Housing and Employment Outcomes for Mental Health Self-Direction Participants

Outcome analysis on individual health budgets in mental Health: finding from the Friuli Venezia Giulia Region, Italy

BACKGROUND

Individual Health Budget (IHB) is used for social and health integration and to facilitate processes of resource reorientation in healthcare. Despite its increased use in mental health settings, few studies investigated its effectiveness in severe mental disorders.

METHODS

383 IHB beneficiaries were recruited among Mental Health Departments users of the Italian region Friuli Venezia Giulia. Data involved sociodemographic and clinical variables, IHB type and scores of Health of the Nation Outcome Scale (HoNOS) at admission to IHB programme (T0), after 12 months (T1), and after 24 months (T2).

RESULTS

The length and the mean number of hospitalisations and healthcare interventions decreased at T1. A significant scores' reduction from T0 to T1 evaluation was found in HoNOS total score (T-test (P) < 0.05) and in most of its items. An improvement throughout the whole evaluation period (T0 vs. T2) was found in 36% of the IHB beneficiaries, while more than 60% of them remained in the same HoNOS severity category.

CONCLUSIONS

Our results support the use of IHB in patients with severe mental problems, since it may contribute to an improvement in social and clinical functioning, consequently lowering the burden on MHDs.

Randomized Controlled Trial of Self-Directed Care for Medically Uninsured Adults With Serious Mental Illness

OBJECTIVE

Self-directed care (SDC) is a treatment model in which recipients self-manage funds designated for provision of services. The model is designed to cost no more than traditional services while achieving superior participant outcomes. The authors examined the model's impact on outcomes, service costs, and user satisfaction among medically uninsured, low-income individuals with serious mental illness.

METHODS

Adults in the public mental health system (N=42) were randomly assigned (1:1) to receive SDC or services as usual and were assessed at baseline and 6- and 12-month follow-ups. Outcomes included perceived competence for mental health self-management, met and unmet needs, degree of autonomy support, self-perceived recovery, and employment. Mixed-effects random regression analysis tested for differences in longitudinal changes in outcomes between the two study conditions. Differences in service costs were analyzed with negative binomial regression models.

RESULTS

Compared with individuals in the control condition, SDC participants reported greater improvement in perceived competence, met and unmet needs, autonomy support, recovery from symptom domination, and employment. No differences were found between the two groups in total per-person service costs or costs for individual services. The most frequent nontraditional purchases were for medical, dental, and vision services (33%) and health and wellness supports (33%). Satisfaction with SDC services was high.

CONCLUSIONS

Mental health SDC services achieved participant outcomes superior to treatment as usual, with equivalent service use and costs and high user satisfaction. This model may be well suited to the needs of uninsured adults with low income who receive public behavioral health care.

Staff perceptions of factors affecting the use of RAS-DS to support collaborative mental health practice

BACKGROUND

The Recovery Assessment Scale: Domains and Stages (RAS-DS) was designed to be both a recovery outcome measure and a tool to enhance service-user control over their recovery journey. While extensively and globally used in mental health services for the former purpose, routine use for the latter purpose is yet to be realised. The aim of this study was to identify barriers, facilitators and additional supports needed for RAS-DS to be used to support service user participation, goal setting and recovery action planning.

METHODS

An online survey was conducted of mental health workers who had engaged with RAS-DS, including fixed choice and open-ended questions. Data were analysed using descriptive statistics and interpretive content analysis respectively.

RESULTS

The 65 respondents reported more frequent use of RAS-DS as an outcome measure than as a collaboration tool and more than half reported difficulties in using it in this way. Factors that they described as influencing the use of RAS-DS as a tool for collaboration and support included: previous experiences with RAS-DS; organisational supports and policies; awareness of the RAS-DS amongst colleagues; RAS-DS related training and support; staff time and capacity; the format of RAS-DS; service user population or context; and respondents' own active efforts.

CONCLUSIONS

Extending the use of RAS-DS, an already widely used tool, to routinely support recovery-oriented practice has both efficiency and service user empowerment benefits. However further work is needed to enable this including: provision of co-designed, accessible training resources; a user platform including built in guidance; and strategies to promote management understanding and valuing of the enhanced recovery-orientation opportunities inherent in RAS-DS use.

Benefits and challenges of a personal budget for people with mental health conditions or intellectual disability: A systematic review

Personal budgets (PBs) may improve the lives of people with mental health conditions and people with intellectual disability (ID). However, a clear definition of PB, benefits, and challenges is still faded. This work aims to systematically review evidence on PB use in mental health and ID contexts, from both a qualitative and quantitative perspective, and summarize the recent research on interventions, outcomes, and cost-effectiveness of PBs in beneficiaries with mental health conditions and/or ID. The present systematic review is an update of the existing literature analyzed since 2013. We performed a systematic search strategy of articles using the bibliographic databases PubMed and PsycINFO. Six blinded authors screened the works for inclusion/exclusion criteria, and two blinded authors extracted the data. We performed a formal narrative synthesis of the findings from the selected works. A total of 9,800 publications were screened, and 29 were included. Improvement in responsibility and awareness, quality of life, independent living, paid work, clinical, psychological, and social domains, and everyday aspects of the users' and their carers' life have been observed in people with mental health conditions and/or ID. However, the PBs need to be less stressful and burdensome in their management for users, carers, and professionals. In addition, more quantitative research is needed to inform PBs' policymakers.

SYSTEMATIC REVIEW REGISTRATION

[www.crd.york.ac.uk/prospero/], identifier [CRD42020172607].

Self-direction and the Social Determinants of Health

Social determinants of health-defined by the World Health Organization as "the social factors and physical conditions of the environment in which people are born, live, learn, play, work, and age"-are increasingly discussed as having relevance in community mental health service systems. This brief report describes how self-direction-an approach in which people with serious mental health conditions choose the services and supports that work best for them to support their recovery-is a tool that may directly and uniquely promote the social determinants of health by expanding the bounds of traditional service delivery to address the needs of the whole person.

Self-Determination and Choice in Mental Health: Qualitative Insights From a Study of Self-Directed Care

SELF-DETERMINATION AND CHOICE IN MENTAL HEALTH.