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Jakobsson CE, Genovesi E, Afolayan A, Bella-Awusah T, Omobowale O, Buyanga M, Kakuma R, Ryan GK. Co-producing research on psychosis: a scoping review on barriers, facilitators and outcomes. Int J Ment Health Syst 2023; 17:25. [PMID: 37644476 PMCID: PMC10466887 DOI: 10.1186/s13033-023-00594-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Co-production is a collaborative approach to service user involvement in which users and researchers share power and responsibility in the research process. Although previous reviews have investigated co-production in mental health research, these do not typically focus on psychosis or severe mental health conditions. Meanwhile, people with psychosis may be under-represented in co-production efforts. This scoping review aims to explore the peer-reviewed literature to better understand the processes and terminology employed, as well as the barriers, facilitators, and outcomes of co-production in psychosis research. METHODS Three databases were searched (MEDLINE, EMBASE, PsycINFO) using terms and headings related to psychosis and co-production. All titles, abstracts and full texts were independently double-screened. Disagreements were resolved by consensus. Original research articles reporting on processes and methods of co-production involving adults with psychosis as well as barriers, facilitators, and/or outcomes of co-production were included. Data was extracted using a standardised template and synthesised narratively. Joanna Briggs Institute and the AGREE Reporting Checklist were used for quality assessment. RESULTS The search returned 1243 references. Fifteen studies were included: five qualitative, two cross-sectional, and eight descriptive studies. Most studies took place in the UK, and all reported user involvement in the research process; however, the amount and methods of involvement varied greatly. Although all studies were required to satisfy INVOLVE (2018) principles of co-production to be included, seven were missing several of the key features of co-production and often used different terms to describe their collaborative approaches. Commonly reported outcomes included improvements in mutual engagement as well as depth of understanding and exploration. Key barriers were power differentials between researchers and service users and stigma. Key facilitators were stakeholder buy-in and effective communication. CONCLUSIONS The methodology, terminology and quality of the studies varied considerably; meanwhile, over-representation of UK studies suggests there may be even more heterogeneity in the global literature not captured by our review. This study makes recommendations for encouraging co-production and improving the reporting of co-produced research, while also identifying several limitations that could be improved upon for a more comprehensive review of the literature.
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Affiliation(s)
- C E Jakobsson
- Department of Psychiatry, Sussex Partnership NHS Foundation Trust, Eastbourne, England, UK.
| | - E Genovesi
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - A Afolayan
- Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - T Bella-Awusah
- Department of Psychiatry & Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - O Omobowale
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - M Buyanga
- SUCCEED Africa, University of Zimbabwe, Harare, Zimbabwe
| | - R Kakuma
- London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, London, England, UK.
| | - G K Ryan
- London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, London, England, UK.
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Zhang Z, Yuan M, Shi K, Xu C, Lin J, Shi Z, Fang Y. Association between multimorbidity trajectories, healthcare utilization, and health expenditures among middle-aged and older adults: China Health and Retirement Longitudinal Study. J Affect Disord 2023; 330:24-32. [PMID: 36868387 DOI: 10.1016/j.jad.2023.02.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND To identify the latent groups of multimorbidity trajectories among middle-aged and older adults and examine their associations with healthcare utilization and health expenditures. METHODS We included adults aged ≥45 years who participated in the China Health and Retirement Longitudinal Study from 2011 to 2015 and were without multimorbidities (<2 chronic conditions) at baseline. Multimorbidity trajectories underlying 13 chronic conditions were identified using group-based multi-trajectory modeling based on the latent dimensions. Healthcare utilization included outpatient care, inpatient care, and unmet healthcare needs. Health expenditures included healthcare costs and catastrophic health expenditures (CHE). Random-effects logistic regression, random-effects negative binomial regression, and generalized linear regression models were used to examine the association between multimorbidity trajectories, healthcare utilization, and health expenditures. RESULTS Of the 5548 participants, 2407 developed multimorbidities during follow-up. Three trajectory groups were identified among those with new-onset multimorbidity according to the increasing dimensions of chronic diseases: "digestive-arthritic" (N = 1377, 57.21 %), "cardiometabolic/brain" (N = 834, 34.65 %), and "respiratory/digestive-arthritic" (N = 196, 8.14 %). All trajectory groups had a significantly increased risk of outpatient care, inpatient care, unmet healthcare needs, and higher healthcare costs than those without multimorbidities. Notably, participants in the "digestive-arthritic" trajectory group had a significantly increased risk of incurring CHE (OR = 1.70, 95%CI: 1.03-2.81). LIMITATIONS Chronic conditions were assessed using self-reported measures. CONCLUSIONS The growing burden of multimorbidity, especially multimorbidities of digestive and arthritic diseases, was associated with a significantly increased risk of healthcare utilization and health expenditures. The findings may help in planning future healthcare and managing multimorbidity more effectively.
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Affiliation(s)
- Zeyun Zhang
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China; Center for Aging and Health Research, School of Public Health, Xiamen University, China
| | - Manqiong Yuan
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China; Center for Aging and Health Research, School of Public Health, Xiamen University, China
| | - Kanglin Shi
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China; Center for Aging and Health Research, School of Public Health, Xiamen University, China
| | - Chuanhai Xu
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China; Center for Aging and Health Research, School of Public Health, Xiamen University, China
| | - Jianlin Lin
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China; Center for Aging and Health Research, School of Public Health, Xiamen University, China
| | - Zaixing Shi
- Center for Aging and Health Research, School of Public Health, Xiamen University, China
| | - Ya Fang
- Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China; Center for Aging and Health Research, School of Public Health, Xiamen University, China.
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Awara MA, Downing LM, Edem D, Lewis N, Green JT. Three-year-cohort-study: clinical and cost effectiveness of an inpatient psychiatric rehabilitation. Front Psychiatry 2023; 14:1140265. [PMID: 37187859 PMCID: PMC10175637 DOI: 10.3389/fpsyt.2023.1140265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/20/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction There has been a resurgence of interest in psychiatric rehabilitation to cater to patients with chronic and complex mental illnesses. Aims This study is aimed at examining patients' characteristics and the prevalence of psychiatric and non-psychiatric comorbidity in a local inpatient rehabilitation service, as well as to investigate the impact of the whole-system approach to rehabilitation on future utilization of mental health services and to analyze the cost-effectiveness and quality of this service. Method Patients managed over 3 years in a psychiatric rehabilitation inpatient unit were self-controlled; they were retrospectively (pre-rehabilitation) and prospectively (post-rehabilitation) examined for readmission rate, length of stay (LOS), and emergency room (ER) visits. Relevant information was retrieved from Discharge Abstract Database (DAD), Patient Registration System (STAR), and Emergency Department Information System (EDIS). The quality of care in the rehabilitation unit was examined using the Quality Indicator for Rehabilitative Care (QuIRC), and the cost analysis was conducted using data obtained from a single-payer government medical service insurance (MSI) billing system. Results Of the 185 patients admitted over the study period, 158 were discharged. There was a significant reduction in readmission rate (64% decrease), LOS (6,585 fewer days spent in hospital), and ER presentations (166 fewer visits) (P < 0.0001), respectively. There were substantial subsequent cost savings in the post-rehabilitation year. Conclusion and implications for practice In the 3-year study, an inpatient psychiatric rehabilitation service in Nova Scotia, Canada, resulted in the successful discharge of most patients with severe and persistent mental illness to more socially inclusive environments. It also reduced their post-rehabilitation mental health service utilization, hence greatly enhancing the effectiveness and efficiency of these services.
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Affiliation(s)
- Mahmoud A. Awara
- Department of Psychiatry, Dalhousie University, Medical School, Halifax, NS, Canada
- The College of Physicians and Surgeons of Nova Scotia, Halifax, NS, Canada
- The Royal College of Psychiatrists, London, United Kingdom
- Mental Health and Addictions Services, Nova Scotia Health Authority, Halifax, NS, Canada
- *Correspondence: Mahmoud A. Awara
| | - Laura M. Downing
- Department of Psychiatry, Dalhousie University, Medical School, Halifax, NS, Canada
- The College of Physicians and Surgeons of Nova Scotia, Halifax, NS, Canada
- Mental Health and Addictions Services, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Dorothy Edem
- Mental Health and Addictions Services, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Norma Lewis
- Mental Health and Addictions Services, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Joshua T. Green
- Department of Psychiatry, Dalhousie University, Medical School, Halifax, NS, Canada
- The College of Physicians and Surgeons of Nova Scotia, Halifax, NS, Canada
- Mental Health and Addictions Services, Nova Scotia Health Authority, Halifax, NS, Canada
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Skipworth J, Garrett N, Pillai K, Tapsell R, McKenna B. Imprisonment following discharge from mental health units: A developing trend in New Zealand. Front Psychiatry 2023; 14:1038803. [PMID: 36778630 PMCID: PMC9909696 DOI: 10.3389/fpsyt.2023.1038803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Contemporary models of care for people with mental disorders continue to shift to community-based care, requiring fewer inpatient mental health beds, shorter inpatient lengths of stay, and less use of coercion. It has been suggested that some mentally unwell people, whose behavior can no longer be safely contained in overstretched mental health units where seclusion and restraint are discouraged, are now left to the criminal justice system to manage. It is unclear whether the risk of imprisonment following discharge from a mental health unit has increased over recent years. METHODS A quantitative, retrospective cohort study design was used to investigate any association between an acute inpatient mental health service admission in Aotearoa (New Zealand), and referral to a prison mental health team within 28 days of hospital discharge, from 2012 to 2020. Data were extracted from the national mental health dataset managed by the Ministry of Health. RESULTS Risk of imprisonment within 28 days of inpatient discharge increased over the study period. People experiencing this outcome were more likely to be younger, male, of Mâori or Pacific ethnicity, presenting with substance use and psychotic disorders who were aggressive or overactive, and were subject to coercive interventions such as seclusion and compulsory treatment during their admission. DISCUSSION We concluded that contemporary models of less coercive predominantly community based mental health care may be increasingly reliant on the criminal justice system to manage aggressive and violent behavior driven by mental illness. It is argued from a human rights perspective that mental health inpatient units should retain the capacity to safely manage this type of clinical presentation.
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Affiliation(s)
- Jeremy Skipworth
- Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nick Garrett
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Krishna Pillai
- Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rees Tapsell
- Mental Health and Addictions Service, Waikato District Health Board, Hamilton, New Zealand
| | - Brian McKenna
- Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand.,Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, VIC, Australia
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Higgins A, Murphy R, Barry J, Eustace-Cook J, Monahan M, Kroll T, Hevey D, Doyle L, Gibbons P. Scoping review of factors influencing the implementation of group psychoeducational initiatives for people experiencing mental health difficulties and their families. J Ment Health 2022; 31:859-872. [PMID: 31994955 DOI: 10.1080/09638237.2020.1714002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Despite evidence to support the effectiveness of psychoeducation for people experiencing mental health difficulties and their families, understanding issues around the implementation of such programmes is limited. AIM The aim of this scoping review was to synthesise the peer-reviewed literature on barriers and enablers influencing the implementation of group psychoeducation in adult mental health services. METHODS Using a pre-defined search strategy and PRISMA guidelines, four databases were systematically searched. Two reviewers independently screened and applied exclusion/inclusion criteria. Qualitative, quantitative, and mixed-methods studies were included if they provided empirical evidence on the barriers and enablers. Three reviewers independently extracted data. Following this, data were analysed using a five-level implementation framework. RESULTS Eight articles met the inclusion criteria. Barriers to implementation were identified at all five levels of the framework: participant; practitioner; intervention; organisational; and structural level. Enablers to implementation were evident at four levels: participant; provider; intervention; and organisational level. CONCLUSIONS The findings of the review provide preliminary information on factors that impact implementation. However, large-scale studies informed by implementation theories are required. In addition, other studies are needed to address the potential impact of different models of intervention and explore strategies to minimize obstacles and support sustainability.
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Affiliation(s)
- Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Rebecca Murphy
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Jennifer Barry
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | | | - Mark Monahan
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - David Hevey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Patrick Gibbons
- Kildare West Wicklow Mental Health Service, Naas Hospital, Naas, Ireland
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Martinelli A, Killaspy H, Zarbo C, Agosta S, Casiraghi L, Zamparini M, Starace F, Rocchetti M, de Girolamo G, Ruggeri M, Boero ME, Cerveri G, Clerici M, D’Anna G, De Novellis A, Di Michele V, Di Prisco P, Durbano F, Facchini F, Ghio L, Giosuè P, Greco C, Latorre V, Leuci E, Malagamba D, Maone A, Marina M, Maurizi A, Monzani E, Placenti R, Rancati L, Rippa A, Rovera C, Silva A, Tura G, Zanolini S. Quality of residential facilities in Italy: satisfaction and quality of life of residents with schizophrenia spectrum disorders. BMC Psychiatry 2022; 22:717. [PMID: 36397009 PMCID: PMC9672559 DOI: 10.1186/s12888-022-04344-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 09/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recovery and human rights promotion for people with Schizophrenia Spectrum Disorders (SSDs) is fundamental to provide good care in Residential Facilities (RFs). However, there is a concern about rehabilitation ethos in RFs. This study aimed to investigate the care quality of Italian RFs, the quality of life (QoL) and care experience of residents with SSD. METHODS Fourty-eight RFs were assessed using a quality assessment tool (QuIRC-SA) and 161 residents with SSD were enrolled. Seventeen RFs provided high intensity rehabilitation (SRP1), 15 medium intensity (SRP2), and 16 medium-low level support (SRP3). Staff-rated tools measured psychiatric symptoms and psychosocial functioning; user-rated tools assessed QoL and satisfaction with services. RFs comparisons were made using ANOVA and Chi-squared. RESULTS Over two-thirds patients (41.5 y.o., SD 9.7) were male. Seventy-six were recruited from SRP1 services, 48 from SRP2, and 27 from SRP3. The lowest QuIRC-SA scoring was Recovery Based Practice (45.8%), and the highest was promotion of Human Rights (58.4%). SRP2 had the lowest QuIRC-SA ratings and SRP3 the highest. Residents had similar psychopathology (p = 0.140) and functioning (p = 0.537). SRP3 residents were more employed (18.9%) than SRP1 (7.9%) or SRP2 (2.2%) ones, and had less severe negative symptoms (p = 0.016) and better QoL (p = 0.020) than SRP2 residents. There were no differences in the RF therapeutic milieu and their satisfaction with care. CONCLUSIONS Residents of the lowest supported RFs in Italy had less severe negative symptoms, better QoL and more employment than others. The lowest ratings for Recovery Based Practice across all RFs suggest more work is needed to improve recovery.
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Affiliation(s)
- Alessandra Martinelli
- Section of Psychiatry, Verona Hospital Trust, AOUI, Verona, Italy. .,Unit of Clinical Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni, 4, 25125, Brescia, BS, Italy.
| | - Helen Killaspy
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Cristina Zarbo
- grid.419422.8Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Sara Agosta
- grid.476047.60000 0004 1756 2640Mental Health and Dependence, AUSL of Modena, Modena, Italy ,Clinical Psychology Unit, ASST of Mantua, Mantua, Italy
| | - Letizia Casiraghi
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Manuel Zamparini
- grid.419422.8Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Fabrizio Starace
- grid.476047.60000 0004 1756 2640Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Matteo Rocchetti
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Giovanni de Girolamo
- grid.419422.8Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Mirella Ruggeri
- grid.411475.20000 0004 1756 948XSection of Psychiatry, Verona Hospital Trust, AOUI, Verona, Italy
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Hugunin J, Chen Q, Baek J, Clark RE, Lapane KL, Ulbricht CM. Quality of Nursing Homes Admitting Working-Age Adults With Serious Mental Illness. Psychiatr Serv 2022; 73:745-751. [PMID: 34911354 PMCID: PMC9200905 DOI: 10.1176/appi.ps.202100356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This cross-sectional study examined the association between nursing home quality and admission of working-age persons (ages 22-64 years) with serious mental illness. METHODS The study used 2015 national Minimum Data Set 3.0 and Nursing Home Compare (NHC) data. A logistic mixed-effects model estimated the likelihood (adjusted odds ratios [AORs] and 95% confidence intervals [CIs]) of a working-age nursing home resident having serious mental illness, by NHC health inspection quality rating. The variance partition coefficient (VPC) was calculated to quantify the variation in serious mental illness attributable to nursing home characteristics. Measures included serious mental illness (i.e., schizophrenia, bipolar disorder, and other psychotic disorders), health inspection quality rating (ranging from one star, below average, to five stars, above average), and other sociodemographic and clinical covariates. RESULTS Of the 343,783 working-age adults newly admitted to a nursing home in 2015 (N=14,307 facilities), 15.5% had active serious mental illness. The odds of a working-age resident having serious mental illness was lowest among nursing homes of above-average quality, compared with nursing homes of below-average quality (five-star vs. one-star facility, AOR=0.78, 95% CI=0.73-0.84). The calculated VPC from the full model was 0.11. CONCLUSIONS These findings indicate an association between below-average nursing homes and admission of working-age persons with serious mental illness, suggesting that persons with serious mental illness may experience inequitable access to nursing homes of above-average quality. Access to alternatives to care, integration of mental health services in the community, and improving mental health care in nursing homes may help address this disparity.
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Affiliation(s)
- Julie Hugunin
- Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences (Hugunin, Chen, Baek, Clark, Lapane), and Department of Population and Quantitative Health Sciences (Hugunin, Chen, Baek, Clark, Lapane, Ulbricht), UMass Chan Medical School, University of Massachusetts, Worcester; National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Ulbricht)
| | - Qiaoxi Chen
- Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences (Hugunin, Chen, Baek, Clark, Lapane), and Department of Population and Quantitative Health Sciences (Hugunin, Chen, Baek, Clark, Lapane, Ulbricht), UMass Chan Medical School, University of Massachusetts, Worcester; National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Ulbricht)
| | - Jonggyu Baek
- Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences (Hugunin, Chen, Baek, Clark, Lapane), and Department of Population and Quantitative Health Sciences (Hugunin, Chen, Baek, Clark, Lapane, Ulbricht), UMass Chan Medical School, University of Massachusetts, Worcester; National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Ulbricht)
| | - Robin E Clark
- Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences (Hugunin, Chen, Baek, Clark, Lapane), and Department of Population and Quantitative Health Sciences (Hugunin, Chen, Baek, Clark, Lapane, Ulbricht), UMass Chan Medical School, University of Massachusetts, Worcester; National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Ulbricht)
| | - Kate L Lapane
- Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences (Hugunin, Chen, Baek, Clark, Lapane), and Department of Population and Quantitative Health Sciences (Hugunin, Chen, Baek, Clark, Lapane, Ulbricht), UMass Chan Medical School, University of Massachusetts, Worcester; National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Ulbricht)
| | - Christine M Ulbricht
- Clinical and Population Health Research Program, Morningside Graduate School of Biomedical Sciences (Hugunin, Chen, Baek, Clark, Lapane), and Department of Population and Quantitative Health Sciences (Hugunin, Chen, Baek, Clark, Lapane, Ulbricht), UMass Chan Medical School, University of Massachusetts, Worcester; National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Ulbricht)
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Higgins A, Downes C, Murphy R, Barry J, Monahan M, Doyle L, Gibbons P. Factors Influencing Attendees' Engagement with Group Psychoeducation: A Multi-stakeholder Perspective. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:539-551. [PMID: 34989933 PMCID: PMC9233715 DOI: 10.1007/s10488-021-01182-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 12/05/2022]
Abstract
Few studies have explored the problem of engagement in relation to group psychoeducation from a multi-site and multi-stakeholder perspective. The aim of the study was to explore the factors influencing service user and family engagement with group psychoeducation programmes. The study design was qualitative descriptive. Data were collected through individual and focus group interviews with key stakeholders (n = 75) involved with the programme within 14 mental health sites in the Republic of Ireland. Enablers and barriers to engagement were identified at participant, provider, programme and organization level. Motivated participants and engaged clinicians, peer co-facilitation and support, and skilled and responsive facilitators were some of the factors which enhanced engagement. Barriers to engagement included readiness among participants, concerns related to stigma and confidentiality, desire to distance oneself from mental health services, a lack of support for programme participation within families, group discomfort, the time and length of the programme, issues with transport, visibility of the programme, and structural supports for clinicians. Findings from the study illustrate the multifaceted nature of engagement as well as provide a greater understanding of the multifactorial influences on engagement. Strategies to enhance engagement should therefore reflect a multipronged approach. At the outset of programme implementation, organizations should address their readiness to engage, conduct local needs assessments to anticipate individuals’ needs and plan accordingly in order to maximize engagement, and bolster facilitators’ engagement skills through the provision of training and mentoring opportunities.
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Affiliation(s)
- Agnes Higgins
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland.
| | - Carmel Downes
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
| | - Rebecca Murphy
- Department of Psychology, National University of Ireland, Maynooth, Kildare, Ireland
| | - Jennifer Barry
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
| | - Mark Monahan
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
| | - Louise Doyle
- School of Nursing & Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
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Gao Q, Prina M, Wu YT, Mayston R. Unmet healthcare needs among middle-aged and older adults in China. Age Ageing 2022; 51:6458942. [PMID: 34923586 DOI: 10.1093/ageing/afab235] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Unmet healthcare needs have increasingly been recognised as an indicator of equity of healthcare access and utilisation, having the potential to capture frailty of health and social protection systems. OBJECTIVES This study aimed to estimate the prevalence of unmet healthcare needs and its correlates among middle-aged and older adults in China. METHODS This study is based on analyses of the China Health and Retirement Longitudinal Study carried out in 2011 among Chinese adults aged 45 years and above. Multivariable logistic regression models were conducted to examine associated factors, stratified by rural or urban residence. Reasons for having unmet needs for inpatient and outpatient services were also analysed. RESULTS Among 14,774 participants, the prevalence of unmet healthcare needs was 13.0% (95% confidence interval 12.3-13.8%) and was higher in rural areas. The most prevalent reasons for unmet need for inpatient and outpatient care were 'not enough money' and 'illness is not serious, don't need treatment', respectively. The respondents who were unmarried, employed, had poor self-reported health, needed help with activities of daily living, reported lower life satisfaction, multiple chronic conditions and depressive symptoms had increased odds of unmet healthcare needs. CONCLUSION This study suggests that unmet healthcare needs are more concentrated among people living with multiple health conditions and mental health problems in China. If universal health coverage goals and sustainable development goal 3 are to be met, it is essential that effective mechanisms for addressing unmet healthcare needs are identified.
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Affiliation(s)
- Qian Gao
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Matthew Prina
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Yu-Tzu Wu
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Rosie Mayston
- Department of Global Health & Social Medicine, Social Science & Public Policy, King’s Global Health Institute, King’s College London, London, UK
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Hugunin J, Yuan Y, Baek J, Clark RE, Rothschild AJ, Lapane KL, Ulbricht CM. Characteristics of Working-Age Adults With Schizophrenia Newly Admitted to Nursing Homes. J Am Med Dir Assoc 2021; 23:1227-1235.e3. [PMID: 34919836 DOI: 10.1016/j.jamda.2021.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/22/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Persons aged <65 years account for a considerable proportion of US nursing home residents with schizophrenia. Because they are often excluded from psychiatric and long-term care studies, a contemporary understanding of the characteristics and management of working-age adults (22-64 years old) with schizophrenia living in nursing homes is lacking. This study describes characteristics of working-age adults with schizophrenia admitted to US nursing homes in 2015 and examines variations in these characteristics by age and admission location. Factors associated with length of stay and discharge destination were also explored. DESIGN This is a cross-sectional study using the Minimum Data Set 3.0 merged to Nursing Home Compare. SETTING AND PARTICIPANTS This study examines working-age (22-64 years) adults with schizophrenia at admission to a nursing home. METHODS Descriptive statistics of resident characteristics (sociodemographic, clinical comorbidities, functional status, and treatments) and facility characteristics (ownership, geography, size, and star ratings) were examined overall, stratified by age and by admission location. Generalized estimating equation models were used to explore the associations of age, discharge to the community, and length of stay with relevant resident and facility characteristics. Coefficient estimates, adjusted odds ratios, and 95% CIs are presented. RESULTS Overall, many of the 28,330 working-age adults with schizophrenia had hypertension, diabetes, and obesity. Those in older age subcategories tended to have physical functional dependencies, cognitive impairments, and clinical comorbidities. Those in younger age subcategories tended to exhibit higher risk of psychiatric symptoms. CONCLUSIONS AND IMPLICATIONS Nursing home admission is likely inappropriate for many nursing home residents with schizophrenia aged <65 years, especially those in younger age categories. Future psychiatric and long-term care research should include these residents to better understand the role of nursing homes in their care and should explore facility-level characteristics that may impact quality of care.
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Affiliation(s)
- Julie Hugunin
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Yiyang Yuan
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jonggyu Baek
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robin E Clark
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA
| | - Anthony J Rothschild
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA; UMass Memorial Healthcare, Worcester, MA, USA
| | - Kate L Lapane
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christine M Ulbricht
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
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Gurrera RJ, Grosso D. Treatment Bed Utilization Following Placement in a Foster Care Program for Veterans with Serious Mental Illness. Community Ment Health J 2021; 57:1442-1448. [PMID: 33386531 DOI: 10.1007/s10597-020-00758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022]
Abstract
Hospital and residential treatment bed utilization rates were measured before and after foster home placement in individuals with serious mental illness. Medical records of all Veterans consecutively enrolled in a Department of Veterans Affairs Community Residential Care (CRC) program during a 6 year period (N = 140) were reviewed retrospectively. Treatment bed days were tabulated by bed type (psychiatric hospital, inpatient detoxification, medical hospital, physical rehabilitation, and psychosocial residential treatment) for each patient during symmetric pre- and post-placement time intervals. Pre- and post-placement bed days were compared using the paired-sample t test in a naturalistic one-group pretest-posttest analytic design. Psychiatric hospital and residential treatment bed days were significantly reduced post-placement (-77.5% and -99.8%, respectively). Most patients (89.0%) had fewer psychiatric hospital bed days post-placement, and all patients with pre-placement residential treatment program bed days had fewer of those days post-placement. Longer CRC placements were associated with greater reductions in bed utilization.
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Affiliation(s)
- Ronald J Gurrera
- VA Boston Healthcare System, 940 Belmont Street (116A), Brockton, MA, 02301, USA.
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Darryl Grosso
- VA Boston Healthcare System, 940 Belmont Street (116A), Brockton, MA, 02301, USA
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Chong BTW, Wahab S, Muthukrishnan A, Tan KL, Ch'ng ML, Yoong MT. Prevalence and Factors Associated with Suicidal Ideation in Institutionalized Patients with Schizophrenia. Psychol Res Behav Manag 2020; 13:949-962. [PMID: 33204188 PMCID: PMC7667143 DOI: 10.2147/prbm.s266976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/21/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose The shorter life expectancy and increased risk of suicide in patients with schizophrenia have been well documented. However, study outcomes on suicidality in this special population have been few to date. This study investigated the prevalence and factors associated with suicidal ideation in a population of institutionalized patients with schizophrenia. Methods Two hundred fifty-six patients with schizophrenia between the age of 18 and 65 years were randomly recruited. This cross-sectional study utilised the Calgary Depression Scale for Schizophrenia (CDSS), the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scale (PSYRATS-AH). Univariate analysis was performed using an independent t-test or chi-square test, followed by binary logistic regression to determine the factors associated with increased suicidal risks. Results The socio-demographic factors associated with suicidal ideation included level of education (p=0.039); secondary-level education (OR=5.76, 95% CI:1.49, 22.34, p=0.011) and tertiary-level education (OR=9.30, 95% CI: 1.80, 48.12, p=0.008) posed a greater risk. A history of attempted suicide (OR=2.09, 95% CI: 1.01, 4.36, p=0.049) and the presence of co-morbid physical illnesses (OR=2.07, 95% CI: 1.02, 4.21, p=0.044) were also found to be associated with a suicidal ideation. Other significant factors associated with suicidal thoughts were concurrent depression (OR=9.68, 95% CI: 3.74, 25.05, p<0.001) and a higher PSYRATS score in emotional characteristics of auditory hallucinations (OR=1.13, 95% CI: 1.06, 1.21, p<0.001). Conclusion Suicide in schizophrenia appears to be more closely associated with certain socio-demographic factors and affective symptoms. Appropriate screening and treatment addressing these challenges must be emphasized if suicidal thoughts and actions are to be reduced.
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Affiliation(s)
- Benedict Tak Wai Chong
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Wilayah Persekutuan 56000, Malaysia
| | - Suzaily Wahab
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Wilayah Persekutuan 56000, Malaysia
| | - Arunakiri Muthukrishnan
- Department of Psychiatry, Hospital Bahagia Ulu Kinta, Tanjung Rambutan, Perak Darul Ridzwan 31250, Malaysia
| | - Kok Leong Tan
- Department of Community Medicine, School of Medicine, International Medical University (IMU), Kuala Lumpur, Wilayah Persekutuan 57000, Malaysia
| | - May Lee Ch'ng
- Department of Community Medicine, School of Medicine, International Medical University (IMU), Kuala Lumpur, Wilayah Persekutuan 57000, Malaysia
| | - Mei Theng Yoong
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Wilayah Persekutuan 56000, Malaysia
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de Girolamo G, Rocchetti M, Benzi IMA, Agosta S, Casiraghi L, Ferrari C, De Franceschi N, Macis A, Pogliaghi S, Starace F. DAily time use, Physical Activity, quality of care and interpersonal relationships in patients with Schizophrenia spectrum disorders (DiAPASon): an Italian multicentre study. BMC Psychiatry 2020; 20:287. [PMID: 32513140 PMCID: PMC7278132 DOI: 10.1186/s12888-020-02588-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/05/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Schizophrenia spectrum disorders (SSD) are ranked among the leading causes of disabilities worldwide. Many people with SSD spend most of their daily time being inactive, and this is related to the severity of negative symptoms. Here, we present the 3-year DiAPAson project aimed at (1) evaluating the daily time use among patients with SSD living in Residential Facilities (RFs) compared to outpatients with SSD and to the general population (Study 1); (2) evaluating the quality of staff-patient relationships, its association with specific patient outcomes and the quality of care provided in RFs (Study 2); and (3) assessing daily activity patterns in residential patients, outpatients with SSD and healthy controls using real-time methodologies (Study 3). METHODS Study 1 will include 300 patients with SSD living in RFs and 300 outpatients; data obtained in these clinical populations will be compared with normative data obtained by the National Institute of Statistics (ISTAT) in the national survey on daily time use. Time use assessments will consist of daily diaries asking participants to retrospectively report time spent in different activities. In Study 2, a series of questionnaires will be administered to 300 residential patients (recruited for Study 1) to evaluate the quality of care and staff-patient relationships, level of well-being and burnout of RFs' staff, and quality of RFs using a European standardized questionnaire (QuIRC-SA). In Study 3, the daily time use will be evaluated in a subgroup of 50 residential patients, 50 outpatients and 50 healthy controls using the Experience Sampling Method approach (participants will complete a brief questionnaire -about time use, mood and perceived energy- on a smartphone 8 times a day for 1 week) to compare retrospective and real-time reports. Moreover, their level of physical activity, sleep patterns, and energy expenditure will be monitored through a multi-sensor device. DISCUSSION This project is highly innovative because it combines different types of assessments (i.e., retrospective and real-time reports; multi-sensor monitoring) to trace an accurate picture of daily time use and levels of physical activity that will help identify the best therapeutic options promoting daily activities and physical exercise in patients with SSD. TRIAL REGISTRATION ISRCTN registry ID ISRCTN21141466.
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Affiliation(s)
- Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
| | - Matteo Rocchetti
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy ,grid.8982.b0000 0004 1762 5736Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Ilaria Maria Antonietta Benzi
- grid.419422.8Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Sara Agosta
- grid.476047.60000 0004 1756 2640Department of Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Letizia Casiraghi
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy ,grid.8982.b0000 0004 1762 5736Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Clarissa Ferrari
- grid.419422.8Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Nicola De Franceschi
- grid.7637.50000000417571846Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Ambra Macis
- grid.419422.8Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Silvia Pogliaghi
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Fabrizio Starace
- grid.476047.60000 0004 1756 2640Department of Mental Health and Dependence, AUSL of Modena, Modena, Italy
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Mental health recovery among hospitalized patients with mental disorder: Associations with anger expression mode and meaning in life. Arch Psychiatr Nurs 2020; 34:134-140. [PMID: 32513463 DOI: 10.1016/j.apnu.2020.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 11/21/2022]
Abstract
This study aimed to investigate the effect of anger expression mode and meaning in life on mental health recovery among hospitalized patients with mental disorder in South Korea. Data were collected from 141 such patients using the Korean version of anger expression mode, meaning in life, and mental health recovery. Date were as analyzed using stepwise multiple regression analysis. Significant predictors of mental health recovery included presence of meaning, search for meaning, and anger control. The regression model explained 48.2% of mental health recovery. Interventions for fostering meaning in life and beneficial anger expression techniques may increase mental health recovery in this clinical population.
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15
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Frasch JJ, Petrea I, Chihai J, Smit F, Oud M, Shields-Zeeman L. Taking steps towards deinstitutionalizing mental health care within a low and middle-income country: A cross-sectional study of service user needs in the Republic of Moldova. Int J Soc Psychiatry 2020; 66:49-57. [PMID: 31603368 PMCID: PMC6963171 DOI: 10.1177/0020764019879951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIM The current research was conducted in the context of an ongoing reform of mental health services in the Republic of Moldova since 2014, where efforts have been devoted to creating community-based mental health services. This article presents a snapshot of the needs of mental health service users in the Republic of Moldova and helps to understand how and with which services their needs can be addressed. METHODS This cross-sectional study compared the levels of needs (CANSAS scale), quality of life (EQ-5D 3L), mental health status (MINI for psychotic disorders) and functioning (WHO-DAS) among mental health service users in the psychiatric hospital in Chisinau, Moldova. All service users resided in districts where community mental health services were being developed. Correlations between quality of life, functioning and unmet need were explored. RESULTS Of 83 participants, one third had a psychotic or a mood disorder. On average, participants reported needs in 9.41 domains (SD = 4.41), of which 4.29 were unmet (SD = 3.63). Most unmet needs related to intimacy and relation to others. The level of functioning and quality of life were reported. We found strong, negative associations between the number of unmet needs and level of functioning, as well as the quality of life. We also found that higher functioning levels were positively associated with higher quality of life. CONCLUSION There were a high number of unmet needs among this inpatient population, particularly social needs and service-related needs. A continuum of inpatient and outpatient care and individual treatment plans can help address the different needs of different patients. Individual treatment plans for patients and the choice of the appropriate treatment for patients could be guided by an assessment of service users' (unmet) needs of care and level of functioning.
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Affiliation(s)
- Jona J Frasch
- Trimbos Instituut, Utrecht, The Netherlands.,Leiden University, Leiden, The Netherlands
| | | | - Jana Chihai
- Trimbos Moldova, Chișinău, The Republic of Moldova.,Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy 'Nicolae Testemițanu', Chișinău, The Republic of Moldova
| | - Filip Smit
- Trimbos Instituut, Utrecht, The Netherlands.,Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer S. Patient safety in inpatient mental health settings: a systematic review. BMJ Open 2019; 9:e030230. [PMID: 31874869 PMCID: PMC7008434 DOI: 10.1136/bmjopen-2019-030230] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER CRD42016034057.
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Affiliation(s)
- Bethan Thibaut
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lindsay Helen Dewa
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sonny Christian Ramtale
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Adam
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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Harvey C, Brophy L, Tibble H, Killaspy H, Spittal MJ, Hamilton B, Ennals P, Newton R, Cruickshank P, Hall T, Fletcher J. Prevention and Recovery Care Services in Australia: Developing a State-Wide Typology of a Subacute Residential Mental Health Service Model. Front Psychiatry 2019; 10:383. [PMID: 31244691 PMCID: PMC6580196 DOI: 10.3389/fpsyt.2019.00383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/15/2019] [Indexed: 01/15/2023] Open
Abstract
Aims: Community-based residential alternatives to hospitalization are an emerging service model. Evidence for their acceptability and effectiveness is promising but limited. Prevention and Recovery Care (PARC) services are one such residential model, offering short-term subacute treatment and care (usually between 7 and 28 days). PARC services in Victoria, Australia, are designed to support consumers with severe mental illness to either avoid a psychiatric hospital admission (step-up care) or transition from hospital back into the community (step-down care). As a precursor to a series of studies investigating the appropriateness, effectiveness and efficiency of PARC services, we aimed to investigate whether a typology of PARC services can be developed. Methods: A manager or other appropriately knowledgeable staff member from each of the 19 adult PARC services included in the study completed a tool based on PARC operational guidelines (the Victorian PARC service mapping questionnaire) and a validated instrument measuring the quality of care in residential mental health settings (the Quality Indicator for Rehabilitative Care, QuIRC). Thirty (of 42) stakeholders participated in a modified Delphi study to select 23 from the available 230 variables for entry into a hierarchical cluster analysis. Results: Cluster analysis produced three clusters of equal dissimilarity. At the 90% confidence level, there were four variables which were significantly different between clusters. These were the year the PARC was opened, the QuIRC Living Environment domain score, the proportion of all admissions that were a step-down admission from an inpatient unit, and how often families were invited to care meetings. Sensitivity analyses suggested the findings were robust to the method used to identify clusters. Conclusions: Although PARC services were broadly similar, their identified differences suggest there is variable model implementation across Victoria sufficient to generate a PARC service typology. This typology may prove important for interpreting differences in outcomes experienced by consumers and carers using PARC services, when applied in our analyses of service effectiveness. The value of conducting service mapping and typology studies is underscored. Further research to characterize subacute residential services, including recovery-promoting features of the built environment, is warranted.
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Affiliation(s)
- Carol Harvey
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
- Psychosocial Research Centre, NorthWestern Mental Health, Coburg, VIC, Australia
| | - Lisa Brophy
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
- Mind Australia Ltd, Heidelberg, VIC, Australia
- La Trobe University School of Allied Health, Human Services and Sport, Bundoora, VIC, Australia
| | - Holly Tibble
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, United Kingdom
| | - Matthew J. Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Bridget Hamilton
- School of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | | | - Richard Newton
- Peninsula Mental Health Service, Frankston, VIC, Australia
| | | | - Teresa Hall
- Nossal Institute for Global Health, and Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Justine Fletcher
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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Farkas M, Coe S. From Residential Care to Supportive Housing for People With Psychiatric Disabilities: Past, Present, and Future. Front Psychiatry 2019; 10:862. [PMID: 31849724 PMCID: PMC6893903 DOI: 10.3389/fpsyt.2019.00862] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/04/2019] [Indexed: 11/24/2022] Open
Abstract
For centuries, treatment and accommodation for people with significant mental health conditions in many countries, including the United States, have been viewed as necessarily inseparable elements, first in asylums and then, with deinstitutionalization, in community care models. The advent of psychiatric rehabilitation and later, recovery, helped to shift the paradigm of mental health services and the role of housing, to one focused on promoting the ability of individuals to achieve not only a life located in the community, but one that reflects a meaningful life as part of a community. In this context, supportive housing emerged as a model based on integrated, permanent, affordable housing, selected by the person, with flexible supports that are functionally separate, but available as needed and wanted. This model of housing has been predominant in American mental health services for over 20 years, and evidence now exists for its outcomes in terms of housing stability, symptom reduction, and psychosocial variables. Current challenges, both at the societal and the individual level, confront the sustainability of supportive housing, with some efforts being made by housing groups to address these challenges. This article reviews the evolution of supportive housing and its basic tenets, identifying the challenges and some efforts to address them. In addition, the article discusses the current social and economic climate, which appears to be shaping opposing trends, and makes a call to action, to mitigate the possible risks to the future of this value-based housing approach.
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Affiliation(s)
- Marianne Farkas
- Center for Psychiatric Rehabilitation, Sargent College, Boston University, Boston, MA, United States
| | - Steve Coe
- Community Access, New York, NY, United States
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Dalton-Locke C, Attard R, Killaspy H, White S. Predictors of quality of care in mental health supported accommodation services in England: a multiple regression modelling study. BMC Psychiatry 2018; 18:344. [PMID: 30342501 PMCID: PMC6195958 DOI: 10.1186/s12888-018-1912-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 09/26/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Specialist mental health supported accommodation services are a key component to a graduated level of care from hospital to independently living in the community for people with complex, longer term mental health problems. However, they come at a high cost and there has been a lack of research on the quality of these services. The QuEST (Quality and Effectiveness of Supported tenancies) study, a five-year programme of research funded by the National Institute for Health Research, aimed to address this. It included the development of the first standardised quality assessment tool for supported accommodation services, the QuIRC-SA (Quality Indicator for Rehabilitative Care - Supported Accommodation). Using data collected from the QuIRC-SA, we aimed to identify potential service characteristics that were associated with quality of care. METHODS Data collected from QuIRC-SAs with 150 individual services in England (28 residential care, 87 supported housing and 35 floating outreach) from four different sources were analysed using multiple regression modelling to investigate associations between service characteristics (local authority area index score, total beds/spaces, staffing intensity, percentage of male service users and service user ability) and areas of quality of care (Living Environment, Therapeutic Environment, Treatments and Interventions, Self-Management and Autonomy, Social Interface, Human Rights and Recovery Based Practice). RESULTS The local authority area in which the service is located, the service size (number of beds/places) and the usual expected length of stay were each negatively associated with up to six of the seven QuIRC-SA domains. Staffing intensity was positively associated with two domains (Therapeutic Environment and Treatments and Interventions) and negatively associated with one (Human Rights). The percentage of male service users was positively associated with one domain (Treatments and Interventions) and service user ability was not associated with any of the domains. CONCLUSIONS This study identified service characteristics associated with quality of care in specialist mental health supported accommodation services that can be used in the design and specification of services.
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Affiliation(s)
- Christian Dalton-Locke
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Rosie Attard
- 0000000121901201grid.83440.3bDivision of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Helen Killaspy
- 0000000121901201grid.83440.3bDivision of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Sarah White
- 0000 0000 8546 682Xgrid.264200.2Population Health Research Institute, St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
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Tsoutsoulis K, Maxwell A, Menon Tarur Padinjareveettil A, Zivkovic F, Rogers JM. Impact of inpatient mental health rehabilitation on psychiatric readmissions: a propensity score matched case control study. J Ment Health 2018; 29:532-540. [DOI: 10.1080/09638237.2018.1466049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Katrina Tsoutsoulis
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia,
| | - Anna Maxwell
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia,
| | - Aparna Menon Tarur Padinjareveettil
- South Eastern Sydney Local Health District, Sydney, NSW, Australia, and
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia
| | - Frank Zivkovic
- South Eastern Sydney Local Health District, Sydney, NSW, Australia, and
| | - Jeffrey M. Rogers
- South Eastern Sydney Local Health District, Sydney, NSW, Australia, and
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Roos E, Bjerkeset O, Svavarsdóttir MH, Steinsbekk A. Like a hotel, but boring: users' experience with short-time community-based residential aftercare. BMC Health Serv Res 2017; 17:832. [PMID: 29246222 PMCID: PMC5732432 DOI: 10.1186/s12913-017-2777-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 12/05/2017] [Indexed: 11/26/2022] Open
Abstract
Background The discharge process from hospital to home for patients with severe mental illness (SMI) is often complex, and most are in need of tailored and coordinated community services at home. One solution is to discharge patients to inpatient short-stay community residential aftercare (CRA). The aim of this study was to explore how patients with SMI experience a stay in CRA established in a City in Central Norway. Methods A descriptive qualitative study with individual interviews and a group interview with 13 persons. The CRA aims to improve the discharge process from hospital to independent supported living by facilitating the establishment of health and social services and preparing the patients. The philosophy is to help patients use community resources by e.g. not offering any organized in-house activities. The main question in the interviews was “How have you experienced the stay at the CRA?” The interviews were analyzed with a thematic approach using systematic text condensation. Results The participants experienced the stay at the CRA “Like a hotel” but also boring, due to the lack of organized in-house activities. The patients generally said they were not informed about the philosophy of the CRA before the stay. The participants had to come up with activities outside the CRA and said they got active help from the staff to do so; some experienced this as positive, whereas others wanted more organized in-house activities like they were used to from mental health hospital stays. Participants described the staff in the CRA to be helpful and forthcoming, but they did not notice the staff being active in organizing the aftercare. Conclusions The stay at the CRA was experienced as different from other services, with more freedom and focus on self-care, and lack of in-house activities. This led to increased self-activity among the patients, but some wanted more in-house activities. To prepare the patients better for the stay at the CRA, more information about the philosophy is needed in the pre-admission process. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2777-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eirik Roos
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, 7491, Trondheim, Norway. .,, Municipality of Trondheim, Norway.
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Margrét Hrönn Svavarsdóttir
- Department of Health Sciences, Norwegian University of Sciences and Technology, Gjøvik, Norway.,School of Health Sciences, University of Akureyri, Akureyri, Iceland
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, 7491, Trondheim, Norway
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Macpherson R, Calciu C, Foy C, Humby K, Lozynskyj D, Garton C, Steer H, Elliott H. A service evaluation of outcomes in two in-patient recovery units. BJPsych Bull 2017; 41:330-336. [PMID: 29234510 PMCID: PMC5709682 DOI: 10.1192/pb.bp.116.055137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims and method To evaluate outcomes for patients during their admission or in the first year of treatment in two in-patient recovery units. Changes in health and social functioning, service use and need (rated by patients and staff) were evaluated. Results In 43 patients treated, there was a large (30%) increase in patients discharged to their own tenancies, rather than supported accommodation. There was minimal change in Health of the Nation Outcome Scales (HoNOS) scores in the course of the admission but staff- and patient-rated unmet needs reduced and met needs increased. Needs changed mainly in domains relating to social functioning. Reductions in risk to self and others were rated by staff but not patients. There were no cases of patients being readmitted to acute hospital during the study period. Clinical implications Although these results offer some support to the treatment approach described in these in-patient recovery units, further research in larger samples is needed to identify how these services can best be deployed to help individuals with severe mental illness and complex needs.
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Affiliation(s)
| | | | - Chris Foy
- Gloucestershire Hospitals NHS Foundation Trust
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Salisbury TT, Killaspy H, King M. Relationship between national mental health expenditure and quality of care in longer-term psychiatric and social care facilities in Europe: cross-sectional study. Br J Psychiatry 2017; 211:45-49. [PMID: 28302698 DOI: 10.1192/bjp.bp.116.186213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 12/11/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022]
Abstract
BackgroundIt is not known whether increased mental health expenditure is associated with better outcomes.AimsTo estimate the association between national mental health expenditure and (a) quality of longer-term mental healthcare, (b) service users' ratings of that care in eight European countries.MethodNational mental health expenditure (per cent of health budget spent on mental health) was calculated from international sources. Multilevel models were developed to assess associations with quality of care and service user experiences of care using ratings of 171 facility managers and 1429 service users.ResultsSignificant positive associations were found between mental health spend and (a) six of seven quality of care domains; and (b) service user autonomy and experiences of care.ConclusionsGreater national mental health expenditure was associated with higher quality of care and better service user experience.
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Affiliation(s)
- Tatiana Taylor Salisbury
- Tatiana Taylor Salisbury, PhD, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Department of Population Health, London School of Hygiene and Tropical Medicine, London; Helen Killaspy, PhD, Michael King, PhD, Division of Psychiatry, University College London, London, UK
| | - Helen Killaspy
- Tatiana Taylor Salisbury, PhD, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Department of Population Health, London School of Hygiene and Tropical Medicine, London; Helen Killaspy, PhD, Michael King, PhD, Division of Psychiatry, University College London, London, UK
| | - Michael King
- Tatiana Taylor Salisbury, PhD, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Department of Population Health, London School of Hygiene and Tropical Medicine, London; Helen Killaspy, PhD, Michael King, PhD, Division of Psychiatry, University College London, London, UK
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Bunyan M, Crowley J, Smedley N, Mutti MF, Cashen A, Thompson T, Foster J. Feasibility of training nurses in motivational interviewing to improve patient experience in mental health inpatient rehabilitation: a pilot study. J Psychiatr Ment Health Nurs 2017; 24:221-231. [PMID: 28248447 DOI: 10.1111/jpm.12382] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2017] [Indexed: 11/30/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Recently, concerns have been raised about how well United Kingdom National Health Service nurses care for their patients and their level of compassion. Motivational interviewing (MI) is an established approach to helping people make positive behaviour changes, through directive, person-centred counselling within a collaborative relationship between clinician and recipient. Based on evidence that MI may influence nursing practice positively, an investigation into the feasibility of training nurses on mental health inpatient rehabilitation wards ('rehabilitation') in MI to improve patient experience was reported. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This pilot study demonstrates that training rehabilitation nurses in MI is feasible and provides preliminary evidence suggesting that a larger study to examine efficacy is warranted, including a calculation of sample size required to draw robust statistical conclusions. Nurses evaluated the training as highly relevant to their work. Patients responded well to interviews and focus groups with support from experts-by-experience; they were generally fairly satisfied with the rehabilitation ward and slight improvements in their experience were found following MI training for nurses but not at 6-month follow-up. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Rehabilitation nurses may face conflicting demands between ensuring patients with severe difficulties meet their basic needs and working with them to develop greater independence. Qualitative findings question whether nurse-patient interactions are fully valued as nursing interventions in inpatient rehabilitation. Learning MI might be a useful way of helping nurses think in detail about their interactions with patients and how to improve communications with their patients. The principles of MI should be incorporated into pre-registration training. ABSTRACT Introduction There is limited research addressing the experiences of patients in inpatient rehabilitation (rehabilitation), who often spend long periods in hospital, and the nursing approaches utilized. Aim Based on evidence that motivational interviewing (MI) may improve nursing practice, this was a pilot study evaluating the feasibility of training rehabilitation nurses in MI and measuring patient experience. Method Nurses underwent training and supervision focusing on MI spirit. Quantitative and qualitative measures were taken pretraining, 2 months post-training and 8 months post-training. Expert-by-experience research assistants facilitated patients' participation in the study. Results This study showed that training rehabilitation nurses in MI was feasible and relevant to their work. Patients participated in interviews and focus groups with support and potential improvements that require further empirical investigation in patient experience were found following the MI training. Discussion This pilot study establishes the feasibility of a larger study addressing efficacy. Tentative qualitative findings question whether interactions between nurses and patients are valued in rehabilitation and support MI as a promising skill set for rehabilitation nurses. Implications for practice Bringing MI into inpatient rehabilitation provoked reflection on nursing practice. Dilemmas for nurses about balancing safety with promoting autonomy and communicating constructively with patients emerged as important.
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Affiliation(s)
- M Bunyan
- Oxleas NHS Foundation Trust, Dartford, UK
| | - J Crowley
- Faculty of Education and Health, University of Greenwich, London, UK
| | - N Smedley
- Oxleas NHS Foundation Trust, Dartford, UK
| | - M-F Mutti
- Oxleas NHS Foundation Trust, Dartford, UK
| | - A Cashen
- Oxleas NHS Foundation Trust, Dartford, UK
| | - T Thompson
- Faculty of Education and Health, University of Greenwich, London, UK
| | - J Foster
- Faculty of Education and Health, University of Greenwich, London, UK
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Killaspy H, King M, Holloway F, Craig TJ, Cook S, Mundy T, Leavey G, McCrone P, Koeser L, Omar R, Marston L, Arbuthnott M, Green N, Harrison I, Lean M, Gee M, Bhanbhro S. The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundThe REAL (Rehabilitation Effectiveness for Activities for Life) research programme, funded by the National Institute for Heath Research (NIHR) from 2009 to 2015, investigated NHS mental health rehabiliation services across England. The users of these services are people with longer-term, complex mental health problems, such as schizophrenia, who have additional problems that complicate recovery. Although only around 10% of people with severe mental illness require inpatient rehabilitation, because of the severity and complexity of their problems they cost 25–50% of the total mental health budget. Despite this, there has been little research to help clinicians and commissioners to plan and deliver effective treatments and services. This research aimed to address this gap.MethodsThe programme had four phases. (1) A national survey, using quantitative and qualitative methods, was used to provide a detailed understanding of the scope and quality of NHS mental health rehabilitation services in England and the characteristics of those who use them. (2) We developed a training intervention for staff of NHS inpatient mental health rehabilitation units to facilitate service users’ activities. (3) The clinical effectiveness and cost-effectiveness of the staff training programme was evaluated through a cluster randomised controlled trial involving 40 units that scored below average on our quality assessment tool in the national survey. A qualitative process evaluation and a realistic evaluation were carried out to inform our findings further. (4) A naturalistic cohort study was carried out involving 349 service users of 50 units that scored above average on our quality assessment tool in the national survey, who were followed up over 12 months. Factors associated with better clinical outcomes were investigated through exploratory analyses.ResultsMost NHS trusts provided inpatient mental health rehabilitation services. The quality of care provided was higher than that in similar facilities across Europe and was positively associated with service users’ autonomy. Our cluster trial did not find our staff training intervention to be clinically effective [coefficient 1.44, 95% confidence interval (CI) –1.35 to 4.24]; staff appeared to revert to previous practices once the training team left the unit. Our realistic review suggested that greater supervision and senior staff support could help to address this. Over half of the service users in our cohort study were successfully discharged from hospital over 12 months. Factors associated with this were service users’ activity levels [odds ratio (OR) 1.03, 95% CI 1.01 to 1.05] and social skills (OR 1.13, 95% CI 1.04 to 1.24), and the ‘recovery’ orientation of the unit (OR 1.04, 95% CI 1.00 to 1.08), which includes collaborative care planning with service users and holding hope for their progress. Quality of care was not associated with costs of care. A relatively small investment (£67 per service user per month) was required to achieve the improvement in everyday functioning that we found in our cohort study.ConclusionsPeople who require inpatient mental health rehabilitation are a ‘low-volume, high-needs’ group. Despite this, these services are able to successfully discharge most to the community within 18 months. Our results suggest that this may be facilitated by recovery-orientated practice that promotes service users’ activities and social skills. Further research is needed to identify effective interventions that enhance such practice to deliver these outcomes. Our research provides evidence that NHS inpatient mental health rehabilitation services deliver high-quality care that successfully supports service users with complex needs in their recovery.Main limitationOur programme included only NHS, non-secure, inpatient mental health rehabilitation services.Trial registrationCurrent Controlled Trials ISRCTN25898179.FundingThe NIHR Programme Grants for Applied Research programme.
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Affiliation(s)
- Helen Killaspy
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Frank Holloway
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Thomas J Craig
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Sarah Cook
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Tim Mundy
- Centre for Leadership in Health and Social Care, Sheffield Hallam University, Sheffield, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Belfast, UK
| | - Paul McCrone
- David Goldberg Centre, King’s College London, London, UK
| | | | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, London, UK
| | | | - Nicholas Green
- Division of Psychiatry, University College London, London, UK
| | - Isobel Harrison
- Division of Psychiatry, University College London, London, UK
| | - Melanie Lean
- Division of Psychiatry, University College London, London, UK
| | - Melanie Gee
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Sadiq Bhanbhro
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
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Roux P, Passerieux C, Fleury MJ. Mediation analysis of severity of needs, service performance and outcomes for patients with mental disorders. Br J Psychiatry 2016; 209:511-516. [PMID: 27758837 DOI: 10.1192/bjp.bp.116.184010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 06/14/2016] [Accepted: 06/20/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Needs and service performance assessment are key components in improving recovery among individuals with mental disorders. AIMS To test the role of service performance as a mediating factor between severity of patients' needs and outcomes. METHOD A total of 339 adults with mental disorders were interviewed. A mediation analysis between severity of needs, service performance (adequacy of help, continuity of care and recovery orientation of services) and outcomes (personal recovery and quality of life) was carried out using structural equation modelling. RESULTS The structural equation model provided a good fit with the data. An increase in needs was associated with lower service performance and worse outcomes, whereas higher service performance was associated with better outcomes. Service performance partially mediated the effect of patient needs on outcomes. CONCLUSIONS Poorer service performance has a negative impact on outcomes for patients with the highest needs. Ensuring more efficient services for patients with high needs may help improve their recovery and quality of life.
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Affiliation(s)
- Paul Roux
- Paul Roux, MD, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Christine Passerieux, MD, PhD, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Marie-Josée Fleury, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada
| | - Christine Passerieux
- Paul Roux, MD, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Christine Passerieux, MD, PhD, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Marie-Josée Fleury, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada
| | - Marie-Josée Fleury
- Paul Roux, MD, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Christine Passerieux, MD, PhD, Service Universitaire de Psychiatrie d'adultes, Centre Hospitalier de Versailles, Le Chesnay, Laboratoire HandiRESP, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux and Fondation Fondamental, Créteil, France; Marie-Josée Fleury, PhD, Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Montreal, Canada
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D'Lima D, Archer S, Thibaut BI, Ramtale SC, Dewa LH, Darzi A. A systematic review of patient safety in mental health: a protocol based on the inpatient setting. Syst Rev 2016; 5:203. [PMID: 27894331 PMCID: PMC5126859 DOI: 10.1186/s13643-016-0365-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/31/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the growing international interest in patient safety as a discipline, there has been a lack of exploration of its application to mental health. It cannot be assumed that findings based upon physical health in acute care hospitals can be applied to mental health patients, disorders and settings. To the authors' knowledge, there has only been one review of the literature that focuses on patient safety research in mental health settings, conducted in Canada in 2008. We have identified a need to update this review and develop the methodology in order to strengthen the findings and disseminate internationally for advancement in the field. This systematic review will explore the existing research base on patient safety in mental health within the inpatient setting. METHODS To conduct this systematic review, a thorough search across multiple databases will be undertaken, based upon four search facets ("mental health", "patient safety", "research" and "inpatient setting"). The search strategy has been developed based upon the Canadian review accompanied with input from the National Reporting and Learning System (NRLS) taxonomy of patient safety incidents and the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). The screening process will involve perspectives from at least two researchers at all stages with a third researcher invited to review when discrepancies require resolution. Initial inclusion and exclusion criteria have been developed and will be refined iteratively throughout the process. Quality assessment and data extraction of included articles will be conducted by at least two researchers. A data extraction form will be developed, piloted and iterated as necessary in accordance with the research question. Extracted information will be analysed thematically. DISCUSSION We believe that this systematic review will make a significant contribution to the advancement of patient safety in mental health inpatient settings. The findings will enable the development and implementation of interventions to improve the quality of care experienced by patients and support the identification of future research priorities. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016034057.
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Affiliation(s)
- Danielle D'Lima
- Department of Applied Health Research, 1-19 Torrington Place, London, WC1E 7HB, UK. d.d'
| | - Stephanie Archer
- Patient Safety Translational Research Centre, Medical School Building Room 5.03, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Bethan Ines Thibaut
- Patient Safety Translational Research Centre, Medical School Building Room 5.03, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Sonny Christian Ramtale
- Patient Safety Translational Research Centre, Medical School Building Room 5.03, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Lindsay H Dewa
- Patient Safety Translational Research Centre, Medical School Building Room 5.03, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Ara Darzi
- Department of Surgery and Cancer, 10th Floor, Queen Elizabeth the Queen Mother Wing (QEQM), St Mary's Campus, Norfolk Place, London, W2 1PG, UK
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Lawn S, Lucas T. Addressing Smoking in Supported Residential Facilities for People with Severe Mental Illness: Has Any Progress Been Achieved? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13100996. [PMID: 27735881 PMCID: PMC5086735 DOI: 10.3390/ijerph13100996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/16/2016] [Accepted: 09/30/2016] [Indexed: 11/30/2022]
Abstract
Background: Smoking rates for people with severe mental illness have remained high despite significant declines in smoking rates in the general population, particularly for residents of community supported residential facilities (SRFs) where smoking has been largely neglected and institutionalized. Methods: Two studies undertaken 10 years apart (2000 and 2010) with SRFs in Adelaide, Australia looked at historical trends to determine whether any progress has been made to address smoking for this population. The first study was ethnographic and involved narrative description and analysis of the social milieu of smoking following multiple observations of smoking behaviours in two SRFs. The second study involved an eight-week smoking cessation group program providing tailored support and free nicotine replacement therapy to residents across six SRFs. Changes in smoking behaviours were measured using pre and post surveys with residents, with outcomes verified by also seeking SRF staff and smoking cessation group facilitator qualitative feedback and reflection on their observations of residents and the setting. Results: The culture of smoking in mental health SRFs is a complex part of the social milieu of these settings. There appears to have been little change in smoking behaviours of residents and attitudes and support responses by staff of SRFs since 2000 despite smoking rates declining in the general community. Tailored smoking cessation group programs for this population were well received and did help SRF residents to quit or cut down their smoking. They did challenge staff negative attitudes to residents’ capacity to smoke less or quit. Conclusions: A more systematic approach that addresses SRF regulations, smoke-free policies, staff attitudes and training, and consistent smoking cessation support to residents is needed.
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Affiliation(s)
- Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Flinders University, P.O. Box 2100, Adelaide, South Australia 5001, Australia.
| | - Teri Lucas
- Cancer Council SA, P.O. Box 929, Unley, South Australia 5061, Australia.
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Thornicroft G, Deb T, Henderson C. Community mental health care worldwide: current status and further developments. World Psychiatry 2016; 15:276-286. [PMID: 27717265 PMCID: PMC5032514 DOI: 10.1002/wps.20349] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
This paper aims to give an overview of the key issues facing those who are in a position to influence the planning and provision of mental health systems, and who need to address questions of which staff, services and sectors to invest in, and for which patients. The paper considers in turn: a) definitions of community mental health care; b) a conceptual framework to use when evaluating the need for hospital and community mental health care; c) the potential for wider platforms, outside the health service, for mental health improvement, including schools and the workplace; d) data on how far community mental health services have been developed across different regions of the world; e) the need to develop in more detail models of community mental health services for low- and middle-income countries which are directly based upon evidence for those countries; f) how to incorporate mental health practice within integrated models to identify and treat people with comorbid long-term conditions; g) possible adverse effects of deinstitutionalization. We then present a series of ten recommendations for the future strengthening of health systems to support and treat people with mental illness.
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Affiliation(s)
- Graham Thornicroft
- Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, UK
| | - Tanya Deb
- Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, UK
| | - Claire Henderson
- Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, UK
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Assessing the performance of mental health service facilities for meeting patient priorities and health service responsiveness. Epidemiol Psychiatr Sci 2016; 25:417-421. [PMID: 27222319 PMCID: PMC7137587 DOI: 10.1017/s2045796016000354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The World Health Organisation has defined health service responsiveness as one of the key-objectives of health systems. Health service responsiveness relates to the ability to respond to service users' legitimate expectations on non-medical issues when coming into contact with the services of a healthcare system. It is defined by the areas showing respect for persons and patient orientation. Health service responsiveness is particularly relevant to mental health services, due to the specific vulnerability of mental health patients but also because it matches what mental health patients consider as good quality of care as well as their priorities when seeking healthcare. As (mental) health service responsiveness applies equally to all concerned services it would be suitable as a universal indicator for the quality of services' performance. However, performance monitoring programs in mental healthcare rarely assess health service performance with respect to meeting patient priorities. This is in part due of patient priorities as an outcome being underrepresented in studies that evaluate service provision. The lack of studies using patient priorities as outcomes transmits into evidence based guidelines and subsequently, into underrepresentation of patient priorities in performance monitoring. Possible ways out of this situation include more intervention studies using patient priorities as outcome, considering evidence from qualitative studies in guideline development and developing performance monitoring programs along the patient pathway and on key-points of relevance for service quality from a patient perspective.
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31
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McFarlane WR. Family Interventions for Schizophrenia and the Psychoses: A Review. FAMILY PROCESS 2016; 55:460-82. [PMID: 27411376 DOI: 10.1111/famp.12235] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Family psychoeducation as a treatment for schizophrenia was developed 40 years ago almost simultaneously and independently by investigators who at the time were not family therapists. Although the original goal was to decrease high expressed emotion as a means of preventing relapse, later variations have gone beyond to focus on social and role functioning and family well-being. Explicitly disavowing the earlier assumptions that family pathology caused relapse and deterioration, family psychoeducation seeks to engage family members as more sophisticated partners, complementing interventions by clinicians with specialized interactions and coping skills that counter the neurologic deficits inherent to the disorder. It has proved to be one of the most consistently effective treatments available. Reports on outcome studies now number more than 100, while meta-analyses put relapse rate reduction at 50-60% over treatment as usual. The most recent application in first episode and prodromal psychosis, combined with other evidence-based interventions, is yielding perhaps the most promising results yet achieved-substantial return of functioning and avoidance of psychosis altogether. Reviewed here are its scientific, theoretical, and clinical sources, a description of the most commonly applied version-the multifamily group format, selected clinical trials spanning those four decades, international and ethnic adaptations, and studies on mechanisms of efficacy.
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Affiliation(s)
- William R McFarlane
- Tufts University School of Medicine, Maine Medical Center Research Institute, Portland, ME.
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Zaraza-Morales DR, Hernández-Holguín DM. Towards a community mental health care for people with schizophrenia in Colombia. CIENCIA & SAUDE COLETIVA 2016; 21:2607-18. [PMID: 27557033 DOI: 10.1590/1413-81232015218.14732015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/17/2015] [Indexed: 01/30/2023] Open
Abstract
Mental health care based on the community has shown to be effective and successful for the health care service to people with severe mental disorders such as schizophrenia, evidence that is less clear in the health care system in Colombia, where weaknesses are present, both for prevention and rehabilitation, although national guidelines give importance to the social context in relation to the disease. As a contribution to the discussion on providing care for people living with schizophrenia, a topic review was conducted with the aim of identifying experiences in community mental health care services, in relation to their relevance to these people at the national level. Articles were searched on Scientific Electronic Library Online (SciELO) Medline with Full text, Science Direct and documents of the World Health Organization, Pan American Health Organization and the Colombian Ministry of Health and Social Protection. Few experiences in community care for people with schizophrenia in Colombia were found and given its importance to public health worldwide, a call for attention is made towards the construction and implementation of these models in the Colombian context.
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Affiliation(s)
- Daniel Ricardo Zaraza-Morales
- Grupo de Investigación en Salud Mental - GISAME, Facultad Nacional de Salud Pública, Universidad de Antioquia. Cl. 62 #52-59. 1226 Medellín Antioquia Colombia.
| | - Dora María Hernández-Holguín
- Grupo de Investigación en Salud Mental - GISAME, Facultad Nacional de Salud Pública, Universidad de Antioquia. Cl. 62 #52-59. 1226 Medellín Antioquia Colombia.
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Siu BWM, Tsang MMY, Lee VCK, Liu ACY, Tse S, Luk HSM, Lo NKY, Lo PH, Leung YL. Pathway to mental health recovery: a qualitative and quantitative study on the needs of Chinese psychiatric inpatients. BMC Psychiatry 2016; 16:236. [PMID: 27405280 PMCID: PMC4942969 DOI: 10.1186/s12888-016-0959-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/04/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Exploration of the information and participation needs of psychiatric inpatients is an important step for the implementation of recovery-oriented mental health service. The objective of this study was to explore the information and participation needs of Chinese psychiatric inpatients in the largest psychiatric hospital in Hong Kong. METHODS The study was divided into two parts. In the first part, eight focus groups with patients, patients' relatives and healthcare professionals were held to identify 22 items of information needs and 16 items of participation needs of Chinese psychiatric inpatients. Basing on the items identified in the first part of the study, a questionnaire was developed to survey on the importance of the different information and participation needs in the second part of the study. Participants were asked to rate in rank order their perceived importance of the items in the questionnaire survey. RESULTS A hundred and eighty three Chinese psychiatric inpatients completed the questionnaire and the majority of them suffered from schizophrenia (68.3 %). For information needs, the top three needs rated by patients as the most important in descending order were: "Information on the classifications of mental illnesses, signs and symptoms and factors contributing to relapse", "Information on the criteria and arrangements for discharge", and "Information on the importance of psychiatric drug taking and its side effects". For participation needs, the top three needs rated by patients as the most important in descending order were: "Enquiring about personal needs and arrangements", "Keeping in touch with the outside world", and "Learning and practising self-management". CONCLUSIONS This study reveals that Chinese psychiatric inpatients are concerned about information on their mental illness and its treatments as well as the criteria for discharge. On the other hand, patients are concerned about their personal needs, their self-management, as well as their keeping in touch with the outside world during their hospitalisation. Moreover, patients with different socio-demographic and clinical characteristics have different information and participation needs. The results of the present study serve as a reference for designing guidelines, strategies, and programmes to meet the information needs and participation needs of psychiatric inpatients in Hong Kong.
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Affiliation(s)
- B. W. M. Siu
- Department of Psychiatry, Castle Peak Hospital, Hong Kong, SAR People’s Republic of China ,Department of Forensic Psychiatry, Castle Peak Hospital, 15 Tsing Chung Koon Road, Tuen Mun, New Territories Hong Kong
| | - M. M. Y. Tsang
- Department of Psychiatry, Castle Peak Hospital, Hong Kong, SAR People’s Republic of China
| | - V. C. K. Lee
- The Mental Health Association of Hong Kong, Hong Kong, SAR People’s Republic of China
| | - A. C. Y. Liu
- Department of Psychiatry, Castle Peak Hospital, Hong Kong, SAR People’s Republic of China
| | - S. Tse
- Department of Social Work and Social Administration, Associate Dean at Faculty of Social Sciences, The University of Hong Kong, Hong Kong, SAR People’s Republic of China
| | - H. S. M. Luk
- Department of Psychiatry, Castle Peak Hospital, Hong Kong, SAR People’s Republic of China
| | - N. K. Y. Lo
- Department of Psychiatry, Castle Peak Hospital, Hong Kong, SAR People’s Republic of China
| | - P. H. Lo
- Department of Psychiatry, Castle Peak Hospital, Hong Kong, SAR People’s Republic of China
| | - Y. L. Leung
- Department of Psychiatry, Castle Peak Hospital, Hong Kong, SAR People’s Republic of China
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Parker S, Dark F, Newman E, Korman N, Meurk C, Siskind D, Harris M. Longitudinal comparative evaluation of the equivalence of an integrated peer-support and clinical staffing model for residential mental health rehabilitation: a mixed methods protocol incorporating multiple stakeholder perspectives. BMC Psychiatry 2016; 16:179. [PMID: 27255702 PMCID: PMC4891925 DOI: 10.1186/s12888-016-0882-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A novel staffing model integrating peer support workers and clinical staff within a unified team is being trialled at community based residential rehabilitation units in Australia. A mixed-methods protocol for the longitudinal evaluation of the outcomes, expectations and experiences of care by consumers and staff under this staffing model in two units will be compared to one unit operating a traditional clinical staffing. The study is unique with regards to the context, the longitudinal approach and consideration of multiple stakeholder perspectives. METHODS/DESIGN The longitudinal mixed methods design integrates a quantitative evaluation of the outcomes of care for consumers at three residential rehabilitation units with an applied qualitative research methodology. The quantitative component utilizes a prospective cohort design to explore whether equivalent outcomes are achieved through engagement at residential rehabilitation units operating integrated and clinical staffing models. Comparative data will be available from the time of admission, discharge and 12-month period post-discharge from the units. Additionally, retrospective data for the 12-month period prior to admission will be utilized to consider changes in functioning pre and post engagement with residential rehabilitation care. The primary outcome will be change in psychosocial functioning, assessed using the total score on the Health of the Nation Outcome Scales (HoNOS). Planned secondary outcomes will include changes in symptomatology, disability, recovery orientation, carer quality of life, emergency department presentations, psychiatric inpatient bed days, and psychological distress and wellbeing. Planned analyses will include: cohort description; hierarchical linear regression modelling of the predictors of change in HoNOS following CCU care; and descriptive comparisons of the costs associated with the two staffing models. The qualitative component utilizes a pragmatic approach to grounded theory, with collection of data from consumers and staff at multiple time points exploring their expectations, experiences and reflections on the care provided by these services. DISCUSSION It is expected that the new knowledge gained through this study will guide the adaptation of these and similar services. For example, if differential outcomes are achieved for consumers under the integrated and clinical staffing models this may inform staffing guidelines.
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Affiliation(s)
- Stephen Parker
- Metro South Addiction and Mental Health Service, 128 Main Street, Redland Bay, QLD, 4162, Australia.
- The University of Queensland, Herston, Australia.
| | - Frances Dark
- Metro South Addiction and Mental Health Service, 128 Main Street, Redland Bay, QLD, 4162, Australia
| | - Ellie Newman
- Metro South Addiction and Mental Health Service, 128 Main Street, Redland Bay, QLD, 4162, Australia
| | - Nicole Korman
- Metro South Addiction and Mental Health Service, 128 Main Street, Redland Bay, QLD, 4162, Australia
| | - Carla Meurk
- The University of Queensland, Herston, Australia
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, 128 Main Street, Redland Bay, QLD, 4162, Australia
- University of Queensland School of Medicine, Herston, Australia
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Ridente P, Mezzina R. From Residential Facilities to Supported Housing: The Personal Health Budget Model as a Form of Coproduction. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2016. [DOI: 10.1080/00207411.2016.1146510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bramesfeld A, Amaddeo F, Caldas-de-Almeida J, Cardoso G, Depaigne-Loth A, Derenne R, Donisi V, Jørgensen M, Lindelius B, Lora A, Mainz J, Mulder CL, Szecsenyi J, Killaspy H. Monitoring mental healthcare on a system level: Country profiles and status from EU countries. Health Policy 2016; 120:706-17. [PMID: 27178799 DOI: 10.1016/j.healthpol.2016.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 04/27/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
Abstract
AIMS Routinely collected data can be used to monitor the performance and improve the quality of mental healthcare systems. Data-based and system-level Quality Monitoring Programmes in Mental Health Care (QMP-MHC) are increasingly being implemented in EU countries. They are believed to be indispensable for the sustainable improvement of the quality of mental healthcare. However, there is a paucity of comparative research on national strategies in quality monitoring. This study explores the status of system-level Quality Monitoring Programmes in Mental Health Care (QMP-MHC) in EU countries. It aims to provide a descriptive overview, which is intended to be the first step for comparative research in this field. METHODS Case studies of system-level QMP-MHCs were gathered from eight EU countries. Experts from each country were asked to describe their approach using a template. These experts were all members of a Europe-wide network of researchers and members of public institutions involved in quality assessment and performance monitoring of mental healthcare. RESULTS Country profiles were gathered from England, Denmark, France, Germany, Italy, the Netherlands, Portugal, and Sweden. All these countries have - or are in the process of implementing - system-level QMP-MHCs. Implementation seems to be facilitated when a national performance monitoring programme for general healthcare is already in place, although in the Netherlands, a QMP-MHC was established without being attached to a general monitoring programme. All the monitoring programmes described use various quality and performance indicators; some systems enhance this methodology with the addition of qualitative assessment methods such as peer reviews linked to accreditation processes. CONCLUSIONS Research is needed to better understand the historical, political and technical backgrounds of the different national cases and to explore the effectiveness of different improvement mechanisms on the actual quality of healthcare. Policy makers and those designing performance measurement programmes are recommended to look across the borders of their own healthcare systems as there are many ways to assess performance and many ways to feedback results to service providers. No evidence is available whether one of these methods is superior to the others in improving the quality of mental healthcare.
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Affiliation(s)
- Anke Bramesfeld
- AQUA Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany; Institute for Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany.
| | - Francesco Amaddeo
- Department of Neurological, Biomedical and Movement Sciences, Section of Psychiatry, Ospedale Policlinico "G.B. Rossi", Verona, Italy
| | - José Caldas-de-Almeida
- CEDOC Chronic Diseases Research Center, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Graça Cardoso
- CEDOC Chronic Diseases Research Center, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Anne Depaigne-Loth
- Direction de l'Amélioration de la Qualité et de la Sécurité des Soins, Haute Autorité de Santé, Saint-Denis La Plaine Cedex, France
| | - Rose Derenne
- Direction de l'Amélioration de la Qualité et de la Sécurité des Soins, Haute Autorité de Santé, Saint-Denis La Plaine Cedex, France
| | - Valeria Donisi
- Department of Neurological, Biomedical and Movement Sciences, Section of Psychiatry, Ospedale Policlinico "G.B. Rossi", Verona, Italy
| | - Mette Jørgensen
- Aalborg University Hospital, Psychiatry Region North Denmark, Aalborg, Denmark
| | | | - Antonio Lora
- Department of Mental Health, Lecco General Hospital, Lecco, Italy
| | - Jan Mainz
- Aalborg University Hospital, Psychiatry Region North Denmark, Aalborg, Denmark
| | - Cornelis Lambert Mulder
- Epidemiological and Social Psychiatric Research Institute, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Joachim Szecsenyi
- AQUA Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany; Department of General Practice and Health Services Research, Heidelberg University Hospital, Germany
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, United Kingdom
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Salisbury TT, Thornicroft G. Deinstitutionalisation does not increase imprisonment or homelessness. Br J Psychiatry 2016; 208:412-3. [PMID: 27143004 DOI: 10.1192/bjp.bp.115.178038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 11/23/2022]
Abstract
Closing long-stay psychiatric beds remains contentious. The review by Winkler et al in this issue examines 23 studies of deinstitutionalisation for the outcomes of people discharged from psychiatric hospitals after an admission of 1 year or longer. The majority of these studies identified no cases of homelessness, incarceration or suicide after discharge from hospital.
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Affiliation(s)
- Tatiana Taylor Salisbury
- Tatiana Taylor Salisbury, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and London School of Hygiene and Tropical Medicine, UK; Graham Thornicroft, PhD, Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Graham Thornicroft
- Tatiana Taylor Salisbury, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and London School of Hygiene and Tropical Medicine, UK; Graham Thornicroft, PhD, Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Adaptation of the Quality Indicator for Rehabilitative Care (QuIRC) for use in mental health supported accommodation services (QuIRC-SA). BMC Psychiatry 2016; 16:101. [PMID: 27075574 PMCID: PMC4831104 DOI: 10.1186/s12888-016-0799-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 03/31/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND No standardised tools for assessing the quality of specialist mental health supported accommodation services exist. To address this, we adapted the Quality Indicator for Rehabilitative care-QuIRC-that was originally developed to assess the quality of longer term inpatient and community based mental health facilities. The QuIRC, which is completed by the service manager and gives ratings of seven domains of care, has good psychometric properties. METHODS Focus groups with staff of the three main types of supported accommodation in the UK (residential care, supported housing and floating outreach services) were carried out to identify potential amendments to the QuIRC. Additional advice was gained from consultation with three expert panels, two of which comprised service users with lived experience of mental health and supported accommodation services. The amended QuIRC (QuIRC-SA) was piloted with a manager of each of the three service types. Item response variance, inter-rater reliability and internal consistency were assessed in a random sample of 52 services. Factorial structure and discriminant validity were assessed in a larger random sample of 87 services. RESULTS The QuIRC-SA comprised 143 items of which only 18 items showed a narrow range of response and five items had poor inter-rater reliability. The tool showed good discriminant validity, with supported housing services generally scoring higher than the other two types of supported accommodation on most domains. Exploratory factor analysis showed that the QuIRC-SA items loaded onto the domains to which they had been allocated. CONCLUSIONS The QuIRC-SA is the first standardised tool for quality assessment of specialist mental health supported accommodation services. Its psychometric properties mean that it has potential for use in research as well as audit and quality improvement programmes. A web based application is being developed to make it more accessible which will produce a printable report for the service manager about the performance of their service, comparison data for similar services and suggestions on how to improve service quality.
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Cardoso G, Papoila A, Tomé G, Killaspy H, King M, Caldas-de-Almeida JM. Living conditions and quality of care in residential units for people with long-term mental illness in Portugal--a cross-sectional study. BMC Psychiatry 2016; 16:34. [PMID: 26897745 PMCID: PMC4761132 DOI: 10.1186/s12888-016-0743-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 02/12/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND As in most European countries, mental health care has shifted from large hospitals to smaller community based settings in Portugal. Our study objectives were to determine: a) the characteristics of users of mental health residential facilities in Portugal; b) the quality of care provided comparing community and hospital units; and c) to investigate associations between quality of care, service and service users' characteristics and experiences of care. METHODS All longer term mental health units in Portugal providing on-site staffed support for at least 12 h per day were assessed with the Quality Indicator for Rehabilitative Care (QuIRC), a standardised tool completed by the unit manager. The QuIRC rates seven domains of care (Living Environment, Therapeutic Environment, Treatments and Interventions, Self/Management and Autonomy, Recovery Based Practice, Social Inclusion, and Human Rights). A random sample of service users were interviewed using standardised measures of autonomy, experiences of care and quality of life. RESULTS Most (60 %) of the 42 units were in Lisbon and surrounding districts with 50 % based in the community and 50 % in hospital settings. They had a mean of 11.5 beds. Service users (n = 278) were mainly men (66.2 %), with a diagnosis of schizophrenia (72.7 %), and a mean age of 49.4 years. Community units scored higher than hospital units on the Living Environment, Treatments and Interventions, and Self-Management and Autonomy domains of the QuIRC. Increased service user age was negatively associated with all but one domain. All QuIRC domains were positively associated with service users' autonomy and experiences of care. CONCLUSIONS Investing in better quality, community based mental health facilities is associated with better outcomes for service users who require longer term support.
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Affiliation(s)
- Graça Cardoso
- Chronic Diseases Research Center (CEDOC), NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056, Lisboa, Portugal.
| | - Ana Papoila
- NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056, Lisboa, Portugal.
| | - Gina Tomé
- Chronic Diseases Research Center (CEDOC), NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056, Lisboa, Portugal.
| | - Helen Killaspy
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road,, London, W1T 7NF, UK.
| | - Michael King
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road,, London, W1T 7NF, UK.
| | - José Miguel Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC), NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria 130, 1169-056, Lisboa, Portugal.
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Killaspy H, Cardoso G, White S, Wright C, Caldas de Almeida JM, Turton P, Taylor TL, Schützwohl M, Schuster M, Cervilla JA, Brangier P, Raboch J, Kalisova L, Onchev G, Alexiev S, Mezzina R, Ridente P, Wiersma D, Visser E, Kiejna A, Adamowski T, Ploumpidis D, Gonidakis F, King M. Quality of care and its determinants in longer term mental health facilities across Europe; a cross-sectional analysis. BMC Psychiatry 2016; 16:31. [PMID: 26868834 PMCID: PMC4750356 DOI: 10.1186/s12888-016-0737-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 02/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Quality Indicator for Rehabilitative Care (QuIRC) is an international, standardised quality tool for the evaluation of mental health facilities that provide longer term care. Completed by the service manager, it comprises 145 items that assess seven domains of care: living environment; treatments and interventions; therapeutic environment; self-management and autonomy; social interface; human rights; and recovery based practice. We used the QuIRC to investigate associations between characteristics of longer term mental health facilities across Europe and the quality of care they delivered to service patients. METHODS QuIRC assessments were completed for 213 longer term mental health units in ten countries that were at various stages of deinstitutionalisation of their mental health services. Associations between QuIRC domain scores and unit descriptive variables were explored using simple and multiple linear regression that took into account clustering at the unit and country level. RESULTS We found wide variation in QuIRC domain scores between individual units, but across countries, fewer than a quarter scored below 50 % on any domains. The quality of care was higher in units that were smaller, of mixed sex, that had a defined expected maximum length of stay and in which not all patients were severely disabled. CONCLUSIONS This is the first time longer term mental health units across a number of European countries have been compared using a standardised measure. Further use of the QuIRC will allow greater understanding of the quality of care in these units across Europe and provide an opportunity to monitor pan-European quality standards of care for this vulnerable patient group.
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Affiliation(s)
- Helen Killaspy
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, UK.
| | - Graça Cardoso
- CEDOC and Mental Health Department, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal.
| | - Sarah White
- Population Health Research Institute, St George's University London, Cranmer Terrace, London, UK.
| | - Christine Wright
- Population Health Research Institute, St George's University London, Cranmer Terrace, London, UK.
| | - José Miguel Caldas de Almeida
- CEDOC and Mental Health Department, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal.
| | - Penny Turton
- Population Health Research Institute, St George's University London, Cranmer Terrace, London, UK.
| | - Tatiana L Taylor
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, UK.
| | - Matthias Schützwohl
- Department of Psychiatry and Psychotherapy, University Hospital, Technische Universitaet Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Mirjam Schuster
- Department of Psychiatry and Psychotherapy, University Hospital, Technische Universitaet Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Jorge A Cervilla
- CIBERSAM, Department of Psychiatry, Universidad de Granada, Avenida de Madrid 11, 18012, Granada, Spain.
| | - Paulette Brangier
- CIBERSAM, Department of Psychiatry, Universidad de Granada, Avenida de Madrid 11, 18012, Granada, Spain.
| | - Jiri Raboch
- Department of Psychiatry, lst Faculty of Medicine, Charles University, Ke Karlovu 11, 128 00, Prague 2, Czech Republic.
| | - Lucie Kalisova
- Department of Psychiatry, lst Faculty of Medicine, Charles University, Ke Karlovu 11, 128 00, Prague 2, Czech Republic.
| | - Georgi Onchev
- Department of Psychiatry, Medical University Sofia, St Georgi Sofiisky str. L, Sofia, 1431, Bulgaria.
| | - Spiridon Alexiev
- Department of Psychiatry, Medical University Sofia, St Georgi Sofiisky str. L, Sofia, 1431, Bulgaria.
| | - Roberto Mezzina
- Dipartimento di Salute Mentale, Via Sai, 1-3, Trieste, 34127, Italy.
| | - Pina Ridente
- Dipartimento di Salute Mentale, Via Sai, 1-3, Trieste, 34127, Italy.
| | - Durk Wiersma
- University Medical Centre, Hanzeplein1, Groningen, 9700 RB, Netherlands.
| | - Ellen Visser
- University Medical Centre, Hanzeplein1, Groningen, 9700 RB, Netherlands.
| | - Andrzej Kiejna
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10, Wroclaw, 50-367, Poland.
| | - Tomasz Adamowski
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10, Wroclaw, 50-367, Poland.
| | - Dimitris Ploumpidis
- University Mental Health Research Institute, Soranou Tou Efessiou 2, Athens, 11527, Greece.
| | - Fragiskos Gonidakis
- University Mental Health Research Institute, Soranou Tou Efessiou 2, Athens, 11527, Greece.
| | - Michael King
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, UK.
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Ako-Arrey DE, Brouwers MC, Lavis JN, Giacomini MK. Health systems guidance appraisal--a critical interpretive synthesis. Implement Sci 2016; 11:9. [PMID: 26800684 PMCID: PMC4724139 DOI: 10.1186/s13012-016-0373-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health systems guidance (HSG) are systematically developed statements that assist with decisions about options for addressing health systems challenges, including related changes in health systems arrangements. However, the development, appraisal, and reporting of HSG poses unique conceptual and methodological challenges related to the varied types of evidence that are relevant, the complexity of health systems, and the pre-eminence of contextual factors. To address this gap, we are conducting a program of research that aims to create a tool to support the appraisal of HSG and further enhance HSG development and reporting. The focus of this paper was to conduct a knowledge synthesis of the published and grey literatures to determine quality criteria (concepts) relevant for this process. METHODS We applied a critical interpretive synthesis (CIS) approach to knowledge synthesis that enabled an iterative, flexible, and dynamic analysis of diverse bodies of literature in order to generate a candidate list of concepts that will constitute the foundational components of the HSG tool. Using our review questions as compasses, we were able to guide the search strategy to look for papers based on their potential relevance to HSG appraisal, development, and reporting. The search strategy included various electronic databases and sources, subject-specific journals, conference abstracts, research reports, book chapters, unpublished data, dissertations, and policy documents. Screening the papers and data extraction was completed independently and in duplicate, and a narrative approach to data synthesis was executed. RESULTS We identified 43 papers that met eligibility criteria. No existing review was found on this topic, and no HSG appraisal tool was identified. Over one third of the authors implicitly or explicitly identified the need for a high-quality tool aimed to systematically evaluate HSG and contribute to its development/reporting. We identified 30 concepts that may be relevant to the appraisal of HSG and were able to cluster them into three meaningful domains: process principles, content, and context principles. CONCLUSIONS Our study showed the role that the quality criteria play in the development, appraisal, and reporting of HSG and demonstrated the link and resonance within and between the various concepts in the three domains.
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Affiliation(s)
- Denis E Ako-Arrey
- McMaster University, Juravinski Hospital Site, G Wing, 2nd Floor, Room 207, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada.
| | - Melissa C Brouwers
- McMaster University, Juravinski Hospital Site, G Wing, 2nd Floor, Room 207, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada.
| | - John N Lavis
- McMaster University, MML-417, 1280 Main St. West, Hamilton, ON, L8S 4L6, Canada.
| | - Mita K Giacomini
- McMaster University, CRL-218, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
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Mahaffey L, Burson KA, Januszewski C, Pitts DB, Preissner K. Role for Occupational Therapy in Community Mental Health: Using Policy to Advance Scholarship of Practice. Occup Ther Health Care 2015; 29:397-410. [PMID: 26115330 DOI: 10.3109/07380577.2015.1051689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.
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Affiliation(s)
- Lisa Mahaffey
- a 1 Department of Occupational Therapy , Midwestern University , Downers Grove, IL, USA
| | - Kathrine A Burson
- b 2 Division of Mental Health, Illinois Department of Human Services , Hines, IL, USA
| | - Celeste Januszewski
- c 3 Occupational Therapy, University of Illinois at Chicago , Chicago, IL, USA
| | - Deborah B Pitts
- d 4 Occupational Therapy, University of Southern California , Los Angeles, CA, USA
| | - Katharine Preissner
- c 3 Occupational Therapy, University of Illinois at Chicago , Chicago, IL, USA
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De Vecchi N, Kenny A, Kidd S. Stakeholder views on a recovery-oriented psychiatric rehabilitation art therapy program in a rural Australian mental health service: a qualitative description. Int J Ment Health Syst 2015; 9:11. [PMID: 25834636 PMCID: PMC4381511 DOI: 10.1186/s13033-015-0005-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 02/19/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Recovery-oriented care is a guiding principle for mental health services in Australia, and internationally. Recovery-oriented psychiatric rehabilitation supports people experiencing mental illness to pursue a meaningful life. In Australia, people with unremitting mental illness and psychosocial disability are often detained for months or years in secure extended care facilities. Psychiatric services have struggled to provide rehabilitation options for residents of these facilities. Researchers have argued that art participation can support recovery in inpatient populations. This study addressed the research question: Is there a role for the creative arts in the delivery of recovery-oriented psychiatric rehabilitation for people with enduring mental illness and significant psychosocial disability detained in a secure extended care unit? METHODS The study had two major aims: to explore the experiences of consumers detained in a rural Australian secure extended care unit of an art therapy project, and to examine the views of nurse managers and an art therapist on recovery-oriented rehabilitation programs with regard to the art therapy project. A qualitative descriptive design guided the study, and a thematic network approach guided data analysis. Ethics approval was granted from the local ethics committee (AU/1/9E5D07). Data were collected from three stakeholders groups. Five consumers participated in a focus group; six managers and the art therapist from the project participated in individual interviews. RESULTS The findings indicate that consumer participants benefitted from art participation and wanted more access to rehabilitation-focussed programs. Consumer participants identified that art making provided a forum for sharing, self-expression, and relationships that built confidence, absent in the regular rehabilitation program. Nurse manager and the art therapist participants agreed that art participation was a recovery-oriented rehabilitation tool, however, systemic barriers thwarted its provision. CONCLUSIONS The transformation of mental health services towards a recovery orientation requires commitment from service leaders to provide evidence-based programs. Psychiatric rehabilitation programs based on local need should be included in public mental health services. This study supports the use of art-based rehabilitation programs for people detained in rural secure extended care facilities. Introducing these programs into clinical practice settings can improve the consumer experience and support organisational culture change towards a recovery orientation.
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Affiliation(s)
- Nadia De Vecchi
- />La Trobe Rural Health School, La Trobe University, Bendigo, VIC 3552 Australia
| | - Amanda Kenny
- />La Trobe Rural Health School, La Trobe University, Bendigo, VIC 3552 Australia
| | - Susan Kidd
- />Psychiatric Services Professional Development Unit, Bendigo Health, Bendigo, VIC 3552 Australia
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de Jong M, de Boer AGEM, Tamminga SJ, Frings-Dresen MHW. Quality of working life issues of employees with a chronic physical disease: a systematic review. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:182-96. [PMID: 24832893 DOI: 10.1007/s10926-014-9517-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To assess issues that contribute to the Quality of Working Life (QWL) of employees with a chronic physical disease. METHODS A systematic literature search was conducted using the databases PubMed, PsycINFO and EMBASE. Experiences and perceptions during the working life of employees with a chronic physical disease were extracted and synthesized into issues that contributed to their QWL. We organized these synthesized QWL issues into higher order themes and categories with qualitative data analysis software. RESULTS From a total of 4,044 articles identified by the search, 61 articles were included. Data extraction and data synthesis resulted in an overview of 73 QWL issues that were classified into 30 themes. The following five categories of themes were identified: (1) job characteristics with issues such as job flexibility and work-site access; (2) the social structure and environment containing issues about disclosure, discrimination, misunderstanding, and awareness by employers or colleagues; (3) organizational characteristics with issues such as requesting work accommodations; (4) individual work perceptions including issues about enjoyment and evaluating work or life priorities; and (5) effect of the disease and treatment including issues about cognitive and physical health and work ability. CONCLUSION This systematic review offers an extensive overview of issues that might contribute to the QWL of employees with a chronic physical disease. This overview may function as a starting point for occupational support, such as monitoring and evaluating the QWL of employees with a chronic physical disease during return-to-work and work continuation processes.
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Affiliation(s)
- Merel de Jong
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands,
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Baccari IOP, Campos RTO, Stefanello S. Recovery: revisão sistemática de um conceito. CIENCIA & SAUDE COLETIVA 2015; 20:125-36. [DOI: 10.1590/1413-81232014201.04662013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 09/05/2013] [Indexed: 11/22/2022] Open
Abstract
O conceito de recovery tem sido descrito em artigos como um estado de recuperação ou restabelecimento de funções psíquicas, físicas e sociais no funcionamento cotidiano. O objetivo do artigo é analisar concepções terminológicas em diferentes metodologias investigativas e a evolução paradigmática da noção de recovery. Pesquisa bibliográfica sistemática na base Pubmed com as palavras "recovery + schizophrenia", limitada a dois anos retrospectivos e a artigos completos gratuitos. Dezenove artigos foram analisados. A maioria destes busca associações entre dada característica e recovery, poucos são aqueles que discutem a sua concepção de forma que se distinga de termos comuns como "cura" e "reabilitação". Recovery como um estado em que o portador de transtorno mental grave possa sentir-se criador de seus caminhos tende a estar presente em estudos com metodologia qualitativa e em revisões bibliográficas, em que a medida de recovery deixa de relacionar-se à ausência de sintomas e passa a priorizar o quão participativa pode ser a vida de um indivíduo apesar da doença. Alguns estudos quantitativos vislumbram essa diferença conceitual. Em pesquisas qualitativas ocorre expansão na concepção de recovery e nas formas de promovê-lo.
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Shen GC, Snowden LR. Institutionalization of deinstitutionalization: a cross-national analysis of mental health system reform. Int J Ment Health Syst 2014; 8:47. [PMID: 25473417 PMCID: PMC4253997 DOI: 10.1186/1752-4458-8-47] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/11/2014] [Indexed: 12/03/2022] Open
Abstract
Background Policies generate accountability in that they offer a standard against which government performance can be assessed. A central question of this study is whether ideological imprint left by policy is realized in the time following its adoption. National mental health policy expressly promotes the notion of deinstitutionalization, which mandates that individuals be cared for in the community rather than in institutional environments. Methods We investigate whether mental health policy adoption induced a transformation in the structure of mental health systems, namely psychiatric beds, using panel data on 193 countries between 2001 and 2011. Results Our striking regression results demonstrate that late-adopters of mental health policy are more likely to reduce psychiatric beds in mental hospitals and other biomedical settings than innovators, whereas they are less likely than non-adopters to reduce psychiatric beds in general hospitals. Conclusions It can be inferred late adopters are motivated to implement deinstitutionalization for technical efficiency rather than social legitimacy reasons. Electronic supplementary material The online version of this article (doi:10.1186/1752-4458-8-47) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gordon C Shen
- School of Public Health, Yale University, 60 College Street, P.O. Box 208034, New Haven, CT 06520 USA
| | - Lonnie R Snowden
- School of Public Health, University of California at Berkeley, 235 University Hall, Berkeley, CA 94720 USA
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Feeling in control: comparing older people's experiences in different care settings. AGEING & SOCIETY 2014; 34:1427-1451. [PMID: 25067865 PMCID: PMC4107842 DOI: 10.1017/s0144686x13000184] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2013] [Indexed: 11/07/2022]
Abstract
The promotion of choice and control for older people is a policy priority for social care services in the United Kingdom and is at the heart of recent drives to personalise services. Increasingly, we are seeing a move away from institutionalised care (e.g. in care homes) towards enablement, with more services being delivered in community-based settings. Extra care housing has been promoted as a purpose-built, community-based alternative to residential care for older people. However, whilst accounts of users' experiences in particular service types are plentiful, the use of different instrumentation and measures makes comparison between settings difficult. We combined data from four studies where participants were older people either living in care homes or extra care housing or receiving care at home. All of these studies asked participants to rate their control over daily life, using the Adult Social Care Outcomes Toolkit (ASCOT). This paper presents the results of an ordinal logistic regression analysis indicating that, after controlling for differences in age, ability to perform activities of daily living and self-rated health, setting had a significant effect on older people's sense of control. Residents in care homes and extra care housing report similar levels of control over daily life but consistently report feeling more in control than older people receiving care at home. Implications for policy and practice are discussed.
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Song Y, Liu D, Chen Y, He G. Using focus groups to design a psychoeducation program for patients with schizophrenia and their family members. Int J Clin Exp Med 2014; 7:177-85. [PMID: 24482705 PMCID: PMC3902257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 11/12/2013] [Indexed: 06/03/2023]
Abstract
UNLABELLED The purpose of this project was to determine what factors to be considered in planning a psychoeducation program to better meet the needs of patients with schizophrenia and their family members. METHODS Three focus group sessions were conducted and recorded, transcribed, and analyzed by members of the research team. RESULTS Patients hoped to grasp the fullest possible knowledge about schizophrenia, whereas the factors influencing the efficacy of the schizophrenia health education curriculum included: discrimination, non-understanding of family members, easy to forget, unreasonable timetable. Health education was mainly in the form of classroom teaching. CONCLUSIONS 1. At present, there are a few psychiatric education courses in China; 2. Patients and their family members are eager to acquire knowledge about the contents of schizophrenia; 3. Misconceptions would hinder the rehabilitation of patients; 4. Worry about being discriminated; 5. There is a different knowledge demand between the patients and their family members.
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Affiliation(s)
- Yan Song
- School of Nursing Central South University 172 Tongzipo Road, Hunan, Changsha 410013, China
| | - Dan Liu
- School of Nursing Central South University 172 Tongzipo Road, Hunan, Changsha 410013, China
| | - Yuxiang Chen
- School of Nursing Central South University 172 Tongzipo Road, Hunan, Changsha 410013, China
| | - Guoping He
- School of Nursing Central South University 172 Tongzipo Road, Hunan, Changsha 410013, China
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A modified Drug Attitude Inventory used in long-term patients in sheltered housing. Eur Neuropsychopharmacol 2013; 23:1296-9. [PMID: 23265955 DOI: 10.1016/j.euroneuro.2012.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 11/23/2012] [Accepted: 11/24/2012] [Indexed: 11/22/2022]
Abstract
The self-report Drug Attitude Inventory (DAI), in 30- and 10-item versions, provides unique information of clinical relevance for monitoring treatment adherence among people diagnosed with schizophrenia. The primary purpose of this paper was to evaluate the 10-item version among patients living in sheltered housing. Data were collected among 68 persons living in sheltered housing, most of them (82%) diagnosed with schizophrenia, 6% with non-organic psychoses, and 12% with other diagnoses. The dichotomic response format of the original DAI-10 was replaced by a 4-point Likert scale, in order to improve the resolution of the scale. Over 90% of the participants produced meaningful scores. A factor analysis suggested a 2-factor orthogonal structure: one highly homogenous factor (5 items) reflected wanted effects of the drug and displayed a bimodal distribution; one factor (3 items) reflected side effects. One item concerned the perceived control over one's drug treatment, which is a key clinical issue. One item was conceptually ambiguous and displayed no correlations with the other items. On the basis of the results we suggest cut-off scores which indicate the need for three kinds of adherence-improving interventions. Summing up, by dropping one item and using a Likert scale response format, the resulting instrument, DAI-9, appears to be an easy-to-use self-report instrument for monitoring drug attitudes and to identify needs for treatment adherence interventions among seriously ill patients.
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Storm M, Edwards A. Models of user involvement in the mental health context: intentions and implementation challenges. Psychiatr Q 2013; 84:313-27. [PMID: 23076765 DOI: 10.1007/s11126-012-9247-x] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient-centered care, shared decision-making, patient participation and the recovery model are models of care which incorporate user involvement and patients' perspectives on their treatment and care. The aims of this paper are to examine these different care models and their association with user involvement in the mental health context and discuss some of the challenges associated with their implementation. The sources used are health policy documents and published literature and research on patient-centered care, shared decision-making, patient participation and recovery. The policy documents advocate that mental health services should be oriented towards patients' or users' needs, participation and involvement. These policies also emphasize recovery and integration of people with mental disorders in the community. However, these collaborative care models have generally been subject to limited empirical research about effectiveness. There are also challenges to implementation of the models in inpatient care. What evidence there is indicates tensions between patients' and providers' perspectives on treatment and care. There are issues related to risk and the person's capacity for user involvement, and concerns about what role patients themselves wish to play in decision-making. Lack of competence and awareness among providers are further issues. Further work on training, evaluation and implementation is needed to ensure that inpatient mental health services are adapting user oriented care models at all levels of services.
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Affiliation(s)
- Marianne Storm
- Department of Health Studies, University of Stavanger, 4036 Stavanger, Norway.
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