-10 F20) and non-affective psychoses (ICD-10 F20-F29) in Stockholm County using population-based health records from inpatient and outpatient care.

METHODS

Psychiatric outpatient and inpatient healthcare data during the period 1997 to 2006 in Stockholm County was collected from mental health facilities in a defined geographical area covering almost one million adult inhabitants. Data included 13,561 individuals with ICD-10 diagnoses of non-affective psychoses, their contacts with healthcare and demographic variables constituting the Stockholm Non-Affective Psychoses-registry.

RESULTS

The 1-year prevalence was 6.7/1000 for non-affective psychoses and 3.7/1000 for schizophrenia. The estimates were markedly stable during the study period, years 2000-2005. However, a substantial variation in the 1-year prevalence between areas in Stockholm County was noted (range 3.5/1000-13.2/1000). The 1-year prevalence was correlated to the proportion of immigrants as well as the proportion of individuals receiving social welfare benefits, in the area. An increase in the proportion of individuals only visiting outpatient care was seen.

CONCLUSION

The 1-year prevalence of schizophrenia was 3.7/1000 and approximately twice as high for non-affective psychoses. The estimates were stable over time but varied substantially between local areas, corresponding to social and demographic factors.

Support in housing: a comparison between people with psychiatric disabilities and people with intellectual disabilities

The primary objective of this study was to compare type of housing and support in housing in two groups (people with psychiatric disabilities and people with intellectual disabilities) typically dependent on support in everyday life. A second objective was to examine whether type of housing and support in housing were related to gender within the two groups. Information was obtained by available questionnaire reports provided by staff members. The results indicate unequal accessibility of support in housing in relation to the two groups. Moreover, the findings suggest that type of disability is a more determining factor than gender regarding support in housing.

The life circumstances of persons with a psychiatric disability: a survey in a region in southern Sweden

This article describes the life circumstances of persons with a psychiatric disability living in one urban and six rural areas in a single region in Sweden. Furthermore, the life circumstances of persons with a psychiatric disability are discussed in relation to the aims of social policies in Sweden. Data were collected by means of a survey study exploring the formal support provided by local authorities to its citizens and the informal support given by family members and volunteers. The results reveal how the respondents themselves describe their life circumstances in terms of their living conditions, occupation and activities, health, and formal and informal support. The results indicate that persons with a psychiatric disability, regardless of where they live, need both formal and informal support in order to cope with their everyday lives. The family plays an important role in this, and it is essential for the formal and informal support systems to cooperate with each other. The lack of activities and opportunities for work experienced by persons with a psychiatric disability indicates that the sociopolitical goal of fostering access to employment and work and to earning a living for this group is far from having been attained.