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Duncan A, Stergiopoulos V, Dainty KN, Wodchis WP, Kirst M. Community mental health funding, stakeholder engagement and outcomes: a realist synthesis. BMJ Open 2023; 13:e063994. [PMID: 36725092 PMCID: PMC9896207 DOI: 10.1136/bmjopen-2022-063994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
UNLABELLED Mental health services continues to be a high priority for healthcare and social service systems. Funding structures within community mental health settings have shown to impact service providers' behaviour and practices. Additionally, stakeholder engagement is suggested as an important mechanism to achieving the intended goals. However, the literature on community mental health funding reform and associated outcomes is inconsistent and there are no consistent best practices for stakeholder engagement in such efforts. OBJECTIVES This study sought to understand how stakeholder engagement impacts outcomes when there is a change in public funding within community mental health settings. DESIGN A realist synthesis approach was used to address the research question to fully understand the role of stakeholder engagement as a mechanism in achieving outcomes (system and service user) in the context of community mental health service reform. An iterative process was used to identify programme theories and context-mechanism-outcome configurations within the literature. RESULTS Findings highlight that in the absence of stakeholder engagement, funding changes may lead to negative outcomes. When stakeholders were engaged in some form, funding changes were more often associated with positive outcomes. Stakeholder engagement is multifaceted and requires considerable time and investment to support achieving intended outcomes when funding changes are implemented. CONCLUSIONS To support successful transformation of community mental health programmes, it is important that stakeholders are meaningfully engaged during funding allocation changes. Stakeholder engagement may entail connecting around a shared purpose, individual participation and meaningful interactions and dialogue.
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Affiliation(s)
- Andrea Duncan
- Department of Occupational Sciences & Occupational Therapy, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Leadership Team, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Katie N Dainty
- Patient Centred Outcomes, North York General Hospital, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Maritt Kirst
- Community Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
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2
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Aoki Y, Yaju Y, Utsumi T, Sanyaolu L, Storm M, Takaesu Y, Watanabe K, Watanabe N, Duncan E, Edwards AG. Shared decision-making interventions for people with mental health conditions. Cochrane Database Syst Rev 2022; 11:CD007297. [PMID: 36367232 PMCID: PMC9650912 DOI: 10.1002/14651858.cd007297.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND One person in every four will suffer from a diagnosable mental health condition during their life. Such conditions can have a devastating impact on the lives of the individual and their family, as well as society. International healthcare policy makers have increasingly advocated and enshrined partnership models of mental health care. Shared decision-making (SDM) is one such partnership approach. Shared decision-making is a form of service user-provider communication where both parties are acknowledged to bring expertise to the process and work in partnership to make a decision. This review assesses whether SDM interventions improve a range of outcomes. This is the first update of this Cochrane Review, first published in 2010. OBJECTIVES To assess the effects of SDM interventions for people of all ages with mental health conditions, directed at people with mental health conditions, carers, or healthcare professionals, on a range of outcomes including: clinical outcomes, participation/involvement in decision-making process (observations on the process of SDM; user-reported, SDM-specific outcomes of encounters), recovery, satisfaction, knowledge, treatment/medication continuation, health service outcomes, and adverse outcomes. SEARCH METHODS We ran searches in January 2020 in CENTRAL, MEDLINE, Embase, and PsycINFO (2009 to January 2020). We also searched trial registers and the bibliographies of relevant papers, and contacted authors of included studies. We updated the searches in February 2022. When we identified studies as potentially relevant, we labelled these as studies awaiting classification. SELECTION CRITERIA Randomised controlled trials (RCTs), including cluster-randomised controlled trials, of SDM interventions in people with mental health conditions (by Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. We used GRADE to assess the certainty of the evidence. MAIN RESULTS This updated review included 13 new studies, for a total of 15 RCTs. Most participants were adults with severe mental illnesses such as schizophrenia, depression, and bipolar disorder, in higher-income countries. None of the studies included children or adolescents. Primary outcomes We are uncertain whether SDM interventions improve clinical outcomes, such as psychiatric symptoms, depression, anxiety, and readmission, compared with control due to very low-certainty evidence. For readmission, we conducted subgroup analysis between studies that used usual care and those that used cognitive training in the control group. There were no subgroup differences. Regarding participation (by the person with the mental health condition) or level of involvement in the decision-making process, we are uncertain if SDM interventions improve observations on the process of SDM compared with no intervention due to very low-certainty evidence. On the other hand, SDM interventions may improve SDM-specific user-reported outcomes from encounters immediately after intervention compared with no intervention (standardised mean difference (SMD) 0.63, 95% confidence interval (CI) 0.26 to 1.01; 3 studies, 534 participants; low-certainty evidence). However, there was insufficient evidence for sustained participation or involvement in the decision-making processes. Secondary outcomes We are uncertain whether SDM interventions improve recovery compared with no intervention due to very low-certainty evidence. We are uncertain if SDM interventions improve users' overall satisfaction. However, one study (241 participants) showed that SDM interventions probably improve some aspects of users' satisfaction with received information compared with no intervention: information given was rated as helpful (risk ratio (RR) 1.33, 95% CI 1.08 to 1.65); participants expressed a strong desire to receive information this way for other treatment decisions (RR 1.35, 95% CI 1.08 to 1.68); and strongly recommended the information be shared with others in this way (RR 1.32, 95% CI 1.11 to 1.58). The evidence was of moderate certainty for these outcomes. However, this same study reported there may be little or no effect on amount or clarity of information, while another small study reported there may be little or no change in carer satisfaction with the SDM intervention. The effects of healthcare professional satisfaction were mixed: SDM interventions may have little or no effect on healthcare professional satisfaction when measured continuously, but probably improve healthcare professional satisfaction when assessed categorically. We are uncertain whether SDM interventions improve knowledge, treatment continuation assessed through clinic visits, medication continuation, carer participation, and the relationship between users and healthcare professionals because of very low-certainty evidence. Regarding length of consultation, SDM interventions probably have little or no effect compared with no intervention (SDM 0.09, 95% CI -0.24 to 0.41; 2 studies, 282 participants; moderate-certainty evidence). On the other hand, we are uncertain whether SDM interventions improve length of hospital stay due to very low-certainty evidence. There were no adverse effects on health outcomes and no other adverse events reported. AUTHORS' CONCLUSIONS This review update suggests that people exposed to SDM interventions may perceive greater levels of involvement immediately after an encounter compared with those in control groups. Moreover, SDM interventions probably have little or no effect on the length of consultations. Overall we found that most evidence was of low or very low certainty, meaning there is a generally low level of certainty about the effects of SDM interventions based on the studies assembled thus far. There is a need for further research in this area.
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Affiliation(s)
- Yumi Aoki
- Department of Psychiatric and Mental Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Yukari Yaju
- Department of Epidemiology and Biostatistics for Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Tomohiro Utsumi
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Leigh Sanyaolu
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Marianne Storm
- Department of Public Health, Faculty of Health Science, University of Stavanger, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
- Department of Neuropsychiatry, University of the Ryukyus, Okinawa, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, Kyoto, Japan
| | - Edward Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, The University of Stirling, Scotland, UK
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Grootens KP, Sommer IE. Redesigning phase 3 and 4 trials to adopt shared decision making. Lancet Psychiatry 2022; 9:101-103. [PMID: 34672990 DOI: 10.1016/s2215-0366(21)00385-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Koen P Grootens
- Reinier van Arkel Mental Health Institute, 's-Hertogenbosch 70058, Netherlands.
| | - Iris E Sommer
- Department of Medical Sciences of Cells and Systems and Department of Psychiatry, University Medical Centre Groningen, Groningen, Netherlands
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4
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Poppe A, Bais L, van Duin D, Ćurčić-Blake B, Pijnenborg GHM, van der Meer L. Improving cognition in severe mental illness by combining cognitive remediation and transcranial direct current stimulation: study protocol for a pragmatic randomized controlled pilot trial (HEADDSET). Trials 2021; 22:275. [PMID: 33849658 PMCID: PMC8042354 DOI: 10.1186/s13063-021-05230-8] [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] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/27/2021] [Indexed: 02/08/2023] Open
Abstract
Background A fundamental challenge for many people with severe mental illness (SMI) is how to deal with cognitive impairments. Cognitive impairments are common in this population and limit daily functioning. Moreover, neural plasticity in people with SMI appears to be reduced, a factor that might hinder newly learned cognitive skills to sustain. The objective of this pilot trial is to investigate the effects of cognitive remediation (CR) on cognitive and daily functioning in people dependent on residential settings. In addition, transcranial direct current stimulation (tDCS) is used to promote neural plasticity. It is expected that the addition of tDCS can enhance learning and will result in longer-lasting improvements in cognitive and daily functioning. Methods This is a pragmatic, triple-blinded, randomized, sham-controlled, pilot trial following a non-concurrent multiple baseline design with the participants serving as their own control. We will compare (1) CR to treatment as usual, (2) active/sham tDCS+CR to treatment as usual, and (3) active tDCS+CR to sham tDCS+CR. Clinical relevance, feasibility, and acceptability of the use of CR and tDCS will be evaluated. We will recruit 26 service users aged 18 years or older, with a SMI and dependent on residential facilities. After a 16-week waiting period (treatment as usual), which will serve as a within-subject control condition, participants will be randomized to 16 weeks of twice weekly CR combined with active (N = 13) or sham tDCS (N = 13). Cognitive, functional, and clinical outcome assessments will be performed at baseline, after the control (waiting) period, directly after treatment, and 6-months post-treatment. Discussion The addition of cognitive interventions to treatment as usual may lead to long-lasting improvements in the cognitive and daily functioning of service users dependent on residential facilities. This pilot trial will evaluate whether CR on its own or in combination with tDCS can be a clinically relevant addition to further enhance recovery. In case the results indicate that cognitive performance can be improved with CR, and whether or not tDCS will lead to additional improvement, this pilot trial will be extended to a large randomized multicenter study. Trial registration Dutch Trial Registry NL7954. Prospectively registered on August 12, 2019.
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Affiliation(s)
- Anika Poppe
- Department of Rehabilitation, Lentis Psychiatric Institute, Lagerhout E35, 9741 KE, Zuidlaren, The Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Leonie Bais
- Department of Rehabilitation, Lentis Psychiatric Institute, Lagerhout E35, 9741 KE, Zuidlaren, The Netherlands
| | - Daniëlle van Duin
- Trimbos Institute, Utrecht, The Netherlands.,Phrenos Center of Expertise, Utrecht, The Netherlands
| | - Branislava Ćurčić-Blake
- Department of Biomedical Sciences of Cells and Systems, Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerdina Hendrika Maria Pijnenborg
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.,Department of Psychotic Disorders, GGZ Drenthe, Assen, The Netherlands
| | - Lisette van der Meer
- Department of Rehabilitation, Lentis Psychiatric Institute, Lagerhout E35, 9741 KE, Zuidlaren, The Netherlands. .,Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
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5
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Aoki Y. Shared decision making for adults with severe mental illness: A concept analysis. Jpn J Nurs Sci 2020; 17:e12365. [PMID: 32761783 PMCID: PMC7590107 DOI: 10.1111/jjns.12365] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/08/2020] [Accepted: 06/27/2020] [Indexed: 12/01/2022]
Abstract
AIM Shared decision making for adults with severe mental illness has increasingly attracted attention. However, this concept has not been comprehensively clarified. This review aimed to clarify a concept of shared decision making for adults with severe mental illness such as schizophrenia, depression, and bipolar disorder, and propose an adequate definition. METHODS Rodgers' evolutionary concept analysis was used. MEDLINE, PsychINFO, and CINAHL were searched for articles written in English and published between 2010 and November 2019. The search terms were "psychiatr*" or "mental" or "schizophren*" or "depression" or "bipolar disorder", combined with "shared decision making". In total, 70 articles met the inclusion criteria. An inductive approach was used to identify themes and sub-themes related to shared decision making for adults with severe mental illness. Surrogate terms and a definition of the concept were also described. RESULTS Four key attributes were identified: user-professional relationship, communication process, user-friendly visualization, and broader stakeholder approach. Communication process was the densest attribute, which consisted of five phases: goal sharing, information sharing, deliberation, mutual agreement, and follow-up. The antecedents as prominent predisposing factors were long-term complex illness, power imbalance, global trend, users' desire, concerns, and stigma. The consequences included decision-related outcomes, users' changes, professionals' changes, and enhanced relationship. CONCLUSIONS Shared decision making for adults with severe mental illness is a communication process, involving both user-friendly visualization techniques and broader stakeholders. The process may overcome traditional power imbalance and encourage changes among both users and professionals that could enhance the dyadic relationship.
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Affiliation(s)
- Yumi Aoki
- Psychiatric & Mental Health Nursing, Graduate School of NursingSt. Luke's International UniversityTokyoJapan
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6
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Bitter N, Roeg D, van Nieuwenhuizen C, van Weeghel J. Recovery in Supported Accommodations: A Scoping Review and Synthesis of Interventions for People with Severe Mental Illness. Community Ment Health J 2020; 56:1053-1076. [PMID: 32016620 PMCID: PMC7289772 DOI: 10.1007/s10597-020-00561-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/26/2020] [Indexed: 11/30/2022]
Abstract
Research on the recovery domains beside clinical recovery of people with severe mental illness in need of supported accommodations is limited. The aim of this study was (1) to investigate which recovery interventions exist for this group of people and (2) to explore the scientific evidence. We conducted a scoping review, including studies with different designs, evaluating the effectiveness the recovery interventions available. The search resulted in 53 eligible articles of which 22 focused on societal recovery, six on personal recovery, five on functional recovery, 13 on lifestyle-interventions, and seven on creative and spiritual interventions. About a quarter of these interventions showed added value and half of them initial promising results. The research in this area is still limited, but a number of recovery promoting interventions on other areas than clinical recovery have been developed and evaluated. Further innovation and research to strengthen and repeat the evidence are needed.
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Affiliation(s)
- Neis Bitter
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands
| | - Diana Roeg
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.
| | - Chijs van Nieuwenhuizen
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.,GGzE Institute for Mental Health Care, PO Box 909, 5600, AX, Eindhoven, The Netherlands
| | - Jaap van Weeghel
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.,Phrenos Centre of Expertise, PO Box 1203, 3500, BE, Utrecht, The Netherlands.,Parnassia Group, Dijk en Duin Mental Health Centre, PO Box 305, 1900, AH, Castricum, The Netherlands
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7
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Ådnanes M, Cresswell-Smith J, Melby L, Westerlund H, Šprah L, Sfetcu R, Straßmayr C, Donisi V. Discharge planning, self-management, and community support: Strategies to avoid psychiatric rehospitalisation from a service user perspective. PATIENT EDUCATION AND COUNSELING 2020; 103:1033-1040. [PMID: 31836249 DOI: 10.1016/j.pec.2019.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Psychiatric rehospitalisation is often seen as a negative outcome in terms of healthcare quality and cost, as well as potentially hindering the process of recovery. The purpose of our study was to explore psychiatric rehospitalisation from a service-user perspective, paying attention to how rehospitalisation can be avoided. METHOD Eight focus groups, including a total of 55 mental health service users, were conducted in six European countries (Austria, Finland, Italy, Norway, Romania, and Slovenia). The results were analysed using systematic text condensation. RESULTS All participants had been in touch with mental health services for at least one year, and had experienced more than one psychiatric hospitalisation. Participants emphasised the importance of discharge planning and psychoeducation both during and after the hospital stay, as well as the benefits of structured plans, coping strategies, self-monitoring techniques, and close contact with local community services.Social contacts and meaningful activities were also considered to be critical, as was support from peers and family members. CONCLUSION Efforts to avoid psychiatric rehospitalisation should include actions that support a functional day-to-day life, improve coping strategies, and build on cross-sectoral collaboration. PRACTICE IMPLICATIONS The study emphasises the need for psychoeducational and psychosocial interventions, starting already during the inpatient stay.
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Affiliation(s)
- M Ådnanes
- SINTEF Digital, Dept of Health Research, PO Box 4760 Torgarden, 7465 Trondheim, Norway.
| | - J Cresswell-Smith
- National Institute for Health and Welfare (THL), Mental Health Unit, Helsinki, Finland.
| | - L Melby
- SINTEF Digital, Dept of Health Research, Trondheim, Norway.
| | - H Westerlund
- Competence Centre for Experiential Knowledge and Service Development, Trondheim, Norway.
| | - L Šprah
- Research Centre of the Slovenian Academy of Sciences and Arts, Sociomedical Institute, Ljubljana, Slovenia.
| | - R Sfetcu
- National School of Public Health, Management and Professional Development, Bucharest; 2. Faculty of Psychology and Educational Sciences, Bucharest, Romania.
| | - C Straßmayr
- IMEHPS. Research - Forschungsinstitut für Sozialpsychiatrie, Vienna, Austria.
| | - V Donisi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Hirdes JP, van Everdingen C, Ferris J, Franco-Martin M, Fries BE, Heikkilä J, Hirdes A, Hoffman R, James ML, Martin L, Perlman CM, Rabinowitz T, Stewart SL, Van Audenhove C. The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care. Front Psychiatry 2020; 10:926. [PMID: 32076412 PMCID: PMC6978285 DOI: 10.3389/fpsyt.2019.00926] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection approach, data elements, and care planning protocols. The key applications of these instruments include care planning, outcome measurement, quality improvement, and resource allocation. The composition of these instruments and psychometric properties are reviewed, and examples related to homeless are used to illustrate the various applications of these assessment systems.
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Affiliation(s)
- John P. Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Coline van Everdingen
- Psychiatry and Neuropsychology Department, Maastricht University, Maastricht, Netherlands
| | - Jason Ferris
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Brant E. Fries
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
| | - Jyrki Heikkilä
- Division of Psychiatry, Turku University Hospital, Turku, Finland
| | - Alice Hirdes
- Graduate Program in Health Promotion, Human Development and Society, Lutheran University of Brazil, Canoas, Brazil
| | - Ron Hoffman
- School of Criminology and Criminal Justice, Nipissing University, North Bay, ON, Canada
| | - Mary L. James
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
| | - Lynn Martin
- Department of Health Sciences for Lynn Martin, Lakehead University, Thunder Bay, ON, Canada
| | - Christopher M. Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Terry Rabinowitz
- Departments of Psychiatry and Family Medicine Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Shannon L. Stewart
- Faculty of Education, Althouse College, Western University, London, ON, Canada
| | - Chantal Van Audenhove
- LUCAS Center for Care Research and Consultancy & Academic Center for General Practice in the Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium
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9
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Vaeggemose U, Ankersen PV, Aagaard J, Burau V. Co-production of community mental health services: Organising the interplay between public services and civil society in Denmark. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:122-130. [PMID: 28670769 DOI: 10.1111/hsc.12468] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/08/2017] [Indexed: 06/07/2023]
Abstract
Co-production involves knowledge and skills based on both lived experiences of citizens and professionally training of staff. In Europe, co-production is viewed as an essential tool for meeting the demographic, political and economic challenges of welfare states. However, co-production is facing challenges because public services and civil society are rooted in two very different logics. These challenges are typically encountered by provider organisations and their staff who must convert policies and strategies into practice. Denmark is a welfare state with a strong public services sector and a relatively low involvement of volunteers. The aim of this study was to investigate how provider organisations and their staff navigate between the two logics. The present analysis is a critical case study of two municipalities selected from seven participating municipalities, for their maximum diversity. The study setting was the Community Families programme, which aim to support the social network of mental health users by offering regular contact with selected private families/individuals. The task of the municipalities was to initiate and support Community Families. The analysis built on qualitative data generated at the organisational level in the seven participating municipalities. Within the two "case study" municipalities, qualitative interviews were conducted with front-line co-ordinators (six) and line managers (two). The interviews were recorded, transcribed verbatim and coded using the software program NVivo. The results confirm the central role played by staff and identify a close interplay between public services and civil society logics as essential for the organisation of co-production. Corresponding objectives, activities and collaborative relations of provider organisations are keys for facilitating the co-productive practice of individual staff. Organised in this way, co-production can succeed even in a mental health setting associated with social stigma and in a welfare state dominated by public services.
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Affiliation(s)
- Ulla Vaeggemose
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Pia Vedel Ankersen
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Jørgen Aagaard
- Unit for Psychiatric Research and Department S, Aalborg University Hospital, Psychiatric Hospital, Aalborg, Denmark
- Unit for Psychiatric Research and Department M, Aarhus University Hospital, Risskov, Denmark
| | - Viola Burau
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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10
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Lerbaek B, Aagaard J, Andersen MB, Buus N. Assertive community treatment (ACT) case managers' professional identities: A focus group study. Int J Ment Health Nurs 2016; 25:579-587. [PMID: 26872034 DOI: 10.1111/inm.12211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 12/12/2015] [Accepted: 12/16/2015] [Indexed: 11/29/2022]
Abstract
Assertive community treatment (ACT) case managers provide healthcare services to people with severe and persistent mental illness. These case managers take on generic roles in multidisciplinary teams and provide all-around services in the clients' private homes. This focus group study aimed to gain insight into Danish ACT case managers' professional identity work by examining their discussions of ethical dilemmas and collaboration in their everyday practice. Data were collected during five focus groups at three ACT teams in the North Denmark Region and subjected to discourse analysis emphasizing how identity work was accomplished through talk. The findings indicated that the case managers constructed professional identities by actively positioning themselves and the particular ACT approach in relation to other mental healthcare professionals and clients. They represented themselves as achieving better client-related outcomes by being more assertive and persistent, and as responsible caregivers who provided the help that their clients needed when other services had failed to do so. They depicted their services as being focused on the clients' well-being, and their persistent efforts to establish and sustain interpersonal relationships with clients were an important part of their service. Basic nursing tasks were described as an important part of their everyday work, and even though such tasks were not distinctive for ACT case managers, the representations of their work seemed to give them a sense of worth as professionals and legitimized a unique role in the community mental healthcare services.
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Affiliation(s)
- Birgitte Lerbaek
- RN, MHS, Aalborg University Hospital, Psychiatric Hospital, Aalborg, Denmark
| | - Jørgen Aagaard
- Unit for Psychiatric Research and Department S, Aalborg University Hospital, Psychiatric Hospital, Aalborg, Denmark.,Unit for Psychiatric Research and Department M, Aarhus University Hospital, Risskov, Denmark
| | | | - Niels Buus
- Faculty of Nursing and Midwifery, University of Sydney, Australia and St. Vincent's Private Hospital Sydney, Sydney
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Bitter NA, Roeg DPK, van Nieuwenhuizen C, van Weeghel J. Identifying profiles of service users in housing services and exploring their quality of life and care needs. BMC Psychiatry 2016; 16:419. [PMID: 27881159 PMCID: PMC5120432 DOI: 10.1186/s12888-016-1122-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Housing services aim to support people with mental illness in their daily life and recovery. As the level of recovery differs between service users, the quality of life and care needs also might vary. However, the type and amount of care and support that service users receive do not always match their recovery. In order to improve the quality of care, this study aims to explore whether subgroups of service users exist based on three dimensions of recovery and to examine and compare the quality of life and care needs of the persons in these subgroups. METHODS Latent class analysis was performed with data from 263 service users of housing services in the Netherlands. Classes were based on three variables: personal recovery (Mental Health Recovery Measure), social recovery (Social Functioning Scale), and clinical recovery (Brief Symptom Inventory). Subsequently, the quality of life (MANSA) and care needs (CANSAS) of the different classes were analysed by the use of descriptive and inferential statistics. RESULTS Three classes could be distinguished. Class 1 (45%) comprised of people who score the highest of the three classes in terms of personal and social recovery and who experience the least number of symptoms. People in class 2 (44%) and class 3 (11%) score significantly lower on personal and social recovery, and they experience significantly more symptoms compared to class 1. The distinction between class 2 and 3 can be made on the significantly higher number of symptoms in class 3. All three classes differ significantly on quality of life and unmet needs. CONCLUSIONS The quality of life of service users of housing services needs improvement, as even persons in the best-recovered subgroup have a lower quality of life than the average population. Workers of housing services need to be aware of the recovery of a client and what his or her individual needs and goals are. Furthermore, better care (allocation) concerning mental and physical health and rehabilitation is needed. Care should be provided on all dimensions of recovery at the same time, therefore mental health care organisations should work together and integrate their services. TRIAL REGISTRATION ISRCTN registry ISRCTN77355880 retrospectively registered 05/07/2013.
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Affiliation(s)
- Neis A. Bitter
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Diana P. K. Roeg
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands ,GGzE Centre for Mental Health Care, PO BOX 909, 5600 AX Eindhoven, The Netherlands
| | - Chijs van Nieuwenhuizen
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands ,GGzE Centre for Mental Health Care, PO BOX 909, 5600 AX Eindhoven, The Netherlands
| | - Jaap van Weeghel
- Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands ,Phrenos Centre of Expertise, PO Box 1203, 3500 BE Utrecht, The Netherlands ,Parnassia Group, Dijk en Duin Mental Health Centre, PO Box 305, 1900 AH Castricum, The Netherlands
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