Challenges for policy makers and organizational leaders: addressing trends in mental health inequalities

Healthcare System Responsiveness in Covid-19: An Experience from Capital City of I.R of Iran

Background

As a public health emergency, coronavirus disease 2019 (Covid-19) is a threat to our future; therefore, appropriate health system responsiveness (HSR), as an important criterion, is of crucial importance. This study aimed to evaluate the different dimensions of responsiveness of healthcare centers, both public and private, providing COVID-19 services in Tehran.

Methods

Following a cross-sectional design, this study was conducted in Tehran (the capital city of I.R. Iran) from May to November 2020. Data were collected using the World Health Organization (WHO) questionnaire on responsiveness. Two hundred questionnaires were filled out through face-to-face or phone call interviews in two public and private hospitals (100 in each) providing Covid-19 services. Participants were selected using the convenience sampling technique among all those who received Covid-19 services during the past six months in the city of Tehran.

Results

The mean age of participants was 45.9 ± 15.9 and 51.5% were female. On an average, 52.6% of the respondents evaluated at least one dimension of responsiveness as appropriate and/or strongly appropriate. Communication obtained the highest score (58.2%), followed by confidentiality (56.5%), dignity (56%), and prompt attention (52%). Meanwhile, autonomy and choice were evaluated as poor (moderate, weak, and strongly weak) by 63.5 and 52.5% of respondents. There was no significant association between the type of healthcare center (i.e., public or private) and responsiveness (p-value = 0.896). However, there was a significant difference between gender (p-value = 0.036) and education level (p-value = 0.014) with responsiveness. According to the respondents, prompt attention and choice were the most and least important dimensions, respectively.

Conclusions

Evaluation of HSR in the era of COVID-19 not only provides a tool for qualitative assessment of services but also plays an important role in providing feedback to policymakers to adopt effective policies.

Course of health care costs before and after psychiatric inpatient treatment: patient-reported vs. administrative records

BACKGROUND

There is limited evidence on the course of health service costs before and after psychiatric inpatient treatment, which might also be affected by source of cost data. Thus, this study examines: i) differences in health care costs before and after psychiatric inpatient treatment, ii) whether these differences vary by source of cost-data (self-report vs. administrative), and iii) predictors of cost differences over time.

METHODS

Sixty-one psychiatric inpatients gave informed consent to their statutory health insurance company to provide insurance records and completed assessments at admission and 6-month follow-up. These were compared to the self-reported treatment costs derived from the "Client Socio-demographic and Service Use Inventory" (CSSRI-EU) for two 6-month observation periods before and after admission to inpatient treatment to a large psychiatric hospital in rural Bavaria. Costs were divided into subtypes including costs for inpatient and outpatient treatment as well as for medication.

RESULTS

Sixty-one participants completed both assessments. Over one year, the average patient-reported total monthly treatment costs increased from € 276.91 to € 517.88 (paired Wilcoxon Z = -2.27; P = 0.023). Also all subtypes of treatment costs increased according to both data sources. Predictors of changes in costs were duration of the index admission and marital status.

CONCLUSION

Self-reported costs of people with severe mental illness adequately reflect actual service use as recorded in administrative data. The increase in health service use after inpatient treatment can be seen as positive, while the pre-inpatient level of care is a potential problem, raising the question whether more or better outpatient care might have prevented hospital admission. Findings may serve as a basis for future studies aiming at furthering the understanding of what to expect regarding appropriate levels of post-hospital care, and what factors may help or inhibit post-discharge treatment engagement. Future research is also needed to examine long-term effects of inpatient psychiatric treatment on outcome and costs.

Shortcomings in dealing with psychological effects of natural disasters in iran

BACKGROUND

Natural disasters result in numerous economic, social, psychological and cultural consequences. Of them, psychological consequences of disasters will affect the lives of people long after the critical conditions finish. Thus, concerning the importance of psychological support in disasters, this study has identified problems and weaknesses in dealing with the psychological effects of the disasters occurred in Iran.

METHODS

This qualitative study was carried out using semi-structured in-depth interviews and focus groups. Sample volume consisted of 26 experts in the field of disaster management. Content analysis was used to analyze data.

RESULTS

Nine major problems were identified as weaknesses in handling the psychological effects of the disaster. These weaknesses include: rescuers' unfamiliarity with the basic principles of psychosocial support, shortage of relevant experts and inadequate training, paying no attention to the needs of specific groups, weaknesses in organizational communications, discontinuation of psychological support after disaster, unfamiliarity with native language and culture of the disaster area, little attention paid by media to psychological principles in broadcasting news, people's long-term dependence on governmental aid.

CONCLUSIONS

Disaster management has various aspects; in Iran, less attention has been paid to psychological support in disasters. Increasing education at all levels, establishing responsible structures and programming seem necessary in dealing with the psychological effects of disasters.