The Nordic Comparative Study on Sectorized Psychiatry: contact rates and use of services for patients with a functional psychosis

Psychosis, Socioeconomic Disadvantage, and Health Service Use in South Australia: Findings from the Second Australian National Survey of Psychosis

The association between mental illness and poor physical health and socioeconomic outcomes has been well established. In the twenty-first century, the challenge of how mental illnesses, such as psychosis, are managed in the provision of public health services remains complex. Developing effective clinical mental health support and interventions for individuals requires a coordinated and robust mental health system supported by social as well as health policy that places a priority on addressing socioeconomic disadvantage in mental health cohorts. This paper, thus, examines the complex relationship between socioeconomic disadvantage, family/social supports, physical health, and health service utilization in a community sample of 402 participants diagnosed with psychosis. The paper utilizes quantitative data collected from the 2010 Survey of High Impact Psychosis research project conducted in a socioeconomically disadvantaged region of Adelaide, SA, Australia. Participants (42% female) provided information about socioeconomic status, education, employment, physical health, contact with family and friends, and health service utilization. The paper highlights that socioeconomic disadvantage is related to increased self-reported use of emergency departments, decreased use of general practitioners for mental health reasons, higher body mass index, less family contact, and less social support. In particular, the paper explores the multifaceted relationship between socioeconomic disadvantage and poor health confronting individuals with psychosis, highlighting the complex link between socioeconomic disadvantage and poor health. It emphasizes that mental health service usage for those with higher levels of socioeconomic disadvantage differs from those experiencing lower levels of socioeconomic disadvantage. The paper also stresses that the development of health policy and practice that seeks to redress the socioeconomic and health inequalities created by this disadvantage be an important focus for mental health services. Such health policy would provide accessible treatment programs and linked pathways to illness recovery and diminish the pressure on the delivery of health services. Consequently, the development of policy and practice that seeks to redress the socioeconomic and health inequalities created by disadvantage should be an important focus for the improvement of mental health services.

Predictors of frequent recourse to health professionals by people with severe mental disorders

OBJECTIVE

Based on Andersen's behavioural model, our study sought to determine predictors and blocks of factors that could explain why people with severe mental disorders (SMDs) more often seek the services of health professionals.

METHODS

This longitudinal study involved 292 users with SMDs located in Le Sud-Ouest, the southwest borough of Montreal. Data were collected from participants' medical records and through 7 questionnaires. Using Andersen's Behavioral Model of Health Services Use, independent variables were divided into 3 classes-predisposing factors, enabling factors, and need factors-and were introduced in this order in a hierarchical logistic model.

RESULTS

Among 292 users, 110 (37.7%) were frequent users who consulted about one health professional every 3 days. Participants who were more likely to call on health professionals were single and older, depended on welfare as their main source of income, lived in supervised housing, suffered from schizophrenia, schizophrenia spectrum disorders, and adjustment disorders, and, marginally, exhibited multiple mental disorders.

CONCLUSION

Mental health services could promote strategies to overcome the reluctance of younger people to seek professional services. Professionals should pay close attention to subsidiary conditions, such as adjustment disorders, from which people with SMDs may suffer. Interventions to improve the socioeconomic condition of unemployed people with SMDs may help to reduce health care service use among that clientele. Programs such as supported employment should be tailored and enhanced for people receiving welfare to decrease stigmatization and improve job market integration.

Components of a modern mental health service: a pragmatic balance of community and hospital care: overview of systematic evidence

BACKGROUND

There is controversy about whether mental health services should be provided in community or hospital settings. There is no worldwide consensus on which mental health service models are appropriate in low-, medium- and high-resource areas.

AIMS

To provide an evidence base for this debate, and present a stepped care model.

METHOD

Cochrane systematic reviews and other reviews were summarised.

RESULTS

The evidence supports a balanced approach, including both community and hospital services. Areas with low levels of resources may focus on improving primary care, with specialist back-up. Areas with medium resources may additionally provide out-patient clinics, community mental health teams (CMHTs), acute in-patient care, community residential care and forms of employment and occupation. High-resource areas may provide all the above, together with more specialised services such as specialised out-patient clinics and CMHTs, assertive community treatment teams, early intervention teams, alternatives to acute in-patient care, alternative types of community residential care and alternative occupation and rehabilitation.

CONCLUSIONS

Both community and hospital services are necessary in all areas regardless of their level of resources, according to the additive and sequential stepped care model described here.

The EPSILON study of schizophrenia in five European countries. Design and methodology for standardising outcome measures and comparing patterns of care and service costs

BACKGROUND

There is a lack of cross-national research on care for people with schizophrenia.

AIMS

To produce standardised European versions of five instruments in key areas of mental health service research in five languages, and to compare data from five European countries regarding patients with schizophrenia and mental health care provision and costs.

METHOD

Five centres, in Amsterdam, Copenhagen, London, Santander and Verona, participated. Instruments assessing needs, service use, informal career involvement, quality of life, and service satisfaction were subjected to a conversion procedure including translation, back-translation, focus group discussion and reliability assessment. Patients of local mental health services with a Schedules for Clinical Assessment in Neuropsychiatry diagnosis of schizophrenia were interviewed.

RESULTS

Service provision varied between sites; 404 patients were studied. Instrument reliability was found to be good.

CONCLUSIONS

The instruments developed were reliable across the range of countries, and will facilitate future comparative health service research.